Symptoms Of Chronic Disease Research Articles

Effect of psychosocial interventions for depression in adults with chronic kidney disease: a systematic review and meta-analysis

BackgroundPeople with chronic kidney disease (CKD) treated with dialysis are frequently affected by depression. Psychotherapy has been reported to decrease depressive symptoms in various chronic diseases and is a potential treatment option for depression. We aimed to perform a systematic review and meta-analysis to evaluate the effect of psychotherapy on depression in adults with CKD.MethodsWe searched MEDLINE, Embase, Web of Science, and Cochrane for published studies up to October 31, 2023. Two investigators independently reviewed the included studies and extracted relevant data. Randomized controlled trials (RCTs) assessing the impact of interventions that provide psychological, emotional, or social support without the use of pharmacological substances on depressive symptoms in people with CKD were included and summarized. Scores on different tools for depressive assessment and quality of life were pooled.ResultsA total of 19 RCTs published between 2004 and 2023 were included and analyzed. The weighted mean difference (WMD) for all included studies with regard to depression was − 2.32 (95%CI=-3.83, -0.80, P = 0.003). The WMD for Beck Depression Inventory (BDI) score of depression was − 3.27 (95%CI=-7.81, 1.27, P = 0.158) with significant heterogeneity (I2 = 95.1%). Significant WMD was detected for the Hospital Anxiety and Depression Scale (HADS) tool: WMD=-1.90, 95%CI=-2.91, -0.90, P < 0.001. The WMD for all included studies regarding quality of life was 1.21 (95%CI=-0.51, 2.93, P = 0.168). The WMD for Kidney Disease Quality of Life Short Form (KDQOL-SF) score was 4.55 (95%CI = 0.50, 8.60, P = 0.028). The WMD for SF-36 score was 0.02 (95%CI=-10.33, 10.36, P = 0.998). Significant difference on outcomes of S-PRT scale was observed (WMD = 2.42, 95%CI = 1.07, 3.76, P < 0.001).ConclusionsPsychosocial interventions probably reduce the depression level among CKD patients. Preliminary evidence suggests that psychosocial interventions might be beneficial for the quality of life in CKD patients. Our results provide medical facilities with an evidence-based basis for establishing psychosocial interventions in kidney care settings.

Development of a predictive model for managing lifestyle behaviors among patients with chronic skin diseases: Using machine learning techniques

This study aimed to develop a predictive model using lifestyle behavioral factors related to chronic skin disease symptoms and machine learning techniques. A cross-sectional survey was conducted among patients with chronic skin diseases currently receiving treatment at 19 Saengki Korean Medical Clinics specializing in the treatment of chronic skin diseases. Data were collected from 264 participants through an online survey conducted over a three-month period. We used changes in patients' skin symptoms as the dependent variable and lifestyle, behavioral, and treatment variables that affect chronic skin disease remission as predictors. Based on previous studies, we evaluated the performance of the six models using machine learning techniques (decision tree, logistic regression [LR], random forest [RF], CatBoost, gradient boosting classifier, and LightGBM) that are commonly used to create predictive models using categorical factors. The results showed that RF and LR performed well. We selected LR as the final model based on the confusion matrix and receiver operating characteristic (ROC) curve. The LR results showed that herbal medicine use and hospital visits were associated with chronic skin disease symptoms, whereas the RF results showed that herbal medicine use, exercise, and wheat flour consumption were associated with chronic skin disease symptoms. These findings suggest that both the treatment and lifestyle behaviors are associated with chronic skin disease symptoms.

Sustainable Impact of Intradialytic Exercise and Cognitive Behavior Therapy on the Quality of Life of Patients with Chronic Kidney Disease: A Non-Pharmacological Approach

Chronic kidney disease (CKD) affects a person's psychological and physical health, which lowers their quality of life. Hemodialysis is a common kind of replacement treatment for patients with chronic renal disease. The data on symptoms is expanding as the need to manage symptoms in advanced chronic kidney disease (CKD) patients receiving hemodialysis (HD) becomes more widely recognized. Finding non-pharmacological ways to improve CKD patients' quality of life was the goal of this study. A brief overview of the existing research on non-pharmacologic therapies aimed at improving symptoms and enhancing quality of life in dialysis patients with advanced chronic kidney disease is provided in this study. Not only are there no clinical practice guidelines available to treat those frequent symptoms, but there is also a dearth of research about the best ways to integrate symptom intervention techniques into clinical care. According to the present review research, this combination of physical and cognitive behavioral intervention may be employed as a non-pharmacological technique to limit physical and cognitive decline and improve quality of life in the HD population. This suggests a promising direction for further research and application in HD care.

