Heart rate variability changes in major depressive disorder during sleep: Fractal index correlates with BDI score during REM sleep.

Heart rate variability changes in major depressive disorder during sleep: Fractal index correlates with BDI score during REM sleep.

Psychiatry Res. 2018 Nov 12;271:291-298

Authors: Kwon HB, Yoon H, Choi SH, Choi JW, Lee YJ, Park KS

Abstract
We investigated the relationship between autonomic nervous system activity during each sleep stage and the severity of depressive symptoms in patients with major depressive disorder (MDD) and healthy control subjects. Thirty patients with MDD and thirty healthy control subjects matched for sex, age, and body mass index completed standard overnight polysomnography. Depression severity was assessed using the Beck Depression Inventory (BDI). Time- and frequency-domain, and fractal HRV parameters were derived from 5-min electrocardiogram segments during light sleep, deep sleep, rapid eye movement (REM) sleep, and the pre- and post-sleep wake periods. Detrended fluctuation analysis (DFA) alpha-1 values during REM sleep were significantly higher in patients with MDD than in control subjects, and a significant correlation existed between DFA alpha-1 and BDI score in all subjects. DFA alpha-1 was the strongest predictor for the BDI score, along with REM density as a covariate. This study found that compared with controls, patients with MDD show reduced complexity in heart rate during REM sleep, which may represent lower cardiovascular adaptability in these patients, and could lead to cardiac disease. Moreover, DFA alpha-1 values measured during REM sleep may be useful as an indicator for the diagnosis and monitoring of depression.

PMID: 30513461 [PubMed - as supplied by publisher]

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Validity and interpretability of the QuickDASH in the assessment of hand disability in rheumatoid arthritis.

Validity and interpretability of the QuickDASH in the assessment of hand disability in rheumatoid arthritis.

Rheumatol Int. 2018 Dec 03;:

Authors: Salaffi F, Di Carlo M, Carotti M, Farah S

Abstract
Objective of this study is to evaluate the construct validity and the interpretability of the shortened Disability of Arm, Shoulder and Hand Questionnaire (QuickDASH) in the assessment of rheumatoid arthritis (RA) hand disability. Consecutive RA patients were assessed through the QuickDASH and other function and disease activity indices, respectively, the Health Assessment Questionnaire-Disability Index (HAQ-DI) and the Recent-Onset Arthritis Disability questionnaire (ROAD). For each patient were evaluated the tender and swollen 28-joints counts. Interpretability was defined determining cut-off points of impairment in accordance to the Simplified Disease Activity Index (SDAI) definition of disease activity states. A total of 440 patients (89 men and 351 women, mean age of 57.0 ± 12.7 years) were enrolled. Following the SDAI definition, 98 patients (22.3%) resulted in REM, 115 subjects (26.1%) in LDA, 74 patients (16.8%) in MDA, and 153 subjects (34.8%) in HDA. Mean QuickDASH differed significantly between patients classified as remission (REM), low disease activity (LDA), moderate disease activity (MDA), or high disease activity (HDA) (p < 0.001). High correlations were found comparing QuickDASH to composite indices of disease activity and of physical health function: of special interest are the correlations between the comparable dimension of the QuickDASH and the ROAD Upper Extremity Function (rho = 0.876; p < 0.001). The cut-off points for functional categories (SDAI categories as external criterion) resulted: no impairment ≤ 13, 13 < low impairment ≤ 18.5, 18.5 < moderate impairment ≤ 31.5, and high impairment > 31.5. QuickDASH is useful in clinical practice, for its ease of administration, and positively correlates with the disease activity. It may be a surrogate for evaluating upper extremity impairment, disability index and disease control in RA patients.

PMID: 30511229 [PubMed - as supplied by publisher]

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Electrocardiographic manifestations in severe hypokalemia.

Electrocardiographic manifestations in severe hypokalemia.

