Background. Panic disorder is a debilitating condition characterized by severe symptoms and social avoidance. Due to insufficient knowledge, this study examined the effectiveness of brief cognitive behavioral therapy (CBT) on symptom severity and social avoidance in patients with panic disorder. Patients and Methods. In this randomized controlled trial (RCT), 44 patients were included in the Brief CBT group or the control group after addressing issues related to lost-to-follow-up. Panic disorder symptom severity (PDSS) and the work and social adjustment scale (WSAS) were used to assess symptom severity and social adjustment, respectively. Results. After one month of treatment, the total PDSS scores (1.79 vs. 4.47; P=0.0409) and WSAS scores (2.97 vs. 7.41; P=0.0015) in the brief CBT group were significantly lower compared to the control group. The study revealed that in the brief CBT group, the mean score of PDSS and WSAS significantly decreased from 21.53 to 1.79 (P<0.0001) and from 24.63 to 2.95 (P<0.0001), and in the control group from 19.59 to 4.47 (P<0.0001) in PDSS and from 22.18 to 7.41 (P<0.0001) in WSAS, respectively. Furthermore, the change in WSAS scores in the brief CBT group was independent of the decrease in PDSS. Conclusions. This study demonstrated that the application of brief CBT is an effective technique for reducing symptom severity and social avoidance in patients with panic disorder.
背景。惊恐障碍是一种虚弱的疾病，其特征是严重的症状和社交回避。由于缺乏足够的知识，本研究考察了短暂认知行为疗法(CBT)对恐慌症患者症状严重程度和社交回避的有效性。患者和方法。在这项随机对照试验(RCT)中，44名患者在解决了与失访相关的问题后被纳入简短CBT组或对照组。分别用惊恐障碍症状严重程度量表(PDSS)和工作与社会适应量表(WSAS)评估症状严重程度和社会适应程度。结果。治疗1个月后，两组总PDSS评分(1.79 vs 4.47;P=0.0409)和WSAS评分(2.97 vs. 7.41;P=0.0015)，与对照组相比显著降低。研究发现，在简短CBT组中，PDSS和WSAS的平均得分分别从21.53降至1.79 (P<0.0001)和24.63降至2.95 (P<0.0001)，而在对照组中，PDSS和WSAS的平均得分分别从19.59降至4.47 (P<0.0001)和22.18降至7.41 (P<0.0001)。此外，短暂CBT组WSAS评分的变化与PDSS的下降无关。结论。本研究表明，应用简短的CBT是一种有效的技术，以减轻症状严重程度和社会回避的恐慌症患者。
{"title":"Effectiveness of brief cognitive behavior therapy on symptoms severity in relation to social avoidance among patients with panic disorder: a randomized controlled trial","authors":"Rasoul Sabri Piro, Perjan Hashim Taha","doi":"10.4081/itjm.2023.1664","DOIUrl":"https://doi.org/10.4081/itjm.2023.1664","url":null,"abstract":"Background. Panic disorder is a debilitating condition characterized by severe symptoms and social avoidance. Due to insufficient knowledge, this study examined the effectiveness of brief cognitive behavioral therapy (CBT) on symptom severity and social avoidance in patients with panic disorder. Patients and Methods. In this randomized controlled trial (RCT), 44 patients were included in the Brief CBT group or the control group after addressing issues related to lost-to-follow-up. Panic disorder symptom severity (PDSS) and the work and social adjustment scale (WSAS) were used to assess symptom severity and social adjustment, respectively. Results. After one month of treatment, the total PDSS scores (1.79 vs. 4.47; P=0.0409) and WSAS scores (2.97 vs. 7.41; P=0.0015) in the brief CBT group were significantly lower compared to the control group. The study revealed that in the brief CBT group, the mean score of PDSS and WSAS significantly decreased from 21.53 to 1.79 (P<0.0001) and from 24.63 to 2.95 (P<0.0001), and in the control group from 19.59 to 4.47 (P<0.0001) in PDSS and from 22.18 to 7.41 (P<0.0001) in WSAS, respectively. Furthermore, the change in WSAS scores in the brief CBT group was independent of the decrease in PDSS. Conclusions. This study demonstrated that the application of brief CBT is an effective technique for reducing symptom severity and social avoidance in patients with panic disorder.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136347946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francesca Romana Ponziani, Cristiano Caruso, Ilaria Baglivo, Francesco Macagno, Antonio Gasbarrini, Francesco Santopaolo, Maria Cristina Giustiniani, Stefania Colantuono, Maurizio Pompili
Inflammatory tissue damage plays a role in the onset, progression, and exacerbation of various chronic autoimmune and metabolic diseases such as autoimmune hepatitis. Here we present a case of autoimmune hepatitis with liver eosinophilic infiltrate in a severe eosinophilic asthma patient who failed conventional immunosuppressive treatment and showed improvement in gastrointestinal symptoms after anti-interleukin-5 receptor treatment. Our case highlights the potential role of eosinophils in initiating or worsening liver inflammation in autoimmune liver disease. The link between eosinophilic inflammation, barrier damage, and chronic autoimmune diseases should be considered in clinical practice.
