Symptom Frequency Scores Research Articles

Do Botulinum Toxin Injections for Upper Face Rejuvenation and Lateral Canthal Rhytids Have Unintended Effects on Tear Production?

To report the influence of botulinum toxin A (BoNTA) injections on basal tear production, as measured by Schirmer's test with anesthesia in patients seeking eyelid surgery. A retrospective cohort of patients requesting esthetic eyelid surgery reviewed by a single clinician between January 2021 to April 2024, assessed with Schirmer's test with anesthesia. Demographic data, history of BoNTA treatment in the periocular region, ocular surface disease index dry eye symptom frequency, and requirement for ocular lubricants were recorded. Patients with no history of BoNTA were designated as group 1. Patients with a positive recent history of periocular BoNTA were designated as group 2. The proportions of eyes with Schirmer's test with anesthesia (basal tear production) test result <5 mm ("low"), 5 to 9 mm ("borderline"), and ≥10 mm ("normal") were compared between groups. Seven hundred twenty-two eyes (361 patients) were assessed, of which 670 eyes (335 patients) met the inclusion criteria. Mean age was 55.1 (range, 17-93) years, with 71.3% female. Schirmer's data in group 1 were "low" at 32.9%, "borderline" at 26.4%, and "normal" at 40.7%. In contrast, group 2 had significantly lower results (P ≤ 0.05), with readings "low" at 48.3%, "borderline" at 26.7%, and "normal" at 25.0%. However, there were no significant differences between groups in ocular surface disease index symptom frequency scores or ocular lubricant requirements. Patients who had received BoNTA injections had significantly lower basal tear production compared with patients who had never received BoNTA. Esthetic BoNTA treatment may be associated with an unintended effect of decreased basal tear production and subsequent risk of dry eye.

One-Year Outcomes Among Children Identified With Celiac Disease Through a Mass Screening Program

Celiac disease (CD) mass screening remains controversial in part because of a paucity of data to support its benefit. The Autoimmunity Screening for Kids study is a mass screening study for pediatric CD and type 1 diabetes in Colorado. This study prospectively follows up children ages 1 to 17 years who screened positive for tissue transglutaminase IgA autoantibodies in the Autoimmunity Screening for Kids study subsequently referred for diagnostic evaluation. Children diagnosed with CD by biopsy or serologic criteria were included in this study. Evaluation at baseline and 12 month follow-up evaluation included demographics, laboratory studies, symptoms, health-related quality of life, anxiety/depression, and gluten-free diet adherence. Paired Student t test, chi-square, and Wilcoxon sign rank tests compared baseline and follow-up data. For symptom scores, odds of improvement were assessed. Of the 52 children with CD enrolled, 42 children completed 12-month follow-up evaluation. On the symptom questionnaire completed at diagnostic evaluation, 38 of 42 children reported 1 or more symptoms. CD mean symptom severity and frequency scores improved from baseline to follow-up evaluation (P < .001). Reported health-related quality of life scores improved among caregivers (P= .002). There was no significant change in reported anxiety or depression. Iron deficiency without anemia was common at baseline (21 of 24 children; 87.5%) and normalized at follow-up evaluation (11 of 21 children; 52.3%). Twenty-six of 28 families reported good or excellent gluten-free diet adherence. This novel study of children with CD identified through a mass screening program demonstrated improvement in symptoms, quality of life, and iron deficiency after 1 year follow-up evaluation. This demonstrates that there may be benefit to CD mass screening.

Abstract 15228: Impact of Gender and Left Ventricular Ejection Fraction on Health-Related Quality of Life and Its Change in Patients With Heart Failure