J Int Med Res. 2018 Dec 04;:300060518811058

Authors: Wang X, Han D, Li G

Abstract
Hypokalemia is one of the most common electrolyte disturbances in the clinic and it can increase the risk of life-threatening arrhythmias. Electrocardiographic characteristics associated with hypokalemia include dynamic changes in T-wave morphology, ST-segment depression, and U waves, which are often best seen in the mid-precordial leads (V2-V4). The PR interval can also be prolonged along with an increase in the amplitude of the P wave. We report a case of a patient with hypokalemia (1.31 mmol/L) who showed typical electrocardiographic characteristics of hypokalemia.

PMID: 30509119 [PubMed - as supplied by publisher]

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Hearing loss and satisfaction with healthcare: An unexplored relationship.

Hearing loss and satisfaction with healthcare: An unexplored relationship.

J Am Geriatr Soc. 2018 Dec 04;:

Authors: Reed NS, Betz JF, Kucharska-Newton AM, Lin FR, Deal JA

PMID: 30512196 [PubMed - as supplied by publisher]

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Diagnostic accuracy of ex vivo fluorescence confocal microscopy for Mohs surgery of basal cell carcinomas: a prospective study on 753 margins.

Diagnostic accuracy of ex vivo fluorescence confocal microscopy for Mohs surgery of basal cell carcinomas: a prospective study on 753 margins.

Br J Dermatol. 2018 Dec 04;:

Authors: Longo C, Pampena R, Bombonato C, Gardini S, Piana S, Mirra M, Raucci M, Kyrgidis A, Pellacani G, Ragazzi M

Abstract
BACKGROUND: Frozen histological sections are currently used for intra-operative margin assessment during Mohs surgery. Fluorescence confocal microscopy (FCM) is a new tool, which offers a promising and faster alternative to frozen histology.
OBJECTIVE: The aim of the present study is to prospectively evaluate in a clinical setting, the accuracy of FCM as compared to frozen sections in BCC's margin assessment.
METHODS: Patients with BCC, scheduled for Mohs surgery were prospectively enrolled. Freshly-excised surgical specimens were first examined through FCM and then frozen sections were evaluated. Permanent sections were finally obtained, in order to validate our sample technique. A blind re-evaluation was also performed for discordant cases between FCM and frozen sections. Sensitivity and specificity levels, as well as positive and negative predicting values were calculated and ROC curves were generated.
RESULTS: We enrolled 127 BCCs in as many patients (40.2% females). A total number of 753 sections were examined. All BCCs were located on the head and neck area. When evaluating the performance of FCM as compared to frozen sections 79.8% sensitivity, 95.8% specificity, 80.5% positive predicting and 95.7% negative predicting values were found (Area Under the Curve: .88, 95%CI .84-.92; P<.001). A total of 49 discordant cases between FCM and frozen sections evaluations were blindly re-evaluated, of which 24 were false positive and 25 false negative. The performance of FCM and frozen sections was also evaluated according to the final histopathological assessment.
CONCLUSIONS: We found high levels of accuracy for FCM as compared to frozen sections evaluation, in intra-operative BCC's margin assessment during Mohs surgery. Some technical issues still prevent a wide use of this technique, but new upcoming devices promise to overcome these limitations. This article is protected by copyright. All rights reserved.

PMID: 30512198 [PubMed - as supplied by publisher]

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Correlation of the Refined Hurley Classification for Hidradenitis suppurativa with Patient Reported Quality of Life and Objective Disease Severity Assessment.

Correlation of the Refined Hurley Classification for Hidradenitis suppurativa with Patient Reported Quality of Life and Objective Disease Severity Assessment.