{"title":"Autoimmune hepatitis with eosinophilic infiltration responsive to anti-interleukin-5 receptor treatment: a case report and literature review","authors":"Francesca Romana Ponziani, Cristiano Caruso, Ilaria Baglivo, Francesco Macagno, Antonio Gasbarrini, Francesco Santopaolo, Maria Cristina Giustiniani, Stefania Colantuono, Maurizio Pompili","doi":"10.4081/itjm.2023.1619","DOIUrl":"https://doi.org/10.4081/itjm.2023.1619","url":null,"abstract":"Inflammatory tissue damage plays a role in the onset, progression, and exacerbation of various chronic autoimmune and metabolic diseases such as autoimmune hepatitis. Here we present a case of autoimmune hepatitis with liver eosinophilic infiltrate in a severe eosinophilic asthma patient who failed conventional immunosuppressive treatment and showed improvement in gastrointestinal symptoms after anti-interleukin-5 receptor treatment. Our case highlights the potential role of eosinophils in initiating or worsening liver inflammation in autoimmune liver disease. The link between eosinophilic inflammation, barrier damage, and chronic autoimmune diseases should be considered in clinical practice.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135871115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose. To investigate a cohort of young Italian nurses to identify whether the body mass index (BMI) and eating flexibility differed and were associated according to the basic characteristics of sex, smoking behavior, or shift activity, the levels of neutrophils, lymphocytes, or platelets in blood, and the psychological conditions of anxiety, depression, stress, or insomnia. Materials and Methods. The data include sex, BMI, smoking behavior, shift activity, neutrophil, lymphocyte, and platelet levels, eating flexibility [measured using the eating disorder flexibility index (EDFLIX) and the subdimensions EDFLIX-GF for general flexibility, EDFLIX-FoEx for food and exercise flexibility, and EDFLIX-WeSh for weight and shape flexibility], and mental health [assessed using the depression, anxiety, and stress scale (DASS-21) and the insomnia severity index (ISI)]. Results. Differences in BMI with shift work (P=0.042) and anxiety with total EDFLIX (P<0.001), EDFLIX-GF (P<0.001), and EDFLIX-WeSh (P=0.044) scores were significant. Having depression was associated with significant differences in total EDFLIX (P<0.001), EDFLIX-GF (P=0.005), and EDFLIX-WeSh (P<0.001) scores. Nurses with moderate stress reported high total EDFLIX (P<0.001), EDGLIX-FoEx (P<0.001), and EDFLIX-WeSh (P=0.013) scores. Nurses with mild stress reported high EDFLIX-GF scores (P<0.001). Nurses without insomnia symptoms reported significantly high EDFLIX- FoEx scores (P<0.001). Associations between lymphocyte levels and EDFLIX-FoEx (β=-0.264; P=0.003), stress and EDFLIX-total (β=-0.436; P<0.001), EDFLIX-GF (β=-0.466; P<0.001) and EDFLIX-WeSh (P=0.022), and also between insomnia and EDFLIX-FoEx (β=-0.245; P<0.001) were significant. Conclusions. Nurses, from the beginning of their careers, should be monitored and encouraged to avoid adverse health practices that negatively influence their quality of life.