Introduction: Health-related quality of life (HRQoL) is an important part in managing patients with heart failure (HF). However, the influence of clinical factors on HRQoL in HF remains limited. Hypothesis: This study aimed to examine HRQoL changes based on gender and left ventricular ejection fraction (LVEF) among patients with HF. Methods: A total of 199 patients hospitalized for acute HF (mean age, 71±14 years; men:women=119:80; mean LVEF=42±16) were enrolled in a prospective way from Jan 2022 to Jan 2023. Baseline and 4-month follow-up Kansas City Cardiomyopathy Questionnaire (KCCQ) scores were assessed. Patients were categorized into 4 subgroups: Group 1, women with LVEF≥50% (n=37); Group 2, men with LVEF≥50% (n=26); Group 3, women with LVEF&lt;50% (n=43); Group 4, and men with LVEF&lt;50% (n=93). Results: Women demonstrated lower KCCQ clinical and overall summary scores than men at baseline (p=0.003, 0.004, respectively) and 4-month follow-up (p=0.029, 0.038, respectively) after adjusting for age and body mass index. In addition, these scores tended to be lower in patients with LVEF ≥50% than those with LVEF &lt;50% at both baseline and follow-up (all p&lt;0.05). When we assessed KCCQ scores according to group, group 1 showed the lowest KCCQ overall summary score (KCCQ-OS: 36.9 [IQR 22.9-49.8], p=0.004) and clinical summary score (KCCQ-CS: 37.8 [IQR: 24.5-51.1], p=0.001). Also, the scores for physical limitation, symptom frequency, symptom burden, social limitation, self-efficacy scale, and total symptom score were lowest in Group 1 (all p&lt;0.05). Although HRQoL improved across all groups, the follow-up KCCQ-OS and KCCQ-CS scores remained lowest in Group 1 (KCCQ-OS: 54.0 [IQR 44.3-64.4], p=0.026; KCCQ-CS: 56.5 [IQR: 45.0-63.9], p=0.031). Conclusions: Among patients with HF, women with LVEF≥50% reported significantly worst HRQoL even after HF treatment, suggesting more attention should be paid to HRQoL in managing this specific population during HF treatment.

Quelles modalités de traitement par immunothérapie allergénique sublinguale en France pour des patients atteints de rhinoconjonctivite allergique liée aux graminées – étude Diagram

IntroductionAllergen sublingual immunotherapy (SLIT) may be prescribed according to pre-co-seasonal or perennial treatment schedules. The DIAGRAM study describes French prescribing practices and the factors associated with the choice of one or other of these treatment plans. MethodologyCross-sectional observational study conducted between October 2018 and February 2020 including patients ≥5years with grass pollen allergic rhinoconjunctivitis (ARC) and initiating SLIT. On initiation of the SLIT, a retrospective symptom frequency score (RSFS) scored the 6 symptoms on a scale of 0 to 3 for the eyes and nose (total possible score 0 to 18) and patient discomfort reported by the investigator on a Visual Analogic Scale (VAS) ranging from 0 to 10. Comparisons between the two modalities were performed using statistical tests. ResultsData from a total of 1,119 patients (mean age 27 years, 54.4% of men) were analysed. The majority of patients (70.8%) had persistent severe ARC. The SLIT was prescribed on a perennial basis for 8% of patients and as pre-co-seasonal treatment for 92% of patients. The patients on a perennial treatment schedule had more concomitant asthma (39% vs 27%; P<0.01). They had a higher RSFS (67% vs 58% with an RSFS scored [13–18]; P<0.01) and their mean discomfort level score was also higher (8 vs 7.5; P<0.01). Among the reasons given for choosing the treatment plan, the desire to improve symptoms was greater in the perennial schedule group (50% vs 27% in the pre-co-seasonal group). ConclusionAlthough the pre-co-seasonal prescribing schedule was chosen for the majority of patients, the perennial schedule appeared to be preferred for the patients with the most severe symptoms.

The longitudinal progression of autonomic dysfunction in Parkinson's disease: A 7-year study.

Autonomic dysfunction, including gastrointestinal, cardiovascular, and urinary dysfunction, is often present in early Parkinson's Disease (PD). However, the knowledge of the longitudinal progression of these symptoms, and the connection between different autonomic domains, is limited. Furthermore, the relationship between the presence of autonomic symptoms in early-stage PD and olfactory dysfunction, a possible marker of central nervous system involvement, has not been fully investigated. We aimed to investigate the occurrence and progression of autonomic dysfunction in recently diagnosed (< 2 years) untreated PD patients and determine any coexistence of symptoms in individual patients. We also investigated the relationship between autonomic symptoms, olfactory dysfunction, and motor impairment. Data were obtained from the Parkinson's Progression Markers Initiative (PPMI) database. Autonomic dysfunction was measured using the Scales for Outcomes in Parkinson's Disease (SCOPA-AUT). Symptom frequency and mean scores over 7 years were determined. The simultaneous occurrence of different autonomic symptoms was also examined. Finally, the relationships between SCOPA-AUT scores, olfactory dysfunction, and motor impairment were investigated using the University of Pennsylvania Smell Identification Test (UPSIT) and the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), respectively. Follow-up data were available for 7 years for 171 PD patients and for 5 years for 136 HCs. Mean SCOPA-AUT score increased significantly from baseline to the 7-year follow-up for each autonomic domain, except for female sexual dysfunction. Most patients reported three or more autonomic symptoms. Common clusters of symptoms were composed of combinations of gastrointestinal, urinary, thermoregulatory, and sexual dysfunction. At baseline, greater SCOPA-AUT total score was associated with lower UPSIT scores (r = -0.209, p = 0.006) and with greater total MDS-UDPRS III score (r = 0.218, p = 0.004). Autonomic dysfunction, often with coexistence of autonomic manifestations, is common in early PD and progressively worsens over the first 7 years of disease, suggesting that these symptoms should be addressed with appropriate treatments early in the disease. The association between greater autonomic dysfunction and greater olfactory impairment, coupled with the association with more severe motor scores at baseline, indicates that patients who show more severe autonomic dysfunction could also have more severe involvement of the central nervous system at the time of diagnosis.