Relevance of multidimensional dyspnea assessment in the context of pulmonary rehabilitation.

Objectives: While dyspnea is the main symptom in chronic obstructive pulmonary disease (COPD), it is often inadequately evaluated in pulmonary rehabilitation (PR), as it is typically measured using only the impact dimension (ID). However, dyspnea is a multidimensional construct including perception (PD) and emotional (ED) domains. Our work aimed to study the complementarity of dyspnea dimensions and their respective ability to identify different evolutions during PR. Methods: 145 people with COPD attending PR were included in this retrospective study. Dyspnea scores from the modified Medical Research Council scale (ID) and the Multidimensional Dyspnea Profile questionnaire (PD/ED), exercise capacity, quality of life at the start (T1) and the end of PR (T2) were collected from existing databases/medical files. The evolution of each dyspnea dimension was evaluated using the delta score between T2-T1. PR response was defined using the minimal clinically important difference. Results: Our results show that each dyspnea dimension was associated with different health-outcomes. Positive correlations were found between PD-ED at baseline and between their T2-T1 delta score (ρ = 0.51; ρ = 0.41 respectively, p < .01), but there was no significant correlation between ID-PD or -ED (p > .05). 51% of the patients did not respond on ID, but 85% of them nonetheless responded on either PD or ED. Finally, 92% of patients responded on at least one dimension after PR. Discussion: Our study emphasizes the significance of assessing each dimension of dyspnea independently and complementary, as dimensions are associated with different elements and evolve differently under PR effects. This approach is crucial to identifying weak points and allows professionals to focus on program elements that most effectively address the specific dimension causing problems.

Introduction: Addressing patient-reported symptoms of chronic liver disease

Introduction: Addressing patient-reported symptoms of chronic liver disease

Effects of Dronabinol on Dyspnea and Quality of Life in Patients With COPD.

Dyspnea is frequently a debilitating symptom of chronic obstructive pulmonary disease (COPD). Cannabinoid receptor agonists have the potential to alter dyspnea in these patients. Our objective was to determine if dronabinol, a pure cannabinoid, improves dyspnea and exercise tolerance in COPD. In this double-blind randomized, crossover pilot study, COPD patients received up to 20mg of oral dronabinol or placebo daily for 6 weeks with an intervening washout period. Dyspnea and fatigue were assessed using the Borg scale at rest and after an incremental shuttle walk. Functional status, mood, and depression were measured using the St George's Respiratory Questionnaire (SGRQ), the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ), and the Geriatric Depression Scale (GDS). A total of 11 participants (with mean forced expiratory volume in 1 second 50.8 ± 24.8%) completed the study with no improvement in dyspnea at rest or postexercise taking dronabinol versus placebo (Borg scale 0.27, 95% confidence interval [CI] -0.59 to 1.14 versus 0.23 points, 95% CI -0.71 to 1.07 at rest and 0.82, 95% CI -0.59 to 2.22 versus 0.36 points, 95% CI 0.13 to 2.78 post exercise; p=0.94 and p=0.69 respectively). Dronabinol compared with placebo showed no significant change in PFSDQ dyspnea scores (0.64, 95% CI -3.92 to 5.20 versus 5.0, 95% CI -6.29 to 16.29; p=0.43) or shuttle walk distances (20.7m, 95% CI -21.5 to 62.8 versus 13.7m, 95% CI -24.8 to 52.2; p=0.69). There were no significant differences in fatigue at rest and postexercise, SGRQ scores, or GDS scores. In this pilot study, dronabinol did not significantly improve dyspnea or exercise capacity compared with placebo.

Prevalence and associated factors of insomnia symptoms among doctors and nurses under the context of high prevalence of multiple infectious diseases: a cross-sectional study.