{"title":"Body mass index conditions and eating attitudes in young nurses: a pilot psycho-immune-endocrine investigation","authors":"Yun-Chen Chang, Elsa Vitale","doi":"10.4081/itjm.2023.1654","DOIUrl":"https://doi.org/10.4081/itjm.2023.1654","url":null,"abstract":"Purpose. To investigate a cohort of young Italian nurses to identify whether the body mass index (BMI) and eating flexibility differed and were associated according to the basic characteristics of sex, smoking behavior, or shift activity, the levels of neutrophils, lymphocytes, or platelets in blood, and the psychological conditions of anxiety, depression, stress, or insomnia. Materials and Methods. The data include sex, BMI, smoking behavior, shift activity, neutrophil, lymphocyte, and platelet levels, eating flexibility [measured using the eating disorder flexibility index (EDFLIX) and the subdimensions EDFLIX-GF for general flexibility, EDFLIX-FoEx for food and exercise flexibility, and EDFLIX-WeSh for weight and shape flexibility], and mental health [assessed using the depression, anxiety, and stress scale (DASS-21) and the insomnia severity index (ISI)]. Results. Differences in BMI with shift work (P=0.042) and anxiety with total EDFLIX (P<0.001), EDFLIX-GF (P<0.001), and EDFLIX-WeSh (P=0.044) scores were significant. Having depression was associated with significant differences in total EDFLIX (P<0.001), EDFLIX-GF (P=0.005), and EDFLIX-WeSh (P<0.001) scores. Nurses with moderate stress reported high total EDFLIX (P<0.001), EDGLIX-FoEx (P<0.001), and EDFLIX-WeSh (P=0.013) scores. Nurses with mild stress reported high EDFLIX-GF scores (P<0.001). Nurses without insomnia symptoms reported significantly high EDFLIX- FoEx scores (P<0.001). Associations between lymphocyte levels and EDFLIX-FoEx (β=-0.264; P=0.003), stress and EDFLIX-total (β=-0.436; P<0.001), EDFLIX-GF (β=-0.466; P<0.001) and EDFLIX-WeSh (P=0.022), and also between insomnia and EDFLIX-FoEx (β=-0.245; P<0.001) were significant. Conclusions. Nurses, from the beginning of their careers, should be monitored and encouraged to avoid adverse health practices that negatively influence their quality of life.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135273402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this study, we analyzed long-term sequelae in patients hospitalized at Montichiari Hospital (Brescia, Italy) during the COVID-19 acute phase, who needed a high-flow oxygen treatment. The follow-up evaluation has been performed after more than one year from discharge through a quality-of-life phone interview, standard laboratory tests, chest computed tomography, and global spirometry with an evaluation of the diffusing capacity of the lungs for carbon monoxide (DLCO). In our analysis, we found that patients who needed high FiO2 support during the acute phase, independently from the device used to administer it, showed a long-term heavy burden of pulmonary consequences: more than half of patients presented radiological alterations and persistent dyspnea or DLCO alterations; about 17% of them had alterations compatible with pulmonary fibrosis. Further analysis included a comparison of long-term consequences in patients treated with different devices. An interesting result was that prolonged positive pressure ventilation treatment didn’t seem to cause persistent pulmonary damage and thus could be considered a safe approach. In conclusion, this study confirms the heavy quality-of-life impact of moderate to severe COVID-19 and highlights the importance of recognizing patients who will benefit from rehabilitative programs and customized follow-up depending on the acute phase disease severity.