Translation and cultural adaptation of the Short Version of the Reflux Symptom Score: Reflux Symptom Score-12 into Brazilian Portuguese.

To describe the process of translation into Brazilian Portuguese and cross-cultural adaptation of the French Reflux Symptom Score-12 questionnaire used for the diagnosis of laryngopharyngeal reflux. This was a cross-cultural translation and adaptation study of a health instrument, with a cross-sectional design. It was carried out in eight stages: translation from French into Brazilian Portuguese, cultural adaptation by a panel of experts, application of the first version (pilot test 1), adaptation by a panel of experts, application of the second version (pilot test 2), back translation, reviewing by a committee in conjunction with the author of the original instrument and, application of the final version. The Brazilian Portuguese versions of the questionnaire were applied to individuals with symptoms and signs of laryngopharyngeal reflux who underwent pHmetry and esophageal manometry at the study site. In pilot test 1, the first version of the RSS-12 in Brazilian Portuguese was applied to 30 patients. The patients had no difficulty to understand any of the 12 symptom items, but 15 patients (50%) had difficulty interpreting the symptom frequency score. After adapting the format of the frequency score, a version 2 of the RSS-12 in Brazilian Portuguese was applied to another 23 patients, who completed the questionnaire in full without any difficulty. Along with the review committee, the author of the original RSS-12 considered the version 2 to be adequate and did not propose any changes, so it was approved as the final version of the Brazilian Portuguese RSS-12. The Brazilian Portuguese version of the instrument, called Reflux Symptom Score-12 PT-BR, shows good understanding and linguistic, conceptual and content equivalence, in relation to the original Reflux Symptom Score-12.

Area disadvantage and mental health over the life course: a 69-year prospective birth cohort study

PurposeExisting evidence on the mental health consequences of disadvantaged areas uses cross-sectional or longitudinal studies with short observation periods. The objective of this research was to investigate this association over a 69-year period.MethodsData were obtained from the MRC National Survey of Health and Development (NSHD; the British 1946 birth cohort), which consisted of 2125 participants at 69 years. We assessed longitudinal associations between area disadvantage and mental health symptoms at adolescence and adulthood with use of multilevel modelling framework.ResultsAfter adjustment for father’s social class, for each one percentage increase in area disadvantage at age 4, there was a 0.02 (95% CI 0.001, 0.04) mean increase in the total score of the neuroticism scale at age 13–15. After adjustment for father’s social class, adult socio-economic position, cognitive ability and educational attainment, a one percentage increase in change score of area disadvantage between age 4 and 26 was associated with a mean increase in the total Psychiatric Symptom Frequency score (MD 0.06; 95% CI 0.007, 0.11). Similar associations were observed with change scores between ages 4, 53, 60 and total General Health Questionnaire-28 score at age 53 (MD 0.05; 95% CI 0.01, 0.11) and 60–64 (MD 0.06; 95% CI 0.009, 0.11).ConclusionsCohort members who experienced increasing area disadvantage from childhood were at increased risk of poor mental health over the life course. Population-wide interventions aiming at improving social and physical aspects of the early neighbourhood environment could reduce the socio-economic burden of poor mental health.

Subjective Dry Eye Symptoms in Pregnant Women-A SPEED Survey.