Insomnia symptoms are prevalent among healthcare workers and represent a potential public health problem. However, there is currently insufficient evidence on insomnia symptoms among doctors and nurses under the context of high prevalence of multiple infectious diseases after the pandemic in China. The purpose of this study was to analyze the prevalence of insomnia symptoms among doctors and nurses in third-grade class-A general hospitals under the context of high prevalence of multiple infectious diseases, and to explore the influence of demographic characteristics, work-related factors, health and lifestyle-related factors on insomnia symptoms. An institution-based cross-sectional survey was conducted among doctors and nurses in two third-grade class-A general hospitals. A structured questionnaire was used to collect information on demographic characteristics, work-related factors, health and lifestyle-related factors, and insomnia symptoms among doctors and nurses. Multivariate logistics regression analysis was applied to identify factors significantly associated with insomnia symptoms among doctors and nurses, respectively. A total of 1,004 participants were included in this study, including 503 doctors and 501 nurses. The prevalence of insomnia symptoms in doctors and nurses was 47.7 and 51.3%, respectively. Multivariate logistics regression analysis showed that workplace violence (OR: 1.631, 95% CI: 1.050-2.532), doctor-patient relationship (OR: 1.603, 95% CI: 1.049-2.450), chronic pain (OR: 4.134, 95% CI: 2.579-6.625), chronic disease (OR: 1.825, 95% CI: 1.164-2.861), and anxiety symptoms (OR: 2.273, 95% CI: 1.357-3.807) were associated factors with insomnia symptoms in doctors. Education (OR: 0.301, 95% CI: 0.106-0.851), service years (OR: 1.978, 95% CI: 1.304-3.002), weekly working hours (OR: 1.694, 95% CI: 1.061-2.705), chronic pain (OR: 5.359, 95% CI: 3.241-8.860), and anxiety symptoms (OR: 2.472, 95% CI: 1.478-4.136) were associated factors with insomnia symptoms in nurses. The prevalence of insomnia symptoms among doctors and nurses was high, and affected by many factors. This information can inform tailored interventions to insomnia symptoms by doctors and nurses who play an important role in public health.

The Impact of Stress on Child Development and Healthcare Interventions for Children with Chronic Illnesses in Albania

This study is of paramount importance for advancing healthcare and improving the quality of life for children with chronic diseases in Albania. Chronic illnesses in children present significant challenges that extend beyond the physical aspects of the disease. These conditions often require continuous medical management and can have substantial emotional and psychological impacts. In Albania, it is estimated that approximately 15-20% of children are affected by chronic illnesses. Among these children, about 30-40% experience high levels of stress, which can significantly impact their overall health and well-being. Understanding the relationship between stress and chronic illnesses is crucial for developing effective healthcare strategies. Stress can exacerbate the symptoms of chronic diseases and contribute to a deterioration in the child’s condition. This study aims to explore the intricate relationship between stress and health interventions, analyzing how stress impacts the health and well-being of children with chronic illnesses. It investigates whether increased stress levels are associated with worsening of the child’s condition and evaluates the effectiveness of various health interventions in mitigating this stress. The methodology of the study includes using surveys to measure stress levels among children and medical monitoring to identify changes in their health status in relation to stress. The hypotheses guiding this research suggest that elevated stress levels may significantly increase symptoms and the risk of worsening chronic conditions. By examining these relationships, the study seeks to confirm the importance of stress management in the healthcare and treatment of children with chronic illnesses. The findings reveal a noticeable link between stress levels and the worsening of chronic illnesses, underscoring the critical need for effective stress management strategies. The results suggest that psychosocial interventions and family support are essential components in reducing stress and improving the quality of life for these children. Practical implications of the study include the development and implementation of targeted interventions designed to address the specific stressors faced by children with chronic conditions, potentially enhancing their overall care and support. However, the study does have limitations. Measuring stress and accounting for other variables that may affect health can be challenging, and these factors may impact the accuracy and comprehensiveness of the findings. Despite these limitations, the study’s insights have significant social implications. A deeper understanding of how stress affects health can contribute to the development of more effective policies and practices, fostering better healthcare environments for children with chronic illnesses. Overall, this study provides valuable new perspectives on the impact of stress on children with chronic conditions and highlights the necessity of effective interventions. By addressing both the physical and psychological aspects of chronic illness management, the study aims to improve the overall quality of life for affected children, reduce healthcare costs, and support their emotional and social well-being. Keywords: Stress, chronic illnesses, children, health interventions, quality of life, healthcare implications

Assessment of the impact of working under COVID-19 conditions on the psychophysical state of nurses

