Significant Improvement In Quality Of Life Scores Research Articles

Outcomes and Quality of Life After Resorbable Synthetic Ventral Hernia Repair in Contaminated Fields.

The ideal mesh type for hernia repair in a contaminated field remains controversial. Data regarding outcomes beyond 1 year and the impact on quality of life (QoL) are unknown. This study aims to evaluate the long-term surgical outcomes and patient-reported outcomes (PROs) after contaminated repair with poly-4-hydroxybutyrate (P4HB) mesh. Patients undergoing a contaminated hernia repair with P4HB between 2015 and 2020 were identified. Surgical site occurrences and hernia recurrences were recorded. Long-term PROs as defined by the Abdominal Hernia-Q and Hernia-Related Quality-of-Life Survey were assessed. Fifty-five patients were included with a mean age of 54.5 years, a body mass index of 34 kg/m2, and a defect size of 356.9 ± 227.7 cm2. Median follow-up time was 49 months with a reoperation rate of 14.5% and a hernia recurrence rate of 7.3%. Of the 55 patients, 37 completed preoperative and postoperative PRO questionnaires. When comparing preoperative with postoperative Abdominal Hernia-Q, there was significant improvement in overall PROs (2.1 vs 3.5, P < 0.001). This improvement was maintained with no significant changes between postoperative scores over the course of 5 years. Patients with complications saw the same improvement in postoperative PRO scores as those without complications. Our study found a low hernia recurrence and acceptable long-term reoperation rates in patients undergoing hernia repair with P4HB mesh in a contaminated setting. We demonstrate a sustained significant improvement in QoL scores after hernia repair. These data yield insight into the long-term outcomes and QoL improvement, providing physicians further knowledge to better counsel their patients.

A252 DRUG DISCONTINUATION AND PERSISTENT SYMPTOMS AMONG THE USERS OF BIOSIMILAR AND LEGACY ANTI-TNF DRUGS IN A REAL-WORLD CANADIAN IBD COHORT

Abstract Background Biosimilars and their reference originator drugs are increasingly used for inducing and maintaining remission in Inflammatory Bowel Diseases (IBD). Persistent symptoms, such as fatigue and joint pain, have been reported among individuals with IBD in remission. However, there is limited data on the persistence of symptoms among long-term users of biological therapy. Aims We report on drug discontinuation and persistent symptoms among a multicentre cohort of IBD patients 12 months after initiating anti-TNF originators or biosimilars. Methods We enrolled and followed individuals with IBD (ampersand:003E18 years) who initiated therapy with infliximab or adalimumab, bio-originators/biosimilars, between January 2019 and March 2023. We determined the rate of discontinuation of therapy, persistent symptoms, and quality of life (QoL) after 12 months. Difference in effect estimates (proportions and means) between the two groups (originators versus biosimilars) was determined. Results 181 individuals with IBD (CD = 58%, female = 46%, Caucasian = 85%) were enrolled. 62% were biologic-naïve at initiation. Of the 119 participants who completed a 12-month follow-up visit, about 19% (n = 34) discontinued drug use (all were infliximab users). Insufficient disease control was the most common reason for drug discontinuation (18.2%, n = 33). There was a significant reduction in the number of corticosteroid users at follow-up in both originator (rate ratio: 0.33, 95% confidence interval (CI): 0.16-0.49) and biosimilar users (rate ratio: 0.22, 95% CI: 0.14-0.30). With our limited power, we were unable to detect significant reductions in ER visits and hospitalizations in the first year after initiation of anti-TNF agents compared to that in the preceding year. The severity of pain/discomfort anywhere and the frequency of fatigue and anxiety/depression was not significantly reduced at 12 months in either of the groups. The percentage of those reporting moderate/severe abdominal pain was reduced among biosimilar users (46% to 20%; rate ratio of 0.26, 95% CI: 0.15-0.38), and originator users (28% to 13%, rate ratio 0.16, 95% CI: -0.02, 0.33). The proportion of those reporting rectal urgency at least some of the time was also reduced among both originators (30% at baseline to 9% at follow-up) and biosimilar users (33% to 17%). There was a significant improvement in QoL scores among both originator users (mean difference (MD) 13.0, 95% CI: 6.00-22.0) and biosimilar users (MD 10.0, 95% CI: 6.00-14.0) on the SIBDQ. This improvement was replicated on the EQ-5D only among biosimilar users. Conclusions Our study results suggest that even though the use of anti-TNF drugs leads to improvement in QoL, there may be no reduction in some symptoms, such as fatigue, anxiety, depression. Funding Agencies CIHR