Multisystemic physiological changes in pregnancy can result in tear film and refractive changes in the eye. We report dry eye prevalence in pregnant women using Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire. The SPEED questionnaire was self-administered cross-sectionally to 428 pregnant women (mean age: 26.8 ± 4.4 years) with clinically confirmed pregnancy from two obstetric clinics in Chennai, India. Subjects with predisposing risk factors for dry eye were excluded from the study. Subjects were categorized as normal, moderate, and severe dry eye based on the SPEED score. Among the women, 48.5% of the subjects had symptoms like dryness, grittiness or scratchiness, soreness or irritation, burning or watering, or eye fatigue. About 2.3% had moderate dry eye according to SPEED questionnaire criteria. Eye fatigue was the most reported symptom and was present in 76.4% of women. The symptom frequency score and severity score had a strong and significant correlation (r = 0.95, P < .001). No significant correlation was noted among SPEED score vs age (r = -0.02, P > .05). No significant correlation was found between symptoms of dry eye and gravidity (ρ = -0.006, P > .05) and trimester (ρ = 0.38, P > .05). Binary logistic regression showed that only occupational status and systemic condition was significantly associated with dry eye symptoms. About half the pregnant women at the visit reported having one or more dry eye-related symptoms. As per the composite SPEED questionnaire score, dry eye was not prevalent among pregnant women irrespective of their age, gravidity, and the trimester, but we found a majority of pregnant women reported to have experienced dry eye-related symptoms, though tolerable. Awareness about dry eye during pregnancy will improve eye care seeking behaviour in pregnant women.

The Effect of Prenatal Yoga on Pregnancy-Related Symptoms: A Pilot Quasi-Experimental Study

Introduction: In the last decade, yoga has attracted much attention from researchers. Although there are many studies on yoga, research on the effect of prenatal yoga on pregnancy-related symptoms is limited. This study aimed to determine the effect of prenatal yoga on pregnancy-related symptoms. Methods: The study was conducted at antenatal care services between June 2018 and October 2018 in Turkey. Simple random method was used to assign participants to the study arms. The yoga group attended a prenatal yoga program for 60 min once a week for 4 weeks. The control group received routine care. Data were collected before and after the intervention using the Descriptive Characteristics Form and Pregnancy Symptoms Inventory. Data analysis used descriptive statistics (mean, standard deviation/standard error, and percentages), χ², Mann-Whitney, and Wilcoxon tests. Significance was set at p < 0.05. Results: The study was completed with 70 participants (the yoga group: 35; the control group: 35). The yoga group had a significantly lower posttest Pregnancy Symptoms Inventory Symptom Frequency Total Score than the pretest score (38.42 ± 18.76 vs. 32.77 ± 16.55, p < 0.05). The total score of the yoga group’s gastrointestinal, respiratory, and mental health symptoms was reduced after the intervention (respectively, 6.74 ± 4.32 vs. 5.31 ± 3.38; 1.48 ± 1.26 vs. 1.05 ± 1.13; 7.08 ± 4.59 vs. 5.22 ± 3.48, p < 0.05). The yoga group had significantly lower mental health symptom scores than the control group (5.22 ± 3.48 vs. 7.34 ± 4.02, p < 0.05). There was no significant difference between the control group’s pretest and posttest Pregnancy Symptoms Inventory Symptom Frequency Scores. Conclusion: Pregnancy-related symptoms were significantly reduced in the yoga group. It is thought that prenatal yoga may be effective on pregnancy-related symptoms. Yoga can be recommended to cope with pregnancy-related symptoms and support activities of daily living.

The Effects of Connective Tissue Manipulation in Primary Dysmenorrhea: a Randomized Placebo-Controlled Study.

The aim of this study was to identify the effects of connective tissue manipulation (CTM) in primary dysmenorrhea (PD) in a randomized, placebo-controlled design. Thirty-eight nulliparous women with PD were randomly allocated into 3 groups: CTM (n = 13), placebo therapeutic ultrasound (US) (n = 13), and control (n = 12). The primary outcome measure was the maximum and mean menstrual pain intensity at the last menstrual period on the visual analogue scale (VAS). Secondary outcome measures were menstrual symptom frequency and distress score, the number of analgesic/anti-inflammatory drugs used during the last menstrual period, and perception of improvement in dysmenorrhea severity via interventions. The chi-square test and analysis of variance were used to determine within-group and between-group differences. Statistical significance level was determined as p < 0.05. Compared with the placebo US and control groups, it was observed that menstrual pain (VAS mean and VAS maximum), menstrual symptom frequency, and distress level decreased more after treatment (T2) and the 3-month follow-up (T3) in de CTM group (p < 0.001, p = 0.001, p = 0.014, p = 0.015, respectively). There was no difference between the groups in terms of analgesic/anti-inflammatory drugs use (p > 0.05). The rate of individuals reporting perceived improvement at the end of intervention period was higher in the CTM group than in the placebo-US and control groups (p < 0.001). In the 3rd month follow-up, there was no difference between groups in the perception of improvement (p > 0.05). CTM is superior to placebo intervention and control in improving menstrual pain and other menstrual symptoms in PD in the short-term. On the other hand, when the application is terminated, this superiority seems to disappear during the follow-up period.