Aim: The COVID-19 pandemic caused many unfavorable changes in nurses’ daily work, which affected their health and well-being. The objective of the study was to assess the impact of working under COVID-19 conditions on the psychophysical condition of nurses. Materials and Methods: The study included a group of 100 nurses from the Łodź Voivodeship working under COVID-19 conditions. A survey questionnaire consisting of questions on health status, the occurrence and severity of symptoms resulting from work in covid conditions was used. Results: Statistically significant (p&lt;0.001) increases in physical ailments were found in nurses after a change in working conditions. The largest effect was observed for dyspnoea, headache and lumbar pain. The severity of physical ailments was mainly affected by the age of the respondents and the presence of chronic diseases. There was also a statistically significant (p&lt;0.001) deterioration in the mental state of the respondents, primarily in terms of feelings of mental fatigue, mood decrease and feelings of fear for the health of relatives. An increase in fear for one’s own health was also observed, particularly in nurses with older age, higher BMI, longer work experience and chronic diseases. Conclusions: The change of working conditions during the COVID-19 pandemic adversely affected the psychophysical health of nurses. The respondents showed an increase of the symptoms of chronic diseases, headaches and back pain. Working in difficult conditions and chronic stress resulted in a depressed mood and fear for one’s own life and that of relatives. Thermal treatment may be recommended to improve the psychophysical condition of nurses.

Feature Selection using Information Gain on the K-Nearest Neighbor (KNN) and Modified K-Nearest Neighbor (MKNN) Methods for Chronic Kidney Disease Classification

Purpose: Kidneys has an important role in the human excretory system. Unhealthy kidneys can affect kidney function. It is important to know the symptoms of chronic kidney disease. One data mining technique that can be applied is the classification technique to determine whether a person has chronic kidney disease or not based on the symptoms (attributes) obtained from medical records. The symptoms of chronic kidney disease obtained amount to 24 symptoms or attributes,Methods/Study design/approach: In this research, the classification of chronic kidney disease is performed using the information gain feature selection method and the KNN and MKNN classification methods. The number of data used is 400 data with 2 classes, namely chronic kidney disease (CKD) and non-chronic kidney disease (non-CKD).Result/Findings: Based on the test results, it was found that the hemo (Hemoglobin) attribute has the highest information gain value, which is 0.6255. The best accuracy for the KNN classification method is 96.61%, and for the MKNN method, it is 98%. Novelty/Originality/Value: The purpose of information gain feature selection is to choose features or attributes that significantly influence chronic kidney disease. Keywords: Chronic Kidney Disease, Information Gain, KNN, MKNN

A Novel Dual Kinase Inhibitor for the Treatment of Chronic Graft Vs. Host Disease

Chronic Graft vs. Host Disease (cGvHD) remains a major debilitating and potentially fatal sequelae of allogeneic hematopoietic cell transplantation. Corticosteroids remain the initial therapy of clinically significant cGvHD. Since 2017 three targeted therapies have been approved for steroid refractory cGVHD, ruxolitinib, a JAK 1/2 inhibitor, is approved post one or two previous therapies. Ibrutinib, a Bruton's tyrosine kinase (BTK) inhibitor, and belumosudil, a ROCK2 inhibitor, are both approved after two previous lines of therapy. We tested RR- RR-1752 a single digit nM dual ROCK/AURK inhibitor in a mouse model of severe cGVHD. BALB/c recipient mice were preconditioned with 7.5 Gy TBI, 8 hours later they received 10 7 T-cell depleted (TCD) C57BL/6 bone marrow cells alone (Group A, n=7) or 10 7 TCD C57Bl bone marrow cells plus 10 6 splenocytes (Groups B, n=8 and C, n=8). Beginning day 7 post cell infusion animals received either oral vehicle control (groups A and B) or vehicle with 1.0 mg/kg RR-1752 (Group C) daily. Body weight, alopecia score and eye score were monitored 3×/week through day 56 or until termination. All animals in groups B and C developed signs and symptoms of chronic graft vs. host disease. Animals in group A exhibited 20% weight loss through seven days post irradiation and cell infusion but began to recover to baseline and recovered weight to 90% of baseline. Animal weights in groups B and C dropped to less than 80% at day seven post irradiation, but only recovered to 80.38% +/- 10.18 (Group B) and 87.11% +/- 7.90 (Group C) on day 14 and then declined to 74.10% +/- 4.19 in Group B and 80.23% +/- 7.35 in Group C by day 28 (Figure 1). Animals in Group A had no significant change in eye score or alopecia. In contrast all animals in groups B and C showed signs of cGvHD. Eye showed moderate effects in Group B and mild changes in group C, while alopecia scores were moderate in both groups B and C. All animals in group A survived through day 56, median survival in group B was 16.5 days, as compared to 38 days in group C (Figure 2). In a separate study in normal mice, RR-1752 given at 1.0 mg/kg/day for 2 weeks showed no negative effects on hemoglobin, hematocrit, platelets, total WBC, or neutrophils, and only a mild decrease in lymphocytes. Using a model for cGVHD, exhibiting weight loss, alopecia, and ocular changes, we demonstrated that RR-1752 1.0 mg/kg/day slows mouse body weight loss, increases survival and shows trends to ameliorate ocular toxicity. The dose tested did not ameliorate the alopecia in the cGVHD mice. Further studies are ongoing to assess higher dose levels and dose schedule effects in the severe cGVHD mouse model. Additional studies to compare effects on cGVHD to ruxolitinib and belumosudil and in combination with those standard of care therapies need to be conducted.