A Comparative Study of the Efficacy of Thulium Fiber Laser Enucleation and Transurethral Resection for Medium- to Large-Size Prostate

Abstract Purpose: The objective of this study was to evaluate the efficacy and safety of the newer, thulium fiber laser enucleation of the prostate (ThuFLEP) versus the transurethral resection of the prostate (TURP) for medium- to large-volume benign prostatic hyperplasia (BPH). Materials and Methods: We performed a single-center retrospective study between May 2020 and June 2021. Among these, we included patients &gt;50 years of age, with prostate size &gt;80 cc, International Prostate Symptom Score (IPSS) &gt;19, and maximum urine flow rate (Qmax) &lt;15 mL/s. All patients underwent either TURP or ThuFLEP. Preoperative parameters such as IPSS score, quality of life (QoL) score, Qmax, and residual urine were assessed. Results: Of the total of 101 patients, 29 underwent ThuFLEP and 72 TURP. The mean prostate volume was significantly higher in the ThuFLEP group compared to the TURP (P = 0.01). The mean operative time was longer for ThuFLEP compared to TURP (P &lt; 0.0001). No significant difference was noted in the postoperative hematuria (P = 0.29) and mean postoperative hemoglobin (P = 0.37). The QoL scores were significantly improved with ThuFLEP than TURP (P = 0.0006). Compared to a day after catheter removal, the proportion of patients with stress, urge, and total incontinence was significantly reduced at the end of 1 month in the ThuFLEP group (P &lt; 0.00001); however, it was significantly greater than with TURP (P &lt; 0.05). At 3 months, no significant difference was found between IPSS (P = 0.37) and Qmax (P = 0.98) scores between the groups; however, the decrease from baseline was significant for IPSS (P &lt; 0.0001). The Clavien–Dindo Grade I and II complications were 31% and 13.8%, respectively, for ThuFLEP and 8.3% and 1.4% for TURP. There was no significant difference of patients with late complications. Conclusion: ThuFLEP demonstrated efficacy similar to TURP in medium- to larger-size BPH in terms of IPSS and Qmax but had significant improvement in QoL scores. The overall complications with ThuFLEP were higher as compared to TURP.

Optimizing prehabilitation in gynecologic oncology (476)

<b>Objectives:</b> Prehabilitation, or therapy implemented prior to surgery, has demonstrated an improved return to physical baseline in colorectal, surgical oncology, and urologic literature but has never been evaluated specifically in gynecologic oncology patients. The intervention generally involves physical therapy (PT); however, reduced stress and anxiety have been noted with the addition of cognitive- behavioral therapy (CBT). Extrapolating from improved outcomes in other surgical literature, we sought to identify the optimal therapy program in gynecologic oncology. We hypothesize that women receiving trimodal treatment with PT, CBT, and nutrition counseling will have earlier physical recovering and higher quality of life (QOL) scores compared to unimodal PT alone. <b>Methods:</b> Women aged 18-90 years undergoing surgery for known or suspected gynecologic malignancy were enrolled. All patients underwent PT assessments at baseline (preoperative), four and eight weeks postoperative. Trimodal patients also had CBT stress reduction and dietician counseling at the same schedule. QOL was assessed with the Functional Assessment of Cancer Therapy-General (FACT- G) at baseline and eight weeks postoperative. Nutritional status was assessed with the Patient-Generated Subjective Global Assessment at baseline and eight weeks. Each patient, therefore, served as her own PT and QOL control. An anonymous survey was completed at the study conclusion. <b>Results:</b> To date, 42 patients have enrolled; 15 withdrew secondary to canceled surgery or scheduling/financial constraints, whereas 17 (five unimodal, 12 trimodal) have mature data for analysis. Patients undergoing unimodal therapy had a significant improvement in PG-SGA scores 5.0 ± 3.4 to 2.0 ± 1.9 (p<0.05) compared to trimodal patients (2.8 ± 2.4 to 1.7 ± 0.9, p=0.39) though they started at poorer scores. Trimodal patients had a significant improvement in QOL scores (81.7 ± 15.5 to 92.0 ± 9.0, p < 0.05) compared to unimodal patients (82.5 ± 23.7 to 6.8 ± 17.9, p=0.43). PT assessments included a 6-Minute Walk Test (6MWT), Timed Up and Go (TUG), Hand Grip Strength (HGS), and 30-Second Sit to Stand (30CST). Overall, at least a trend toward improvement in all PT assessments was noted other than unimodal stable HGS with the greater trimodal trend and significant TUG improvement in both groups at eight weeks (p < 0.05). All patients who completed the anonymous survey reported a helpful experience, with more trimodal patients reporting benefit in surgery expectations (100% vs 71%, p=0.18), faster strength recovery (88% vs 71%, p=0.57), and stress reduction (100% vs 86%, p=0.44). <b>Conclusions:</b> Prehabilitation is feasible and positively received by gynecologic oncology patients regardless of treatment method. Trimodal is associated with reduced stress and improved QOL. Further study enrollment may delineate an optimal group though centers seeking to apply such programs may find any prehabilitation to provide a positive, meaningful patient experience.