Patient reported data integration for management of Eosinophilic Esophagitis.

Eosinophilic Esophagitis (EoE) is an esophageal allergic inflammatory disorder triggered by food proteins. Symptoms of EoE are variable within and between individuals. Presenting symptoms may include dysphagia, food bolus impaction, dyspepsia, or more subtle symptoms such as feeding disorders, regurgitation sensation, or nausea. The development and validation of a pediatric EoE patient self-reported and parent proxy-reported outcome symptom scoring tool was created by Franciosi et al. published in BMJ 2011, titled the Pediatric Eosinophilic Esophagitis Symptom Score (PEESS™ v2.0). To date, its use is largely for research purposes. We propose to evaluate the implementation of the PEESS™ v2.0 in a prospective interventional controlled clinical practice. The study included 620 patients over an 18-month period. Surveys were delivered and administered digitally every month through the MyGeisinger.org Patient Portal. Our analysis demonstrated symptom severity and symptom frequency scores significantly improved over time. However, counter to our hypothesis, patients who completed the PEESS™v2.0 ultimately had higher EoE-related health care utilization of office visits and endoscopies compared with those who did not complete the PEESS™v2.0. This could be related to greater awareness of disease activity and/or increased willingness to seek care. Our study, in the context of mobile health tool and patient-reported outcome trends, represents an opportunity for improved disease monitoring at-home within the field of eosinophilic gastrointestinal diseases.

Turkish translation, cross-cultural adaptation, and psychometric validation of the pregnancy symptoms inventory: An instrument to assess the full spectrum of pregnancy symptoms

Objective: To translate the PSI (Pregnancy Symptoms Inventory) into Turkish, to perform its cultural adaptation, to establish its reliability and validity, and to examine the prevalence of perceived pregnancy symptoms frequency and symptom-related limitation in Turkish pregnant women. Design: This cross-sectional study included healthy pregnant women over 18 years old from all 3 pregnancy trimesters. In the reliability analysis, the test-retest reliability was investigated by the Pearson correlation analysis. For the criterion validity of the PSI, correlations between the total pregnancy symptom frequency scores and the total scores of the Tilburg Pregnancy Distress Scale, the State-Trait Anxiety Inventory, the Beck Depression Inventory, and the Nottingham Health Profile were analyzed. Frequency and limitation perception prevalence of the symptoms were calculated as a percentage based on the response to each symptom. Statistical significance level was accepted as p<0.05. Measurements and Findings: In the present study, 210 pregnant women participated, and 42 pregnant women filled out the Turkish-PSI twice for the test-retest analysis. In the frequency and limitation sections of the PSI, the test-retest correlations for each symptom were found to vary between medium and very strong (0.42–1.00 and 0.39–1.00, p <0.05, respectively). Moderate correlations (rho = 0.39–0.58, p <0.05, p ≤ 0.001) were detected between the frequency section total score and the total scores of the other scales. The top four symptoms indicated as “often” by the Turkish pregnant women were urinary frequency (42.4%), fatigue/tiredness (28.6%), increased vaginal discharge (26.7%), and upper/lower back pain (23.8%). Key conclusions: The Turkish-PSI is a comprehensive, reliable, and valid inventory for evaluating a wide range of pregnancy symptoms in Turkish pregnant women. Further studies are needed to examine the sensitivity of the Turkish-PSI to treatment-induced changes. Implications for practice: Comprehensive and practical symptom questioning tools such as the PSI during pregnancy can lead to the early detection of pregnancy symptoms and to initiate effective non-pharmacological interventions.

Correlation evaluation of the international prostate symptom score (IPSS), visual prostate symptom score (VPSS), and modified visual prostate symptom score (mVPSS) in Thai males with benign prostatic hyperplasia