{"title":"Long-term impact of COVID-19 requiring elevated oxygen support and safety of prolonged positive pressure ventilation","authors":"Francesca Salvotti, Riccardo Pellegrinelli, Veronica Geroldi, Francesca Leidi, Vittorio Scipione, Gigliola Flamminio, Antonella Pastori, Claudia Agabiti-Rosei, Carolina De Ciuceis, Damiano Rizzoni, Gianluca Edoardo Mario Boari","doi":"10.4081/itjm.2023.1641","DOIUrl":"https://doi.org/10.4081/itjm.2023.1641","url":null,"abstract":"In this study, we analyzed long-term sequelae in patients hospitalized at Montichiari Hospital (Brescia, Italy) during the COVID-19 acute phase, who needed a high-flow oxygen treatment. The follow-up evaluation has been performed after more than one year from discharge through a quality-of-life phone interview, standard laboratory tests, chest computed tomography, and global spirometry with an evaluation of the diffusing capacity of the lungs for carbon monoxide (DLCO). In our analysis, we found that patients who needed high FiO2 support during the acute phase, independently from the device used to administer it, showed a long-term heavy burden of pulmonary consequences: more than half of patients presented radiological alterations and persistent dyspnea or DLCO alterations; about 17% of them had alterations compatible with pulmonary fibrosis. Further analysis included a comparison of long-term consequences in patients treated with different devices. An interesting result was that prolonged positive pressure ventilation treatment didn’t seem to cause persistent pulmonary damage and thus could be considered a safe approach. In conclusion, this study confirms the heavy quality-of-life impact of moderate to severe COVID-19 and highlights the importance of recognizing patients who will benefit from rehabilitative programs and customized follow-up depending on the acute phase disease severity.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135888701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Burnout syndrome may threaten medical students’ professional life through negative effects on their academic work and personal life. Therefore, it is very important to identify the risk and protective factors of burnout syndrome in this group of subjects. The present study aimed to determine the association of socio-demographic characteristics, current substance/medication abuse, and personality dimensions with academic burnout among medical students, and examine physical activity as a potential moderator of the personality dimensions-academic burnout relationship. Materials and Methods. In this cross-sectional study, a total of 400 medical students from the four courses of basic sciences, physiopathology, stagers, and internship (100 people at each course) in Zahedan, Iran, in 2018, were selected by stratified sampling method and evaluated using the socio-demographic information form, Baecke physical activity questionnaire, Temperament and character inventory, and Breso’s academic burnout questionnaire. Finally, descriptive statistical methods, the Kruskal-Wallis test, Spearman’s rank correlation coefficient, and hierarchical linear regression were implemented for data analysis. Results. The participants included 156 men and 244 women. The overall frequencies for current substance/medication abuse, exhaustion, cynicism, inefficacy, and academic burnout were reported to be 27.5, 10.3, 12.3, 6.5, and 25.8 percent, respectively. The study results showed that physical activity, persistence, and cooperativeness were negative, and the years in medical school, current substance/medication abuse, and novelty seeking were positively associated with academic burnout. Also, the regression analysis results revealed the moderating effect of physical activity in the novelty-seeking-academic burnout link. Conclusions. These findings are an important contribution to the current literature on academic burnout as they can provide a meaningful guide to integrating treatment protocols designed to reduce both frequency and severity of this syndrome among medical students. However, the etiology of academic burnout among this highly sensitive group should be further investigated in depth.
{"title":"Factors affecting medical students’ academic burnout: a moderation analysis","authors":"Mohsen Khosravi","doi":"10.4081/itjm.2023.1659","DOIUrl":"https://doi.org/10.4081/itjm.2023.1659","url":null,"abstract":"Background. Burnout syndrome may threaten medical students’ professional life through negative effects on their academic work and personal life. Therefore, it is very important to identify the risk and protective factors of burnout syndrome in this group of subjects. The present study aimed to determine the association of socio-demographic characteristics, current substance/medication abuse, and personality dimensions with academic burnout among medical students, and examine physical activity as a potential moderator of the personality dimensions-academic burnout relationship. Materials and Methods. In this cross-sectional study, a total of 400 medical students from the four courses of basic sciences, physiopathology, stagers, and internship (100 people at each course) in Zahedan, Iran, in 2018, were selected by stratified sampling method and evaluated using the socio-demographic information form, Baecke physical activity questionnaire, Temperament and character inventory, and Breso’s academic burnout questionnaire. Finally, descriptive statistical methods, the Kruskal-Wallis test, Spearman’s rank correlation coefficient, and hierarchical linear regression were implemented for data analysis. Results. The participants included 156 men and 244 women. The overall frequencies for current substance/medication abuse, exhaustion, cynicism, inefficacy, and academic burnout were reported to be 27.5, 10.3, 12.3, 6.5, and 25.8 percent, respectively. The study results showed that physical activity, persistence, and cooperativeness were negative, and the years in medical school, current substance/medication abuse, and novelty seeking were positively associated with academic burnout. Also, the regression analysis results revealed the moderating effect of physical activity in the novelty-seeking-academic burnout link. Conclusions. These findings are an important contribution to the current literature on academic burnout as they can provide a meaningful guide to integrating treatment protocols designed to reduce both frequency and severity of this syndrome among medical students. However, the etiology of academic burnout among this highly sensitive group should be further investigated in depth.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136294849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dear Editor, The sudden and unexpected loss of an infant in the first months of life is a heartbreaking and devastating experience for any parent. Understandably, it can be an extremely distressing time for the mother, who may often find herself unfairly burdened with guilt. When this tragic event occurs, a thorough investigation becomes necessary to determine the cause of death and also absolve the mother of any responsibility. [...]