CKD-Associated Pruritus and Clinical Outcomes in Nondialysis CKD

Itching is a frequent symptom experienced by people with chronic kidney disease (CKD). We investigated the associations of CKD-associated pruritus (CKD-aP) with clinical outcomes. This was a longitudinal cohort study. Patients from Brazil, France, and the United States enrolled in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) from 2013 to 2021, an international prospective cohort study of adults with nondialysis dependent CKD, and an estimated glomerular filtration rate (eGFR) of<60 mL/min/1.73 m2 were included. CKD-aP was self-reported by response to the question: "During the past 4 weeks, to what extent were you bothered by itchy skin?" The outcomes were as follows: CKD progression, kidney replacement therapy (KRT) initiation, mortality, hospitalization, cardiovascular events, infection events. Associations with time-to-event outcomes were investigated using Cox proportional hazards models adjusted for potential confounders. There were 4,410 patients from 91 clinics with a median age of 69 years and a median eGFR at patient questionnaire completion of 29 (21-38) mL/min/1.73 m2. The proportion of patients not at all, somewhat, moderately, very much, and extremely bothered by itchy skin was 49%, 27%, 13%, 7%, and 3%, respectively. Patients with more advanced stages of CKD, older age, and greater comorbidities reported to be more likely bothered by itchy skin. Among patients at least moderately bothered, 23% were prescribed at least 1 pharmacotherapy (35% in the United States, 19% in France, 4% in Brazil), including antihistamine (10%), gabapentin (6%), topical corticosteroids (4%), pregabalin (3%), or sedating antihistamine (3%). The HR (95% CI) for patients extremely (vs not at all) bothered was 1.74 (1.11-2.73) for all-cause mortality, 1.56 (1.11-2.18) for all-cause hospitalization, and 1.84 (1.22-2.75) for cardiovascular events. As CKD-aP severity increased, patients also had higher rates of infection events (P= 0.04); CKD-aP severity was not associated with KRT initiation (P= 0.20) or CKD progression (P= 0.87). The limitations were 25% nonresponse rate, recall bias, and residual confounding factors. These results demonstrate a strong association between severe itch and clinical outcomes, providing the nephrology community new insights into the possible adverse consequences of CKD-aP in individuals with nondialysis CKD, and warrant further exploration. Chronic kidney disease-associated pruritus (CKD-aP) is a common disturbing symptom of chronic kidney disease (CKD). This article analyzes longitudinal data from the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) to describe prevalence of CKD-aP in 4,410 individuals with nondialysis CKD, and its association with clinical outcomes. We found that 51% of the surveyed population were bothered by pruritus. CKD-aP was more prevalent in those with more advanced stages of CKD, older age, and with more comorbid conditions. Compared to those not at all bothered by pruritus, those who were extremely bothered had a higher risk of all-cause mortality, hospitalizations, and cardiovascular events. Severity of CKD-aP was not associated with CKD progression or initiation of kidney replacement therapy.

The Impact of Digital Technology on Self-Management in Cancer: Systematic Review.