Objective: To study the correlation between the modified visual prostate symptom score (mVPSS), the visual prostate symptom score (VPSS) and the international prostate symptom score (IPSS) in Thai males who were diagnosed with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Material and Method: One hundred and ten Thai males who were diagnosed with BPH and LUTS by urologists were enrolled onto the study between 1st March and 31st July 2019. They were divided into 2 different groups by simple random sampling. The first group was requested to complete the A questionnaire which was composed of IPSS and VPSS and the second group was assigned to finish the B questionnaire which consisted of IPSS and mVPSS. Both groups had to complete their personal data, including age, education level, monthly income, and duration of treatment for BPH, and they also were classified as high or low educated groups. The correlations between the scores of mVPSS, VPSS, and IPSS in the high or low educated groups were assessed using Pearson’s correlation coefficient with IBM SPSS statistics 22.0. Results: There were statistically significant correlations between mVPSS, VPSS, and IPSS (P&lt;0.05) in total and individual scores, which consisted of quality of life, voiding symptom score, storage symptom score, frequency score and nocturia score. According to this study, it was found that the mVPSS and VPSS questionnaires took less time to complete and were easier than the IPSS. However, in high-educated patients, there was no statistically significant rate to complete the mVPSS, VPSS and IPSS questionnaire by themselves. In addition, this study showed a strong positive correlation between the IPSS versus mVPSS and VPSS in the high-educated groups (r=0.935 and r=0.898, respectively). In contrast, in the low-educated patient group, there was no statistically significant correlation between the VPSS and IPSS questionnaires in frequency score. However, this study found a positive correlation of frequency score between the mVPSS and IPSS questionnaires in all educated groups. Moreover, most patients felt that the mVPSS and VPSS questionnaires were easier to understand and complete than the IPSS questionnaire. Conclusion: The mVPSS shows a statistically significant correlation to the IPSS standard questionnaire, which means that the IPSS can be replaced by the mVPSS in order to evaluate Thai males with BPH and LUTS, because the mVPSS can be used with all educated groups and the patients are able to understand and complete the questionnaire more quickly. For these reasons, the mVPSS is an excellent choice to replace the VPSS and IPSS, which still have many limitations with varieties of patients.

Foreword

Diastolic dysfunction (DD) is common and occurs at an earlier age among human immunodeficiency virus-infected (HIV+) individuals, but the mechanisms and consequences of DD among HIV+ individuals are unclear.The Characterization of Heart Function on Antiretroviral Therapy (CHART) study was a multicenter cross-sectional case-control study of treated and virally suppressed HIV+ individuals with (DD+) and without DD (DD−). All patients had normal ejection fraction (>50%), no significant valvular disease, and no history of coronary revascularization or persistent atrial fibrillation. Overall, 94 DD+ and 101 DD− patients were included. DD+ patients were older with higher body mass index (BMI) and more likely to have hypertension, renal dysfunction, and dyslipidemia. Groups were similar with respect to sex, race, CD4 count, and HIV RNA copies. N-terminal pro-B-type natriuretic peptide levels (median 36 [23, 85] vs 26 [12, 49] pg/mL, P < .01) and high-sensitivity troponin I (3.6 [2.6, 5.1] vs 2.5 [1.8, 3.5] pg/mL, P < .01) were higher among DD+ patients. The latter had similar left atrial size, but increased stiffness (conduit strain: 23.5 [17.5, 36.9] vs 30.0 [22.9, 37.0], P < .01) and impaired relaxation (reservoir strain: 39.7 [32.0, 58.0] vs 45.9 [37.0, 60.6], P = .04). On cardiac magnetic resonance, the prevalence of focal fibrosis was higher among DD+ patients (19.0% vs 5.3%, P < .01). DD+ patients demonstrated higher levels of carboxyl-terminal telopeptide of collagen type I (P = .04), and trends toward higher interleukin-6 and oxidized low-density lipoprotein levels (P ≤ .08). Kansas City Cardiomyopathy Questionnaire physical limitation (87.1±21.4 vs 93.1±18.1, P = .01) and symptom frequency scores were lower among DD+ patients (86.0±21.5 vs 92.5±16.8, P = .01).In this contemporary HIV+ population receiving antiretroviral therapy, DD was associated with multiple alterations in cardiac structure and function, including myocardial fibrosis and left atrial abnormalities, and worse quality of life. Further studies are needed to assess longitudinal changes in these parameters and their potential as therapeutic targets to prevent progressive cardiac remodeling and dysfunction in HIV.

Diastolic Dysfunction in Patients With Human Immunodeficiency Virus Receiving Antiretroviral Therapy: Results From the CHART Study