{"title":"Sudden infant death syndrome: revealing this mystery is possible","authors":"Luca Roncati, Francesco Piscioli","doi":"10.4081/itjm.2023.1651","DOIUrl":"https://doi.org/10.4081/itjm.2023.1651","url":null,"abstract":"Dear Editor, The sudden and unexpected loss of an infant in the first months of life is a heartbreaking and devastating experience for any parent. Understandably, it can be an extremely distressing time for the mother, who may often find herself unfairly burdened with guilt. When this tragic event occurs, a thorough investigation becomes necessary to determine the cause of death and also absolve the mother of any responsibility. [...]","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136352427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We present the case of an 84-year-old female patient admitted to the Internal Medicine Ward for atypical chest pain and laboratory findings of severe pancytopenia. Past medical history was remarkable for an episode of myocardial infarction approximately 4 weeks prior to the current hospitalization which had required angioplasty + drug-eluting stent and dual antiplatelet therapy with acetylsalicylic acid and clopidogrel. Some rare cases of clopidogrel-induced pancytopenia are described in scientific literature, therefore, after excluding infectious, vitamin deficiencies, and autoimmune causes, we modified the antiplatelet therapy by replacing clopidogrel with ticagrelor, obtaining complete leukocyte recovery within a few days. Since clopidogrel is an antiplatelet drug still used in clinical cardiological practice, the knowledge of this rare side effect may lead the clinician to suspect hematological toxicity which, if recognized promptly, may suggest modification of antiplatelet therapy and limit any possible infectious complications for the care of the patient.
{"title":"Rare but possible: clopidogrel-induced pancytopenia","authors":"Pietro Bocchi, Pasquale Gianluca Giuri, Achiropita Bovino, Alessia Casola, Simona Detrenis, Marcello Bertorelli, Michele Meschi, Giancarlo Mangè","doi":"10.4081/itjm.2023.1660","DOIUrl":"https://doi.org/10.4081/itjm.2023.1660","url":null,"abstract":"We present the case of an 84-year-old female patient admitted to the Internal Medicine Ward for atypical chest pain and laboratory findings of severe pancytopenia. Past medical history was remarkable for an episode of myocardial infarction approximately 4 weeks prior to the current hospitalization which had required angioplasty + drug-eluting stent and dual antiplatelet therapy with acetylsalicylic acid and clopidogrel. Some rare cases of clopidogrel-induced pancytopenia are described in scientific literature, therefore, after excluding infectious, vitamin deficiencies, and autoimmune causes, we modified the antiplatelet therapy by replacing clopidogrel with ticagrelor, obtaining complete leukocyte recovery within a few days. Since clopidogrel is an antiplatelet drug still used in clinical cardiological practice, the knowledge of this rare side effect may lead the clinician to suspect hematological toxicity which, if recognized promptly, may suggest modification of antiplatelet therapy and limit any possible infectious complications for the care of the patient.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136353549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Maiello, Annagrazia Cecere, Marco Matteo Ciccone, Pasquale Palmiero