Effectiveness of a chess-training program for improving cognition, mood, and quality of life in older adults: A pilot study

BackgroundRegular practice of a cognitively stimulating activity, such as chess, can help maintain a healthy cognitive, social, and psychological state during the aging process. ObjectiveTo evaluate the effects of a chess-training program on cognitive status, mood, and quality of life (QoL) in a sample of institutionalized and semi-institutionalized older adults. MethodA nonrandomized, controlled pilot study with repeated measures (pre- and post-intervention) was conducted. ResultsAnalyses revealed a positive impact of the chess program on general cognitive status (p < 0.001) and promising evidence (p < 0.043) of an impact on attention, processing speed, and executive functions. The participants in the intervention group also showed significant improvement in QoL scores (p < 0.021). ConclusionsA 12-week chess-training protocol with two 60-minute sessions per week improved cognition and QoL in a sample of institutionalized and semi-institutionalized older adults. Further research with larger samples is needed to explore its effects in depth.

Deep venous stenting in chronic iliac venous obstructive lesions: a single-center experience

Introduction Endovascular management for patients with chronic outflow lesions has been considered as an optimal alternative option for symptom control, as conservative compression therapy may fail later. The study aimed to determine the clinical outcomes and to evaluate the quality of life (QoL) improvement after recanalization and deep venous stenting in patients with postthrombotic syndrome and nonthrombotic iliac vein lesion in whom conventional treatment had failed. Patients and methods This study was conducted prospectively on 40 patients with chronic deep venous diseases (nonthrombotic iliac vein lesion or postthrombotic syndrome) and who presented to Vascular Surgery Department, Faculty of Medicine, Assiut, Egypt from July 2016 to September 2019. Results A total of 40 patients with 50 limbs (21 males; median age, 45.2 years, with range, 18–75 years) were included, and all had successful recanalization and stent deployment. A complete history and physical examination were performed for all included patients as well as assessment of daily activity improvements after endovenous procedures during postoperative follow-up visits at 2 weeks, 1.5, 3, 6, and 12 months. Deep venous recanalization with deployment of stents was medically successful in all 50 limbs with overall high patency (primary, assisted secondary, and secondary patency rates of 76, 88, and 92%, respectively). A statistically significant improvement in QoL scores (VEINESQOL/Sym scores) was observed in all patients as compared with the baseline at 2, 6, and 12 months after stenting (64.4, 69.2, and 73.4, respectively, P Conclusions Our results confirm the significant effect of stenting on QoL of patients with chronic symptomatic iliofemoral venous obstructive lesions with high cumulative patency rate, making it a viable treatment option.

Personalized Yoga Therapy for Multiple Sclerosis: Effect on Symptom Management and Quality of Life.

This study aimed to assess the feasibility of personalized yoga therapy intervention in a private setting and its effect on quality of life (QOL), sleep quality, and symptom relief among patients with multiple sclerosis (MS). A single-group pre- and post-experimental study was conducted among 10 members of the Multiple Sclerosis Society of India between December 2017 and April 2018. At baseline and during follow-up, QOL, sleep quality, symptoms, and pain were assessed using the Multiple Sclerosis Quality of Life, Pittsburgh Sleep Quality Index, MS Symptom Checklist, and visual analogue scale, respectively. The intervention comprised 12 private customized yoga sessions of 1 hour duration and three group sessions, all spread over 3-months. Patient feedback and direct observations by the yoga therapist we re documented at each session. Ten patients (seven female, three male, age 31-52 years) were enrolled in the yoga intervention; seven completed 8-12 sessions, and three completed fewer than 5 sessions. Therapist-to-patient ratio was 1:2. All domains except sexual function showed clinically significant improvement in QOL scores. Statistically significant improvement was found in social function (p = 0.014) and change in health status (p = 0.029) scores after the intervention. Although there was improvement in pain and sleep quality, these changes were not statistically significant. Patients reported improvement in symptoms with practice of yoga alongside lifestyle changes. The study supports the feasibility of this 3-month yoga intervention for patients with MS. Studies with larger sample sizes are required to confirm our findings.