Diastolic dysfunction (DD) is common and occurs at an earlier age among human immunodeficiency virus-infected (HIV+) individuals, but the mechanisms and consequences of DD among HIV+ individuals are unclear. The Characterization of Heart Function on Antiretroviral Therapy (CHART) study was a multicenter cross-sectional case-control study of treated and virally suppressed HIV+ individuals with (DD+) and without DD (DD-). All patients had normal ejection fraction (>50%), no significant valvular disease, and no history of coronary revascularization or persistent atrial fibrillation. Overall, 94 DD+ and 101 DD- patients were included. DD+ patients were older with higher body mass index (BMI) and more likely to have hypertension, renal dysfunction, and dyslipidemia. Groups were similar with respect to sex, race, CD4 count, and HIV RNA copies. N-terminal pro-B-type natriuretic peptide levels (median 36 [23, 85] vs 26 [12, 49] pg/mL, P < .01) and high-sensitivity troponin I (3.6 [2.6, 5.1] vs 2.5 [1.8, 3.5] pg/mL, P < .01) were higher among DD+ patients. The latter had similar left atrial size, but increased stiffness (conduit strain: 23.5 [17.5, 36.9] vs 30.0 [22.9, 37.0], P < .01) and impaired relaxation (reservoir strain: 39.7 [32.0, 58.0] vs 45.9 [37.0, 60.6], P = .04). On cardiac magnetic resonance, the prevalence of focal fibrosis was higher among DD+ patients (19.0% vs 5.3%, P < .01). DD+ patients demonstrated higher levels of carboxyl-terminal telopeptide of collagen type I (P = .04), and trends toward higher interleukin-6 and oxidized low-density lipoprotein levels (P ≤ .08). Kansas City Cardiomyopathy Questionnaire physical limitation (87.1±21.4 vs 93.1±18.1, P = .01) and symptom frequency scores were lower among DD+ patients (86.0±21.5 vs 92.5±16.8, P = .01). In this contemporary HIV+ population receiving antiretroviral therapy, DD was associated with multiple alterations in cardiac structure and function, including myocardial fibrosis and left atrial abnormalities, and worse quality of life. Further studies are needed to assess longitudinal changes in these parameters and their potential as therapeutic targets to prevent progressive cardiac remodeling and dysfunction in HIV.

Therapeutic efficacy of laparoscopic Heller-Dor surgery for chest pain in patients with achalasia: a single institutional experience.

Chest pain reduces the quality of life of patients with achalasia. Although laparoscopic Heller-Dor surgery (LHD) is a standard surgical treatment for achalasia, its therapeutic efficacy for chest pain is not clear. The present study evaluated the therapeutic efficacy of LHD for chest pain and tried to identify factors associated with the relief of chest pain. The study included 244 patients with preoperative chest pain who underwent LHD as the first surgical intervention. The questionnaire-based symptom frequency score was multiplied by the severity score, and the calculated metric was defined as the symptom score. The study population was stratified, by the change in the chest pain symptom score, into Complete Remission (CR), Partial Remission (PR), and No Remission (NR) groups, which were compared for patient background and surgical outcome. Multivariate analysis was also performed to determine factors associated with the relief of chest pain. As for preoperative clinicopathological conditions, the CR subgroup was older (p = 0.0169) with fewer previous balloon dilatations (p = 0.009). Although no difference was detected in the surgical outcome, the NR group had higher postoperative symptom scores for both difficulty in swallowing and vomiting and a lower score for patient satisfaction with surgery (p = 0.0141). Multivariate analysis detected two factors associated with CR: disease duration over 60months and less than two previous balloon dilatations. LHD improved chest pain symptoms in 90% of patients with achalasia. The patients who achieved relief of chest pain were characterized by disease duration over 60months and less than two previous balloon dilatations.

Colorectal cancer survivors: an investigation of symptom burden and influencing factors

BackgroundColorectal cancer is a significant issue internationally, with over 1.3 million people diagnosed annually. Survival rates are increasing as treatments improve, although physical symptoms can persist despite eradication of the tumour. In order to optimize survivorship care, further research is warranted in relation to symptom burden. Therefore, the objectives of this study are to (i) investigate frequency of physical symptoms in colorectal cancer survivors (ii) identify which symptoms occur together (iii) examine the associations between demographic and clinical variables, and symptoms.MethodsParticipants nine months to three years post diagnosis were identified from the population-based National Cancer Registry Ireland. Respondents completed the EORTC QLQ-C30 and EORTC QLQ-CR29. Reported physical symptom frequencies were transformed into continuous scale variables, which were then analysed using one way analysis of variance, general linear modelling and Spearman rank correlations.ResultsThere were 496 participants. Fatigue, insomnia and flatulence were the most frequent symptoms, with ≥20% of respondents reporting these to be often present in the previous week. Eight other symptoms were experienced often by 10–20% of respondents. At least one of these eleven most common symptoms was experienced frequently by almost every respondent (99%). 66% of respondents experienced at least two of these symptoms together, and 16% experienced five or more together. Current stoma was the single most common variable associated with increased symptom scores, although statistically significant relationships (p ≤ 0.05) between symptom frequency scores and clinical/demographic variables were generally weak (R-sq value ≤0.08).ConclusionFindings may inform targeted interventions during the nine month to three year post diagnosis timeframe, which would enable supported self-management of symptoms.