Br J Dermatol. 2018 Dec 04;:

Authors: Rondags A, van Straalen KR, van Hasselt JR, Janse IC, Ardon CB, Vossen ARJV, Prens EP, van der Zee HH, Horváth B

Abstract
BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, debilitating, heterogeneous disease requiring different treatment approaches. Recently, we refined the classic Hurley classification into a seven-stage classification in order to guide these treatment choices. This new classification subdivides Hurley stage I and II into three sub-stages namely mild (A), moderate (B), and severe (C) HS disease. Hurley stage III is not sub-categorised and always severe.
AIM: To investigate the correlation between the given severity grades of Hurley I and Hurley II in the refined Hurley classification, and the patient reported quality of life and physician-assessed objective severity score.
METHODS: In this cross-sectional study, HS patients participating in the observational cohorts of two Dutch tertiary referral centres were included before June 2017. The patient reported Dermatology Life Quality Index (DLQI) and physician-assessed International HS Severity Score System (IHS4) scores were compared between the refined Hurley stages.
RESULTS: In total, 433 patients were analysed. DLQI and IHS4 scores increased within Hurley stage I and II from A through C. There was a significant positive correlation of DLQI and IHS4 with increasing refined Hurley sub-stages (refined Hurley stage I (A, B, and C) to DLQI: rs =0.259, p<0.001 and refined Hurley stage II (A, B, and C) to DLQI rs =0.185, p=0.010; refined Hurley stage I (A, B, and C) to IHS4 rs =0.603, p<0.001 and refined Hurley stage II (A, B, and C) to IHS4 rs =0.532, p<0.001).
CONCLUSION: The refined Hurley classification accurately correlates with HS severity assessed by both patients and clinicians. Therefore, the refined Hurley classification is a useful tool for the quick assessment of severity in HS. This article is protected by copyright. All rights reserved.

PMID: 30512186 [PubMed - as supplied by publisher]

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What are the perceptions and experiences of falls amongst people with stroke who live in the community?

What are the perceptions and experiences of falls amongst people with stroke who live in the community?

Disabil Rehabil. 2018 Dec 04;:1-8

Authors: Munford D, Gunn H

Abstract
PURPOSE: To explore the perceptions and experiences of people with stroke living in the community with regard to the perceived causes, impact and solutions to minimise falls.
METHODS: A qualitative research approach underpinned by a constructivist paradigm utilising a phenomenological methodology. Twelve people with stroke participated in focus groups; the data were analysed using thematic analysis.
RESULTS: Three themes and one foundation theme were identified. (1) Trips and triggers: falls were perceived to be linked to external triggers, one of which was walking aids. (2) Blame and burden: self-blame and worry about being a burden may be associated with underreporting of falls. (3) Restrict and reduce: people with stroke restrict activity and reduce participation to manage falls. The underpinning theme of self-efficacy highlights the apparent diminished falls self-efficacy, and the perception amongst the participants that falls are inevitable.
CONCLUSIONS: This study highlights the perceived negative consequences of falls amongst people with stroke, and the potential contribution of falls to the reduced levels of physical activity often seen following a stroke. Our findings emphasise the need to address falls and balance related self-efficacy alongside strategies to promote safe mobility. A paradigm shift may be needed to highlight potentially modifiable intrinsic risk factors and emphasise the relevance and value of proactive fall prevention to people with stroke. Implications for rehabilitation People with stroke may not report falls or may minimise their significance, using alternative terms such as trips and stumbles. Rehabilitation staff need to approach falls in a way that emphasises the positive value of reporting and addressing falls management proactively. People with stroke may focus on extrinsic rather than intrinsic factors, so it is important to identify and highlight potentially modifiable intrinsic falls risks during assessment and treatment. Falls are associated with the use of mobility aids, and people frequently report using multiple aids obtained from a range of sources. Our study findings suggest that assessment and education about the appropriate use of mobility aids should be integral to stroke-specific falls interventions. Falls are often associated with activity reduction and avoidance, which could contribute to reduced participation and increased secondary issues. Approaches to encourage physical activity after stroke need to include recognition of falls risk and methods to optimise safe mobility. The relationship between self-efficacy and people's attitudes and responses to falling is an important consideration. It is likely that that self-efficacy strategies could positively contribute to the effectiveness of stroke falls management interventions.

PMID: 30513222 [PubMed - as supplied by publisher]

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