Self-management (SM) plays an important role in supporting patients' adaptation to and management of the symptoms of chronic diseases. Cancer is a chronic disease that requires patients to have responsibility in management. Digital technology has the potential to enhance SM support, but there is little data on what SM skills are most commonly supported by digital technology. This review aimed to examine the SM core skills that were enabled and supported by digital interventions in people with cancer and identify any predictors of the effect of digital health intervention on SM core skills. Three electronic databases (MEDLINE, Scopus, and CINAHL) were searched for papers, published from January 2010 to February 2022, that reported randomized controlled trials (RCTs) involving patients with cancer or survivors of cancer where a digital technology intervention was evaluated and change in 1 or more SM core skills was a measured outcome. This systematic review resulted in 12 studies that were eligible to identify which SM core skills were enabled and supported by digital intervention. The total number of participants in the 12 studies was 2627. The most common SM core skills targeted by interventions were decision-making, goal setting, and partnering with health professionals. A total of 8 (67%) out of 12 RCTs demonstrated statistically significant improvement in outcomes including self-efficacy, survivorship care knowledge and attitude, quality of life, increased knowledge of treatment, and emotional and social functioning. A total of 5 (62%) out of 8 positive RCTs used theoretical considerations in their study design; whereas in 1 (25%) out of 4 negative RCTs, theoretical considerations were used. In 3 studies, some factors were identified that were associated with the development of SM core skills, which included younger age (regression coefficient [RC]=-0.06, 95% CI -0.10 to -0.02; P=.002), computer literacy (RC=-0.20, 95% CI -0.37 to -0.03; P=.02), completing cancer treatment (Cohen d=0.31), male sex (SD 0.34 in social functioning; P=.009), higher education (SD 0.19 in social functioning; P=.04), and being a recipient of chemotherapy (SD 0.36 in depression; P=.008). In all 3 studies, there were no shared identical factors that supported the development of SM core skills, whereby each study had a unique set of factors that supported the development of SM core skills. Digital technology for patients with cancer appears to improve SM core skills including decision-making, goal setting, and partnering with health care partners. This effect is greater in people who are younger, male, educated, highly computer literate, completing cancer treatment, or a recipient of chemotherapy. Future research should focus on targeting multiple SM core skills and identifying predictors of the effect of digital technology intervention. PROSPERO CRD42021221922; https://tinyurl.com/mrx3pfax.

Quantitative measurement of pitting edema with a novel edema ruler

Lower extremity edema is a symptom of chronic venous disease and venous insufficiency. However, clinical evaluations rely on the qualitative evaluation of the pitting depth, which is neither well-defined nor quantitative. We created a novel three-dimensionally printed edema ruler as a quantitative method to measure pitting depth. Twenty-five patients (50 legs) with chronic venous disease were evaluated for ankle edema using the edema ruler. The results demonstrate excellent intraclass correlation for both single (0.944, P < .001) and average (0.971, P < .001) measurements. The edema ruler is a noninvasive, useful, and objective tool for the clinical measurement of lower extremity edema.

The Diagnostic Value of ANA and Anti-SMA in Suspected Patients with Autoimmune Hepatitis

BACKGROUND: Autoimmune hepatitis (AIH) is an unknown chronic disease characterized by hepatocellular inflammation with a tendency to progress to cirrhosis. AIH can present with symptoms of acute hepatitis with symptoms of chronic liver disease. AIH occurs globally; it is more commonly found in females. Autoantibodies such as antinuclear, smooth muscle, liver kidney microsome, and soluble liver antigen are used to aid in the diagnosis of AIH, which presents with a variety of symptoms that also contribute to the classification of AIH. AIM: Evaluation of anti-nuclear antibodies (ANA) and anti-smooth muscle antibodies (SMA) positivity in hepatic diseases, gastrointestinal diseases, viral hepatitis, and extra-hepatic diseases, providing better markers for the early diagnosis of AIH-type 1. MATERIALS AND METHODS: The study included 207 individuals. 62.4% of them were female. Regarding the diagnoses, we grouped them into 4 groups: hepatic diseases (n = 73), viral hepatitis B and C (n = 54), gastrointestinal diseases (n = 34), and extra-hepatic diseases (n = 46). Serum levels of ANA and anti-SMA were measured using an indirect immunofluorescence method following the manufacturer’s instructions (Aesku Diagnostics, Germany). Fluorescence intensity was interpreted semi-quantitatively based on negative control (0) and positive control (+4). RESULTS: The positivity of ANA and anti-SMA resulted as follows: In hepatic diseases 34.2% and 48%, in viral hepatitis B and C, ANA positivity was 14.8% and SMA positivity was 22.2%; in gastrointestinal diseases, ANA and SMA positivity were, respectively, 11.8% and 20.6%; and in extrahepatic diseases, positivity of ANA resulted in 32.6% and SMA in 26%. When compared to the viral hepatitis patient group, the ANA specificity for hemagglutination inhibition (HAI) was 85.2% and that of anti-SMA was 77.8%. The analysis of 46 extrahepatic patient groups provided an ANA specificity of 67.4% and an anti-SMA specificity of 74% for HAI. The comparison to gastrointestinal disease showed that ANA specificity for HAI was 88.2% and anti-SMA specificity was 79.4%. CONCLUSION: Diagnosing AIH is difficult because the clinical spectrum ranges from an asymptomatic presentation to an acute and severe disease. So in all cases, AIH must be suspected. Both males and females can develop AIH, but the disease is more common in females. Based on our diagnostic parameters, we can say that ANA and anti-SMA provide moderate sensitivity for AIH, but they are more specific to AIH type 1.