Objective. We studied the prevalence and major predisposing factors of permanent atrial fibrillation (PAF) in a population of hypertensive post-menopausal (HPMW) women. Materials and Methods. We enrolled 125 consecutive HPMW with PAF, 125 HPMW in sinus rhythm were the control group (CG). Women with valvular heart disease, coronary artery disease, WPW syndrome, left ventricular (LV) ejection fraction <45% and thyroid disorders were excluded. The mean age was similar: 53±3 years for women on PAF and 51±6 for women with sinus rhythm (P<0.45). All women who underwent M-B mode echocardiography, LV mass, function, and left atrial (LA) volume were assessed according to American Society of Echocardiography guidelines. Diabetes was assessed according to American Diabetes Association guidelines. Results. In a population of 8945 consecutive women, 4497 were hypertensive (50.2%) and 125 were on PAF (0.3%). We observed a highly significant difference between the two groups in relation to obesity: 31 (24.8%) in the AF-group and 15 (12%) in CG, Chi-squared 10, P<0.0016, OR 2.8, 95%; to increased LA volume: 37 (29.6%) in AF-group and 13 (10.4%) in CG, Chi-squared 14.4, P<0.0001, OR 3.62, 95%. No difference in diabetes: 30 (24%) in AFgroup and 28 (22.4%) in CG, Chi-squared 0.09, P<0.76, OR 1.09, 95%, and LV diastolic dysfunction (LVDD): 24 (19.2%) in AF-group and 20 (16%) in CG, Chi-squared 0.44, P<0.5, OR 1.25, 95%. In contrast to what was expected LV hypertrophy had a lower incidence of 59 (47.2%) in AF-group than in CG 84 (67.2%), Chi-squared 10.21, P<0.0014, OR 0.44, 95%. Conclusions. The prevalence of PAF in HPMW is not elevated, obesity and increased LA volume are strong determinants of PAF, not depending on age. LVDD, LV hypertrophy, and diabetes status seem not to play a relevant role as PAF determinants.
目标。我们研究了高血压绝经后妇女(HPMW)人群中永久性心房颤动(PAF)的患病率和主要易感因素。材料与方法。我们连续入组125例伴有PAF的HPMW，其中125例有窦性心律的HPMW为对照组(CG)。排除瓣膜性心脏病、冠状动脉疾病、WPW综合征、左心室射血分数≥45%和甲状腺疾病的妇女。平均年龄相似:患有PAF的女性为53±3岁，患有窦性心律的女性为51±6岁(P<0.45)。所有接受M-B型超声心动图检查的女性，左室质量、功能和左房(LA)容积均按照美国超声心动图学会指南进行评估。糖尿病是根据美国糖尿病协会的指南进行评估的。结果。在8945名连续的女性人群中，4497名患有高血压(50.2%)，125名服用PAF(0.3%)。我们观察到两组之间与肥胖相关的极显著差异:af组有31例(24.8%)，CG组有15例(12%)，卡方10,P<0.0016, OR 2.8, 95%;到LA体积增加:af组37例(29.6%)，CG组13例(10.4%)，卡方14.4,P<0.0001, OR 3.62, 95%。糖尿病无差异:af组30例(24%)，CG 28例(22.4%)，卡方0.09,P<0.76, OR 1.09, 95%;左室舒张功能障碍(LVDD): af组24例(19.2%)，CG 20例(16%)，卡方0.44,P<0.5, OR 1.25, 95%。与预期相反，af组左室肥厚的发生率为59(47.2%)低于CG组84(67.2%)，卡方10.21,P<0.0014, OR 0.44, 95%。结论。HPMW中PAF的患病率没有升高，肥胖和LA体积增加是PAF的重要决定因素，与年龄无关。左室dd、左室肥厚和糖尿病状态似乎不是PAF的决定因素。
{"title":"Prevalence and determinants of permanent atrial fibrillation in post-menopausal hypertensive women","authors":"Maria Maiello, Annagrazia Cecere, Marco Matteo Ciccone, Pasquale Palmiero","doi":"10.4081/itjm.2023.1652","DOIUrl":"https://doi.org/10.4081/itjm.2023.1652","url":null,"abstract":"Objective. We studied the prevalence and major predisposing factors of permanent atrial fibrillation (PAF) in a population of hypertensive post-menopausal (HPMW) women. Materials and Methods. We enrolled 125 consecutive HPMW with PAF, 125 HPMW in sinus rhythm were the control group (CG). Women with valvular heart disease, coronary artery disease, WPW syndrome, left ventricular (LV) ejection fraction <45% and thyroid disorders were excluded. The mean age was similar: 53±3 years for women on PAF and 51±6 for women with sinus rhythm (P<0.45). All women who underwent M-B mode echocardiography, LV mass, function, and left atrial (LA) volume were assessed according to American Society of Echocardiography guidelines. Diabetes was assessed according to American Diabetes Association guidelines. Results. In a population of 8945 consecutive women, 4497 were hypertensive (50.2%) and 125 were on PAF (0.3%). We observed a highly significant difference between the two groups in relation to obesity: 31 (24.8%) in the AF-group and 15 (12%) in CG, Chi-squared 10, P<0.0016, OR 2.8, 95%; to increased LA volume: 37 (29.6%) in AF-group and 13 (10.4%) in CG, Chi-squared 14.4, P<0.0001, OR 3.62, 95%. No difference in diabetes: 30 (24%) in AFgroup and 28 (22.4%) in CG, Chi-squared 0.09, P<0.76, OR 1.09, 95%, and LV diastolic dysfunction (LVDD): 24 (19.2%) in AF-group and 20 (16%) in CG, Chi-squared 0.44, P<0.5, OR 1.25, 95%. In contrast to what was expected LV hypertrophy had a lower incidence of 59 (47.2%) in AF-group than in CG 84 (67.2%), Chi-squared 10.21, P<0.0014, OR 0.44, 95%. Conclusions. The prevalence of PAF in HPMW is not elevated, obesity and increased LA volume are strong determinants of PAF, not depending on age. LVDD, LV hypertrophy, and diabetes status seem not to play a relevant role as PAF determinants.