Anterior-Apical Transvaginal Mesh (Surelift) for Advanced Urogenital Prolapse: Surgical and Functional Outcomes at 1 Year

To determine the objective and subjective outcomes of pelvic organ prolapse (POP) surgery using a modified Surelift system (Neomedic International, Barcelona, Spain) and to evaluate surgical complications and postoperative impact on quality of life (QOL) and lower urinary tract symptoms. Retrospective cohort study. Tertiary-care university hospital. Patients with symptomatic anterior or apical POP stage III and above. All patients underwent pelvic reconstructive surgery with a modified Surelift transvaginal mesh kit. Eighty-three women who underwent pelvic reconstructive surgery with a modified Surelift for symptomatic anterior or apical prolapse stage III and above from April 2018 to January 2019 were reviewed retrospectively. All completed a 72-hour voiding diary, urodynamic study, and multiple validated QOL questionnaires at baseline and at between 6 and 12 months postoperatively. Descriptive statistics were used for demographics and perioperative data. Paired-samples t test and the McNemar test were applied for comparison of pre- and postoperative continuous and categoric data, respectively. The primary outcomes were the objective cure of POP, defined as anterior and apical prolapse Pelvic Organ Prolapse Quantification System ≤ stage I, and subjective cure on the basis of negative answers to Pelvic Organ Prolapse Distress Inventory 6. The objective and subjective cure rates at 1 year were 97.6% and 92.8%, respectively. There were significant improvements in QOL scores postoperatively. Although bladder outlet obstruction improved, de novo urodynamic stress incontinence and stress urinary incontinence were increased at 18.9% and 21.6%, respectively, at 1-year follow-up. The mesh extrusion rate was 4.8%. A modified Surelift has good objective and subjective cure rates at 1 year postoperatively with 4.8% mesh extrusion rate. There was significant improvement in lower urinary tract symptoms and QOL. De novo urodynamic stress incontinence at 6 months to 12 months was increased, but it was not sufficiently bothersome to warrant surgery.

Quality of life changes after lumbar decompression in patients with tandem spinal stenosis

ObjectiveTandem spinal stenosis (TSS) is a degenerative spinal condition characterized by spinal canal narrowing at 2 or more distinct spinal levels. It is an aging-related condition that is likely to increase as the population ages, but which remains poorly described in the literature. Here we sought to determine the impact of primary lumbar decompression on quality-of-life (QOL) outcomes in patients with symptomatic TSS. Patients and methodsWe retrospectively reviewed 803 patients with clinical and radiographic evidence of TSS treated between 2008 and 2014 with a minimum 2-year follow-up. The records of patients with clinical and radiographic evidence of concurrent cervical and lumbar stenosis were reviewed. Prospectively gathered QOL data, including the Pain Disability Questionnaire (PDQ), Patient Health Questionnaire-9 (PHQ-9), EuroQOL-5 Dimensions (EQ-5D), and Visual Analogue Scale (VAS) for low back pain, were assessed at the 6-month, 1-year, and 2-year follow-ups. ResultsOf 803 identified patients (mean age 66.2 years; 46.9% male), 19.6% underwent lumbar decompression only, 14.1% underwent cervical + lumbar decompression, and 66.4% underwent conservative management only. Baseline VAS scores were similar across all groups, but patients undergoing conservative management had better baseline QOL scores on all other measures. Both surgical cohorts experienced significant improvements in the VAS, PDQ, and EQ-5D at all time points; patients in the cervical + lumbar cohort also had significant improvement in the PHQ-9. Conservatively managed patients showed no significant improvement in QOL scores at any follow-up interval. ConclusionLumbar decompression with or without cervical decompression improves low back pain and QOL outcomes in patients with TSS. The decision to prioritize lumbar decompression is therefore unlikely to adversely affect long-term quality-of-life improvements.