Clinical efficacy of permanent internal mammary artery occlusion in chronic coronary artery disease: a double-blind, randomized, sham-controlled trial

Abstract Introduction Natural internal mammary artery (IMA) bypasses to the coronary circulation have been shown to act as extracardiac sources of myocardial blood supply, which has been found augmented by right IMA device occlusion. The goal of this randomized, sham-controlled trial was to test the efficacy of permanent right or left IMA device occlusion on symptoms of chronic coronary artery disease (CAD), on coronary artery occlusive blood supply, as well as on myocardial ischemia. Methods This was a prospective superiority trial in 100 patients with chronic CAD randomly allocated (1:1) to IMA permanent vascular device occlusion (verum group) or to IMA sham intervention (placebo group). The primary study endpoint was the change in treadmill exercise time (DET in seconds, s) during 6 weeks of follow-up after trial intervention. Secondary study endpoints were the changes in simultaneously obtained collateral flow index (CFI), and angina pectoris during a 1-minute proximal balloon occlusion of the coronary artery of interest. CFI is the ratio between simultaneous mean coronary occlusive divided by mean aortic pressure both subtracted by central venous pressure. Results In the verum and placebo group, exercise time changed from 398±176s to from 421±198s in the verum group (p=0.1745), and from 426±162s to 430±166s in the placebo group (p=0.55); DET was +23±116s and +4±120s, respectively (p=0.44). CFI change during follow-up was +0.022±0.061 in the verum and -0.039±0.072 in the placebo group (p&amp;lt;0.0001). Angina pectoris at follow-up during the coronary balloon occlusion for CFI measurement had decreased or disappeared in 20/48 patients of the verum group, and in 10/47 patients of the placebo group (p=0.0336). Conclusion Permanent IMA device occlusion tends to augment treadmill exercise time in response to heightened coronary artery occlusive blood supply, the fact of which is reflected by mitigated signs of myocardial ischemia.

Six Principles Energy Conservation Techniques for Respiratory Frequency and Oxygen Saturation in COPD Patients

Background: Chronic obstructive pulmonary disease refers to chronic diseases, such as emphysema, chronic bronchitis, asthma, or a combination of them. The observed symptoms of chronic obstructive pulmonary disease include breathlessness, wheezing, repeated respiratory tract infection, losing weight, and prolonged fatigue.&#x0D; Objectives: This research determined the influence of a 6-principle energy conservation technique on the respiratory frequency and oxygen saturation of COPD patients.&#x0D; Methods: This quasi-experimental research applied one group pretest-posttest design. The research design was useful to measure the respiratory rate and oxygen saturation before and after the implementation of 6-principle energy conservation. The researcher involved 29 respondents taken by accidental sampling.&#x0D; Results: The result showed the frequency mean before the intervention was 26.34 times per minute and after the intervention was 23.83 times per minute. The oxygen saturation, SpO2, before the intervention, was 97.17% while after the intervention was 96.76%. The Wilcoxon test found the influence of a 6-principle energy conservation technique toward the respiratory rate, a p-value of 0.000. On the other hand, the researcher did not find the influence of the 6-principle energy conservation technique on the COPD patient (p-value 0.944).&#x0D; Conclusion: The researcher recommends the implementation of 6-principle energy conservation as the non-pharmacological intervention alternative to manage the abnormal respiratory rate of COPD patients.