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135830024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To control diabetes in a society, risk assessment tools are used to predict disease risk. We aimed to assess the value of different risk factors for diabetes mellitus in a remarkable community in the city of Kerman, one of the vast areas in the southeast of Iran, with the final goal of designing a predictive model for diabetes in this region. This study was a cross-sectional study with the aim of investigating the predictive value of risk factors indicating the presence of diabetes in the population of Kerman City based on the guidelines of the American Diabetes Association (ADA) risk assessment tool. The information of 4000 people participating in the comprehensive screening plan for cardiovascular risk factors in Kerman City was extracted by reviewing the relevant data registry. According to the ADA guideline, 32.5% of participants were at risk for diabetes mellitus. The hazard ratio of diabetes mellitus in the subgroup with the ADA final score ≥5 as compared to those with a lower final score was 1.9. Advanced age, history of gestational diabetes, family history of diabetes mellitus, history of hypertension, low physical activity, and higher body mass index were the main determinants of diabetes mellitus. According to ADA guidelines and the diabetes mellitus risk assessment tool, 32.5% of the population residents in Kerman City are potentially at risk for diabetes mellitus that can be successfully predicted aide by the ADA risk assessment tool.
{"title":"Predictive model for diabetes mellitus occurrence in Iran’s southeastern region: a study based on American diabetes association guidelines","authors":"Seyedeh Mahdieh Khoshnazar, Hamid Najafipour, Lida SoltaniNejad, Sara Pezeshki, Gholamreza Yousefzadeh","doi":"10.4081/itjm.2023.1642","DOIUrl":"https://doi.org/10.4081/itjm.2023.1642","url":null,"abstract":"To control diabetes in a society, risk assessment tools are used to predict disease risk. We aimed to assess the value of different risk factors for diabetes mellitus in a remarkable community in the city of Kerman, one of the vast areas in the southeast of Iran, with the final goal of designing a predictive model for diabetes in this region. This study was a cross-sectional study with the aim of investigating the predictive value of risk factors indicating the presence of diabetes in the population of Kerman City based on the guidelines of the American Diabetes Association (ADA) risk assessment tool. The information of 4000 people participating in the comprehensive screening plan for cardiovascular risk factors in Kerman City was extracted by reviewing the relevant data registry. According to the ADA guideline, 32.5% of participants were at risk for diabetes mellitus. The hazard ratio of diabetes mellitus in the subgroup with the ADA final score ≥5 as compared to those with a lower final score was 1.9. Advanced age, history of gestational diabetes, family history of diabetes mellitus, history of hypertension, low physical activity, and higher body mass index were the main determinants of diabetes mellitus. According to ADA guidelines and the diabetes mellitus risk assessment tool, 32.5% of the population residents in Kerman City are potentially at risk for diabetes mellitus that can be successfully predicted aide by the ADA risk assessment tool.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134886360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marco Delle Monache, Marco Carli, Annarita Vestri, Lorenzo Nosotti, Teresa Morgillo, Michele Delle Monache