Cost and quality of life outcome analysis of postoperative infections after posterior lumbar decompression and fusion

Surgical site infections (SSI) following spine procedures are serious and costly complications that may reduce patient quality of life (QOL). Deep SSIs may also extend hospitalizations and require surgical debridement or antibiotic therapy, increasing costs to both patients and the healthcare system. Here we sought to evaluate the effect of deep SSI on care cost and QOL outcomes in patients undergoing posterior lumbar decompression and fusion. To do so we performed a retrospective study of patients undergoing lumbar decompression and fusion between 2008 and 2012. Patients experiencing postoperative deep SSI were matched to controls not experiencing a deep SSI. Included patients had prospectively-gathered QOL outcome measures collected preoperatively and at 6 months postoperatively. Health resource utilization was recorded from patient electronic medical records over the 6-month follow-up. Direct costs were estimated using Medicare national payment amounts. Indirect costs were based on missed work days and patient income. We found both cohorts experienced significant improvements in QOL scores following surgery, and there were no significant differences between the cohorts. The average total cost was significantly higher in the infected cohort compared to controls ($37,009 vs. $16,227; p < 0.0001). Compared to controls, patients experiencing deep SSI had greater costs in each of the following categories: hospitalizations (p < 0.01), office visits (p = 0.03), imaging (p < 0.01), and medications (p < 0.01). Among those experiencing deep SSI, there are significant increases in costs, with minimal long-term impact on QOL outcomes as compared with controls at the six-month follow-up.

Did surgical failure and complications affect incontinence-related quality of life in women after transobturator sling procedure?

ObjectiveTo report the objective outcome, subjective measurement of incontinence-related quality of life (QoL) for female urodynamic stress incontinence (USI) after transobturator sling surgery (TVT-O) and to evaluate the effects of surgical failure and complications on QoL. Materials and methodsWe analyzed the data from women who underwent TVT-O for USI and completed two validated QoL questionnaires, the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) preoperatively and at least 12 months postoperatively. We evaluated the subjective results of QoL questionnaires, objective results and compare the effect of QoL on those with surgical failure and complications after TVT-O surgery. ResultsA total of 78 women were followed for a median of 13.5 months (range 12–15 months) after surgery. Within this group, 75 (96%) were considered subjectively cured or improved after TVT-O. There were significant improvements in the IIQ-7 and total UDI-6 scores postoperatively, as well as in the UDI-6 subscales for urge, stress and voiding dysfunction symptoms. Even the 18 women with objective urodynamic failure had significant improvement in QoL scores. For those with surgical related complications, the QoL scores were also significantly improved. ConclusionsTVT-O for USI resulted in improvement of incontinence-related QoL including urgency, stress, and voiding dysfunction symptoms. Surgical failure and complications didn't impair postoperative QoL.

Effect of generalized anxiety disorders on the success of pessary treatment for pelvic organ prolapse.

Our aim was to evaluate the impact of generalized anxiety disorders (GAD) on the effectiveness of pessary treatment for pelvic organ prolapse (POP) in postmenopausal women. One-hundred and ten women with symptomatic POP who underwent pessary treatment were enrolled in this prospective study. Subjective evaluations of pelvic floor symptoms were assessed using the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), both at baseline and at the 3-month follow-up visit after pessary use. GAD was measured by the Generalized Anxiety Disorder-7 (GAD-7). Independent samples t tests, Mann-Whitney U test, chi-square test, Fisher's exact test, and Wilcoxon signed rank test were used to analyze data. Twenty-one patients (20.6%) had GAD at baseline. After 3months of pessary use, PFIQ-7, PFDI-20, and GAD scores were significantly improved in all participants (P < 0.001). In the GAD-negative group, total PFIQ-7 and PFDI-20 scores, including all subscales scores, were significantly decreased from baseline to posttreatment (P < 0.05). However, in the GAD-positive group, both PFIQ-7 and PFDI-20 scores, including subscales, were also significantly decreased from baseline to posttreatment (P < 0.05), except for subscale Colorectal-Anal Impact Questionnaire (CRAIQ-7) of PFIQ-7 (P = 0.225), which represented the impact on quality of life (QoL) from bowel dysfunction. Both groups of women with or without GAD showed significant improvement in QoL scores after 3months of pessary treatment. GAD had no influence on the success of pessary treatment for POP.