Pharmacotherapy in Cardiovascular Disease with Chronic Kidney Disease Medications: A Comprehensive Literature

A progressive decrease of renal function is a symptom of chronic kidney disease, commonly known as chronic kidney failure. The body may accumulate hazardous amounts of fluid, electrolytes, and wastes if the patient has advanced chronic kidney disease. There are several causative factors which lead to CKD which include high or low blood pressure, more accumulation of cholesterol, diabetes and many more. According to WHO global health statistics in 2012, 864,226 mortalities (or 15% of all deaths worldwide) were attributed to this illness. CKD was categorized 14th on the index of principal causes of death, having 122 mortalities per 100,000 persons. Most of the causes of deaths were due to sudden cardiac arrests in CKD patients. In this review, we made a list of 10 FDA approved medications which has proven to decrease CKD and fatalities caused by cardiac arrests. SGLT-2 inhibitors have shown promising results in manipulating kidney functions to improve the efficiency of heart.

Translation and psychometric testing of Indonesian Version of Chronic Kidney Disease– Symptom Burden Index

Introduction: Chronic Kidney Disease Symptom Burden Index (CKD-SBI) is an instrument measuring symptom burden developed by Almutary and colleagues in 2015 to refine the identification of symptom burden in chronic kidney disease population. This instrument has not been tested for Indonesian language, thus, the aim of study was to translate and psychometrically testing the Indonesian version of CKD-SBI. Methods: This study design was cross-sectional study. The study methods were divided into translation and psychometric testing. The translation was conducted by adapting Guillemin and Beaton's guidelines. The psychometric properties determined 320 hemodialysis patients with several inclusion criteria such as above 18 years old, regularly receiving hemodialysis for more than 3 months. Patients with cognitive impairment, psychiatric patients, and in critical condition were excluded. Results: The item content validity index of the Indonesian version was 0.92, and the subscale content validity was 0.78. The instrument demonstrated convergent validity with the Kidney Disease Quality of Life. Excellent internal consistency was demonstrated based on a Cronbach’s alpha coefficient of .91 and a subscale ranging from 0.86 to 0.92. The confirmatory factor analysis showed that the five factors of English Version did not fit the Indonesian version. Conclusions: Translated Indonesian versions of CKD-SBI can be used as instruments to assess symptom burden among patients with hemodialysis. By assessing symptom burden, we hope nurses in the hospital are able to decide effective symptom management to increase the health-related quality of life among these populations.

Capnography-Assisted Learned, Monitored (CALM) breathing therapy for dysfunctional breathing in COPD: A bridge to pulmonary rehabilitation

BackgroundAlthough dyspnea is a primary symptom of chronic obstructive pulmonary disease (COPD), its treatment is suboptimal. In both COPD and acute anxiety, breathing patterns become dysregulated, contributing to abnormal CO2, dyspnea, and inefficient recovery from breathing challenges. While pulmonary rehabilitation (PR) improves dyspnea, only 1–2% of patients access it. Individuals with anxiety who use PR have worse outcomes. MethodsWe present the protocol of a randomized controlled trial designed to determine the feasibility and acceptability of a new, four-week mind-body intervention that we developed, called “Capnography-Assisted Learned, Monitored (CALM) Breathing,” as an adjunct to PR. Eligible participants are randomized in a 1:1 ratio to either CALM Breathing program or Usual Care. CALM Breathing consists of 10 core, slow breathing exercises combined with real time biofeedback (of end-tidal CO2, respiratory rate, and airflow) and motivational interviewing. CALM Breathing promotes self-regulated breathing, linking CO2 changes to dyspnea and anxiety symptoms and targeting breathing efficiency and self-efficacy in COPD. Participants are randomized to CALM Breathing or a Usual Care control group. ResultsPrimary outcomes include feasibility and acceptability metrics of recruitment efficiency, participant retention, intervention adherence and fidelity, PR facilitation, patient satisfaction, and favorable themes from interviews. Secondary outcomes include breathing biomarkers, symptoms, health-related quality of life, six-minute walk distance, lung function, mood, physical activity, and PR utilization and engagement. ConclusionBy disrupting the cycle of dyspnea and anxiety, and providing a needed bridge to PR, CALM Breathing may address a substantive gap in healthcare and optimize treatment for patients with COPD.