Kidney symptom questionnaire: Development, content validation and relationship with quality of life.

Chronic kidney disease (CKD) is associated with a range of symptoms, even at early stages. The importance of patient symptom experience is increasingly recognised, but validated symptom scores are lacking. This study aimed to refine an existing symptom questionnaire for use with patients not requiring renal replacement therapy (RRT), carry out content validity testing and explore convergent validity by comparing symptom scores with quality of life (QoL). A mixed-methods approach involving questionnaires, semi-structured interviews and a focus group. Patients with CKD not undergoing RRT and expert health professionals. Two hundred and nineteen patients completed an existing symptom questionnaire. The most commonly reported symptoms were identified, and descriptions refined in 11 semi-structured interviews. The questionnaire design was reviewed by a focus group. Content validity was established by a panel of expert health professionals. Seventy patients completed both the symptom questionnaire and a health-related QoL questionnaire (EQ-5D-5L). Thirteen common symptoms were identified. During the content validity phase, 13/16 experts responded (81%); 10/13 symptoms had 'excellent' or 'good' evaluation scores, and the content validity index of the whole questionnaire was 0.81, falling within the recommended threshold. Total symptom frequency scores, number of symptoms and the frequencies of 10/13 individual symptoms were all strongly associated with health-related QoL (EQ-5D-5L index score; p < 0.002 for all). This work has provided a new, validated symptom score for patients with CKD not requiring RRT for clinical management and research purposes.

Laparoscopic Hiatal Hernia Repair with Falciform Ligament Buttress

BackgroundUsing synthetic mesh to buttress the crural repair during laparoscopic hiatal hernia repair may be associated with dysphagia and esophageal erosions, while a biologic mesh is expensive and does not decrease long-term recurrence rates. This study documents outcomes of laparoscopic paraesophageal hernia repairs using the falciform ligament to reinforce the crural repair. MethodsThis is a prospective study of laparoscopic paraesophageal hernia repairs with a falciform ligament buttress. Preoperatively and at 6 and 12 months postoperatively, medications, radiologic studies, and symptom severity and frequency scores were recorded. Patients with a hiatal defect greater than 5 cm were included, while patients with recurrent hiatal hernia repairs or prior gastric surgery were excluded. Symptom scores were compared pre- and postoperatively with a p < 0.05 considered significant. ResultsOne hundred four patients were included with a mean age of 62.4 years, and 57 patients underwent an upper gastrointestinal series at least 12 months from the initial operation with a mean follow-up of 20.6 months. The mean symptom severity score decreased from 14.32±0.93 to 4.75±0.97 (p < 0.001), mean symptom frequency score decreased from 14.99±0.97 to 5.25±0.99 (p < 0.001), and mean total symptom score decreased from 29.31±1.88 to 10.00±1.95 (p < 0.001). Five patients developed recurrent hiatal hernias on upper gastrointestinal series, but only three required operative intervention. ConclusionsLaparoscopic paraesophageal hernia repair with a falciform ligament buttress is a viable option for a durable closure. Ongoing follow-up will continue to illuminate the value of this approach to decrease morbidity and recurrence rates for hiatal hernia repair.

The Effects of Intimate Partner Violence and Probable Traumatic Brain Injury on Central Nervous System Symptoms.

Abused women often report a wide range of physical and psychological symptoms that present challenges to providers. Specifically, injuries to the head or strangulation, may initiate neurological changes that contribute to central nervous system (CNS) symptoms. These symptoms are often attributed to mental health diagnoses in this population. The purpose of this analysis is to examine the prevalence of and associations between reported probable traumatic brain injury (TBI) and CNS symptoms in a sample of women of African descent. A convenience sample of 901 women of African descent from Baltimore, MD and the US Virgin Islands, aged 18-55, was used to examine relationships among self-reported intimate partner violence (IPV), TBI, and CNS symptoms. Data were collected via Audio Computer-Assisted Self-Interview. Abused women who experienced a probable TBI were more likely to report CNS symptoms than those who did not. When controlling for demographics, IPV, and mental health symptoms, probable TBI was associated with a two point increase in CNS symptom frequency score (95% confidence interval: 1.55-2.93, p < 0.001). Women who reported both probable TBI and IPV were more likely than their abused counterparts who reported no TBI to report CNS symptoms. This relationship held true even when controlling for symptoms of depression and post-traumatic stress disorder (PTSD). Clinicians working with women should be aware of TBI as a possible etiology for symptoms in abused women. Appropriate screening and treatment protocols should be designed and implemented across medical settings to improve outcomes for women who have experienced IPV and TBI.