Background. Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease. As an infrequent disease, a Facebook group was created for patients to share experiences and problems. In fact, during the COVID-19 pandemic, patient analysis could only be done through remote connection systems. Therefore, to analyze patients' quality of life (QoL), we exploited social networks and online data collection platforms. Objectives. A survey was carried out to evaluate the QoL of patients with PBC during the COVID-19 pandemic. Materials and Methods. A Facebook group was used for patient enrolment. Age, sex, diagnosis, years since diagnosis, associated diseases, histological stage of the disease, value of elastography, and current therapy were collected. PBC 40 online questionnaire was submitted to patients to assess their QoL. Results. 78 patients participated in the study: 75 females, and 3 males, the mean (±SD) age was 46.4±11.5. The main diagnoses were PBC in 66 patients and overlapping syndrome PBC + autoimmune hepatitis in 10. Histology was available in 45 patients, of whom 34 were stages 1-2 and 11 stages 3-4. The main therapy was ursodeoxycholic acid in 56 pts. The questionnaire is divided into 6 domains, covering fatigue, emotional, social, and cognitive functions, general symptoms, and itching. The mean and standard deviation of the scores were computed. Interpretation of the results obtained by applying a quantitative scale showed no impairment for social, mild impairment for general symptoms, itching, cognitive and emotional function, and moderate impairment for fatigue. No correlation was found between scores and disease duration. Conclusions. This study demonstrates that online questionnaires are a viable substitute for paper questionnaires and that data collected from online surveys on Facebook can have scientific relevance; PBC had the greatest impact on QoL on fatigue and the least on social aspects.
{"title":"Collecting clinical data during an emergency: quality of life in primary biliary cholangitis during the COVID-19 pandemic","authors":"Marco Delle Monache, Marco Carli, Annarita Vestri, Lorenzo Nosotti, Teresa Morgillo, Michele Delle Monache","doi":"10.4081/itjm.2023.1609","DOIUrl":"https://doi.org/10.4081/itjm.2023.1609","url":null,"abstract":"Background. Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease. As an infrequent disease, a Facebook group was created for patients to share experiences and problems. In fact, during the COVID-19 pandemic, patient analysis could only be done through remote connection systems. Therefore, to analyze patients' quality of life (QoL), we exploited social networks and online data collection platforms. Objectives. A survey was carried out to evaluate the QoL of patients with PBC during the COVID-19 pandemic. Materials and Methods. A Facebook group was used for patient enrolment. Age, sex, diagnosis, years since diagnosis, associated diseases, histological stage of the disease, value of elastography, and current therapy were collected. PBC 40 online questionnaire was submitted to patients to assess their QoL. Results. 78 patients participated in the study: 75 females, and 3 males, the mean (±SD) age was 46.4±11.5. The main diagnoses were PBC in 66 patients and overlapping syndrome PBC + autoimmune hepatitis in 10. Histology was available in 45 patients, of whom 34 were stages 1-2 and 11 stages 3-4. The main therapy was ursodeoxycholic acid in 56 pts. The questionnaire is divided into 6 domains, covering fatigue, emotional, social, and cognitive functions, general symptoms, and itching. The mean and standard deviation of the scores were computed. Interpretation of the results obtained by applying a quantitative scale showed no impairment for social, mild impairment for general symptoms, itching, cognitive and emotional function, and moderate impairment for fatigue. No correlation was found between scores and disease duration. Conclusions. This study demonstrates that online questionnaires are a viable substitute for paper questionnaires and that data collected from online surveys on Facebook can have scientific relevance; PBC had the greatest impact on QoL on fatigue and the least on social aspects.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134960305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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