A randomized controlled trial to assess the effectiveness of structured discharge counseling on heart failure outcomes

Introduction: A relatively common disease, heart failure (HF), has a significant impact on the quality of life (QOL). Many of the HF patients are unaware of the importance of self-care, such as weighing themselves regularly, fluid and sodium restriction, and HF symptom monitoring. Important patient-related factors that are known to be related to compliance are HF knowledge and its regimen. The Objectives of the Study: The objective of this study is to assess the effectiveness of structured discharge counseling on HF knowledge, QOL, frequency of repeated hospitalization, and improvement in the New York Heart Association (NYHA) functional class of acute decompensated HF (ADHF) patients. Materials and Methods: Sixty-eight ADHF patients (NYHA functional Class III) were selected and randomized into two groups. HF knowledge and QOL were measured for each patient. A 30-min discharge counseling was provided at hospital visit or at the time of discharge. Both the groups were followed for 1 month. Data on HF knowledge, QOL, NYHA functional class, and repeated hospitalization were collected at baseline and after 1 month. Results: The baseline HF knowledge and QOL were comparable in both the groups. The experimental group showed significant improvement in QOL scores (P = 0.001), HF knowledge score (P = 0.043), and NYHA functional class (P = 0.001) after 1 month of the discharge counseling. Conclusion: The present study showed that the discharge counseling could enhance HF knowledge, QOL, and NYHA functional class in those suffering from ADHF. It is, therefore, advisable that discharge counseling be incorporated in the HF management strategy.

Effect of Adjuvant Yoga Therapy on Pulmonary Function and Quality of Life Among Patients with Chronic Obstructive Pulmonary Disease: A Randomized Control Trial

Introduction: Previous studies have suggested that yoga may have a positive impact on lung function and quality of life (QoL) and hence the present prospective two-arm single-blinded controlled study evaluated effect of adjuvant yoga therapy on pulmonary function and QoL of patients with Chronic Obstructive Pulmonary Disease (COPD). Material and methods:In this interdisciplinary collaborative work, 72 COPD patients were recruited after obtaining informed consent and randomized to yoga group (22 M and 14 F) who received adjuvant yoga therapyin addition to standard medical management and control group (20 M and 16 F) who received only medical management. Yoga therapy protocol validated by CYTER was used and this included loosening exercises, postures (asanas), vitalising breathing techniques (pranayama) and relaxation. Forced vital capacity (FVC), forced expiratory volume in first second (FEV1) and FEV1/FVCwere measured using standard computerized pulmonary function test ‘Trueflow (ndd)’ before and after study period of 4 weeks. Saint George Respiratory Questionnaire (SGRQ) was used to asses QoL. Changes in pulmonary function parameters were correlated with QoL (symptoms, activity, impacts and quality) scores. Intra-group comparisons were done using Student’s paired ‘t’ test and intergroup comparisons using unpaired ‘t’ test. Results:There was significant improvement (p < 0.01) in body weight, BMI, FVC and FEV1 after four weeks of adjuvant yoga therapy while controls showedsignificant decline in all parameters. There were improvements in all QoL scores, namely symptoms score (p<0.001) and activity score (p<0.05), impacts score (p<0.01) and quality score (p<0.001)in yoga group while no significant changes in controls.Significant correlation was found between pulmonary function and QoL in Yoga group. Discussion:Significant improvements of lung function with adjuvant yoga therapy can be attributed to comprehensive yoga therapy package administered to participants. This may be due to with decreased airway resistance and better lung compliance attributed to nonspecific broncho-protective or broncho-relaxing effect. Significant improvement in QoL scores implies patients were able to participate in more activities than earlier, and this can be attributed to improved vital capacity as well as enhanced self-confidence /self-reliance. Our results are consistent with previous such studies and we conclude that yoga has a positive and additive role as an adjuvant therapy along with standard medical management of COPD.

Hypothyroidism and Depression: Are Cytokines the Link?

Context:Primary hypothyroidism has been thought of as an inflammatory condition characterized by raised levels of cytokines such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). Depression is also well known to occur in hypothyroidism. Depression is also characterized by elevated inflammatory cytokines. We planned to study whether cytokines play an important part in linking these two conditions.Objectives:(1) To know the prevalence of depression in overt hypothyroidism due to autoimmune thyroid disease. (2) To correlate the levels of inflammatory markers with the occurrence of depression. (3) To study the effect of levothyroxine on inflammatory markers and depression.Materials and Methods:In this longitudinal, case–controlled study, 33 patients with autoimmune hypothyroidism (thyroid-stimulating hormone >10 uIU/ml) were included with 33 age-, sex-, and body max index-matched healthy controls. Individuals were tested for Serum TNF-α, IL-6, high-sensitivity-CRP (hs-CRP). They were assessed for depression using Montgomery Asberg Depression Rating Scale (MADRS) and World Health Organization Quality of Life (QOL) Scale. Patients received L Thyroxine titrated to achieve euthyroidism and were reassessed for inflammatory markers and cognitive dysfunction.Results:Nineteen patients (57%) had mild to moderate depression (MADRS >11). After 6 months of treatment, eight patients (42%) had remission of depression with significant improvement in QOL scores (P < 0.05). TNF-α, IL-6, and hs-CRP were significantly elevated in patients compared with controls and reduced with therapy but did not reach baseline as controls. The change in inflammatory markers correlated with improvement in QOL scores in social and environmental domains (P < 0.01).Conclusions:Primary autoimmune hypothyroidism is an inflammatory state characterized by elevated cytokines which decline with LT4 therapy. It is associated with depression and poor quality of life. Treatment of hypothyroidism results in alleviation of depression in the majority of patients. Similarly, patients with mild to moderate depression should be tested for hypothyroidism as simple treatment may ameliorate their depression and improves MADRS score and QOL.

Short-term effects of upper extremity circuit resistance training on muscle strength and functional independence in patients with paraplegia.

A number of exercises to strengthen the upper extremities are recommended to increase functional independence and quality of life (QoL) in patients with paraplegia. Circuit resistance training (CRT) is a type of progressive resistive exercise performed repeatedly at fixed mechanical exercise stations. The aim of this study was to investigate the potential benefits of CRT for upper extremity muscle strength, functional independence, and QoL in patients with paraplegia. Twenty-six patients with paraplegia who were participating in a conventional rehabilitation program at a tertiary education and research hospital were enrolled in this study. The participants were randomly assigned to two groups. The exercise group participated in the CRT program, which consisted of repetitive exercises for the upper extremities performed at fixed mechanical stations 5 sessions per week for 6 weeks, in addition to conventional rehabilitation. Participants in the control group received only conventional rehabilitation over the same period. We compared the groups with respect to QoL, as well as isokinetic muscle test outcomes in the upper extremities, using the Functional Independence Measure (FIM) and Borg's scale. We observed significant increases in scores on the physical component of the FIM, Borg's scale, and QoL in both the exercise and control groups. Furthermore, the large majority of isokinetic values were significantly more improved in the exercise group compared to the control group. When post-treatment outcomes were compared between the groups, improvements in scores on the physical component of the FIM and in most isokinetic values were significantly greater in the exercise group. This study showed that CRT has positive effects on muscle strength in the upper extremities and the physical disability components of the FIM when added to conventional rehabilitation programs for paraplegic patients. However, we observed no significant improvement in QoL scores after adding CRT to a conventional treatment regime. Randomized trial (Level II).

Partial Endometrial Ablation: A 10–20-Year Follow-Up of Impact on Bleeding, Pain, and Quality of Life

Background: In an attempt to prevent delayed complications of minimally invasive surgical treatments for heavy menstrual bleeding, the current total or global ablation technique was modified to a partial ablation teachnique (PEA) to successfully treat HMB without causing intrauterine scarring. PEA is defined as ablating or resecting only the anterior or posterior endometrial wall. Objective: The aim of this research was to demonstrate that PEA has the potential for treating abnormal uterine bleeding (AUB) successfully. Design: The study involved 269 patients who underwent PEA. Study questionnaires were sent to those patients and their charts were reviewed. Materials and Methods: This study was conducted in Sacramento, CA. It was a retrospective study consisting of chart reviews and answers to patient questionnaires. Data for pre- and post-PEA bleeding, pain and quality of life (QoL) scores were analyzed using IBM SPSS 21.0. Pre- and post-PEA blood loss during menses was measured by reported clot size. Pre- and post-PEA pain during menses was quantified by type of analgesia required for relief. Impact on QoL scores were measured as well. Patient satisfaction with the procedure was also examined. Results: There was a statistically significant decrease in clot size and pain scores. Eight percent required hysterectomy during the 17-year follow-up. In addition, there was significant improvement in QoL scores. Patient satisfaction was >95%. No hysterectomies included an indication for pain. Conclusions: PEA is a minimally invasive surgical procedure that appears to provide patients with improved QoL scores, long-term satisfaction, low hysterectomy rates, and no known long-term complications. Larger controlled studies should be conducted to assess the viability of this procedure. (J GYNECOL SURG 32:230)

The effect of levodopa-carbidopa intestinal gel infusion long-term therapy on motor complications in advanced Parkinson's disease: a multicenter Romanian experience.

Chronic treatment with oral levodopa is associated with an increased frequency of motor complications in the late stages of Parkinson’s disease (PD). Continuous administration of levodopa–carbidopa intestinal gel (LCIG—Duodopa®, Abbott Laboratories), which has been available in Romania since 2009, represents an option for treating patients with advanced PD. Our primary objective was to report changes in motor complications after initiation of LCIG therapy. The secondary objectives were as follows: to determine the impact of LCIG therapy on the daily levodopa dose variation before/and after LCIG, to collect patient self-assessments of quality of life (QoL), and to study the overall tolerability and safety of LCIG administration. A retrospective analysis (2009–2013) of LCIG therapy and the experience in nine neurology centers in Romania was performed. The impact of LCIG therapy was evaluated by analyzing changes in motor fluctuations, dyskinesia and the patients’ QoL after initiating therapy. The safety of LCIG therapy was estimated by noting agent-related adverse events (AEs) and medical device-related AEs. In the 113 patients included, we observed a significant improvement in PD symptoms after initiation of LCIG therapy. The “on” period increased, with a mean value of 6.14 h, and the dyskinesia period was reduced, with a mean value of 29.4 %. The quantified non-motor symptoms subsided. The patients exhibited significant improvements in QoL scores. There were few AEs and few cases of LCIG therapy discontinuation. LCIG is an important and available therapeutic option for managing patients with advanced PD.

Sudarshan Kriya yoga improves quality of life in healthy people living with HIV (PLHIV): results from an open label randomized clinical trial

Improving quality of life (QOL) of healthy people living with HIV (PLHIV) is critical needing home-based, long-term strategy. Sudarshan Kriya yoga (SKY) intervention is acknowledged for its positive impact on health. It is hypothesised that SKY would improve PLHIV's QOL, justifying an evaluation. In this open label randomized controlled pilot trial, 61 adult PLHIV with CD4 count more than 400 cells/µl and Karnofsky scale score above 70 were enrolled. Those with cardiac disease, jaundice, tuberculosis, or on antiretroviral therapy/yoga intervention were excluded. All were given standard care, randomized to SKY intervention (31: I-SKY) and only standard of care in control (30: O-SOC) arms. The I-SKY participants were trained for six days to prepare for daily practice of SKY at home for 30 min. A validated 31-item WHOQOL-HIVBREF questionnaire was used to document effect in both arms from baseline to three visits at 4 wk interval. Baseline QOL scores, hypertension and CD4 count were similar in both arms. An overall 6 per cent improvement of QOL scores was observed in I-SKY group as compared to O-SOC group, after controlling for baseline variables like age, gender, education and occupation ( p =0.016); 12 per cent for physical ( p =0.004), 11 per cent psychological (p =0.023) and 9 per cent level of independence (p =0.001) domains. Improvement in I-SKY observed at post-training and in the SKY adherence group showed increase in these two domains. A significant improvement in QOL scores was observed for the three health related QOL domains in SKY intervention arm. This low cost strategy improved physical and psychological state of PLHIV calling for upscaling with effective monitoring for sustainability of quality of life.

Hiatus Hernia Repair with Bilateral Oesophageal Fixation.

Background. Despite advances in surgical repair of hiatus hernias, there remains a high radiological recurrence rate. We performed a novel technique incorporating bilateral oesophageal fixation and evaluated outcomes, principally symptom improvement and hernia recurrence. Methods. A retrospective study was performed on a prospective database of patients undergoing hiatus hernia repair with bilateral oesophageal fixation. Retrospective and prospective quality of life (QOL), PPI usage, and patient satisfaction data were obtained. Hernia recurrence was assessed by either barium swallow or gastroscopy. Results. 87 patients were identified in the database with a minimum of 3 months followup. There were significant improvements in QOL scores including GERD HRQL (29.13 to 4.38, P < 0.01), Visick (3 to 1), and RSI (17.45 to 5, P < 0.01). PPI usage decreased from a median of daily to none, and there was high patient satisfaction (94%). 57 patients were assessed for recurrence with either gastroscopy or barium swallow, and one patient had evidence of recurrence on barium swallow at 45 months postoperatively. There was an 8% complication rate and no mortality or oesophageal perforation. Conclusions. This study demonstrates that our technique is both safe and effective in symptom control, and our recurrence investigations demonstrate at least short term durability.