Relations between Coping Skills, Symptom Severity, Psychological Symptoms, and Quality of Life in Patients with Irritable Bowel Syndrome.

BACKGROUND: Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders with significant impact on quality of life (QOL). Considering the role of stress in the clinical course of IBS, we investigated associations between stress coping skills and symptoms and QOL in IBS patient. METHODS: A cross-sectional study was conducted on 95 IBS patients referring to tertiary care centers. Coping skills (Jalowiec coping scale), IBS symptom severity scale, disease-specific QOL (IBS-QOL), and symptoms of depression and anxiety (Hospital Anxiety and Depression Scale [HADS]) were evaluated by questionnaires. Bivariate and multivariate analyses were performed to investigate association among these parameters. RESULTS: Disease severity was positively correlated with emotive (r = 0.30) and fatalistic (r = 0.41) and negatively correlated with optimistic (r = -0.25) and confrontive (r = -0.24) coping strategies. Psychological dysfunction (total HADS score, B [95% (confidence interval) CI] = 2.61 [0.001-5.21]) and fatalistic coping (B [95% CI] = 35.27 [0.42-70.13]) were significant predictors of IBS severity. CONCLUSIONS: However, IBS patients involved in this study utilized adaptive coping strategies more frequently. Our study showed that use of maladaptive coping strategies had positive correlation with symptom severity and degree of anxiety and depression among patients, while implementation of optimistic strategies were found to be negatively correlated to severity of symptoms and also utilization of adaptive coping styles was associated with lesser degree of anxiety and depression.

Sleep quality in women with systemic lupus erythematosus: contributing factors and effects on health-related quality of life.

AIM: Sleep quality disturbances are common in patients with systemic lupus erythematosus (SLE). We evaluated sleep quality and its contributors in women with SLE. Also we evaluated the effects of sleep quality disturbance on patients' health-related quality of life (HRQoL). METHODS: Sleep quality was assessed in 77 women with SLE (age 36.5 ± 10.1 years) using the Pittsburgh Sleep Quality Index (PSQI). Disease activity and cumulative disease damage were assessed with standard indices. Patients completed the Hospital Anxiety and Depression Scale and LupusQoL. Univariate and multivariate analyses were performed to find contributors of poor sleep quality and association of sleep quality with HRQoL. RESULTS: Poor sleep quality was present in 44 patients (57.1%). Poor sleepers were older (P = 0.015) and had higher body mass index (P = 0.027) and more severe anxiety (P < 0.001) and depression symptoms (P < 0.007) compared with good sleepers. In the logistic regression model, age (ß = 1.16, P = 0.006), disease activity (ß = 1.10, P = 0.050), and anxiety/depression composite score (ß = 1.16, P = 0.008) were independent contributors of poor sleep quality. Poor sleepers had impaired HRQoL in almost all domains of the LupusQoL than good sleepers (P < 0.05). CONCLUSION: Poor sleep quality is common in women with SLE and significantly impairs their HRQoL. Age, disease activity and psychological factors were determinants of sleep quality in our study. Studies with objective sleep measures as well as interventional studies are warranted in this regard.

Vitamin D Deficiency Associated with Disease Activity in Patients with Inflammatory Bowel Diseases.

BACKGROUND: Evidence exists on the association between vitamin D deficiency and inflammatory bowel diseases (IBD). AIMS: To investigate whether vitamin D level is associated with disease activity and quality of life in IBD patients. METHODS: This cross-sectional study was conducted on known adult IBD patients referred to an outpatient clinic of gastroenterology in Isfahan city, Iran. Disease activity was evaluated using the Simplified Crohn's Disease Activity Index and Simple Clinical Colitis Activity Index. Quality of life was assessed with the Short-Inflammatory Bowel Disease Questionnaire. Serum 25[OH]D was measured using the radioimmunoassay method. Vitamin D deficiency and insufficiency were defined as concentration of <50 and 50-75 nmol/L, respectively. RESULTS: Studied subjects were 85 ulcerative colitis and 48 Crohn's disease patients (54.1% females) with mean age of 42.0 ± 14.0 years. Vitamin D deficiency and insufficiency were present in 52 (39.0%) and 24 (18.0%) patients, respectively. Thirty patients (22.5%) had active disease who, compared with patients in remission, had more frequent low vitamin D levels (80 vs. 50.4%, P = 0.005). Quality of life was not different between patients with low and those with normal vitamin D levels (P = 0.693). In the logistic regression model, low vitamin D was independently associated with active disease status, OR (95% CI) = 5.959 (1.695-20.952). CONCLUSIONS: We found an association between vitamin D deficiency/insufficiency and disease activity in IBD patients. Prospective cohorts and clinical trials are required to clarify the role of vitamin D deficiency and its treatment in clinical course of IBD.

Comparison between theophylline, N-acetylcysteine, and theophylline plus N-acetylcysteine for the prevention of contrast-induced nephropathy.

BACKGROUND: Few studies compared the efficacy of theophylline with N-acetylcysteine or evaluated the efficacy of combination therapy in the prevention of contrast-induced nephropathy (CIN). We compared the efficacy of theophylline, N-acetylcysteine, and the combination of these agents in the prevention of CIN. METHODS: This randomized controlled trial was conducted on 96 patients referring consecutively to the Shahid Chamran University Hospital in Isfahan, Iran, for elective coronary angiography (with our without angioplasty). Patients with at least moderate risk for CIN were included and were randomized to receive theophylline (200 mg), N-acetylcysteine (600 mg), or theophylline + N-acetylcysteine, twice a day, from 24 h before to 48 h after administration of the contrast material. A non-ionic, low-osmolar contrast material was used. Serum creatinine was measured before and 48 h after contrast material injection. RESULTS: Serum creatinine was increased by 6.83 ± 15.32% with theophylline, 13.09 ± 14.63% with N-acetylcysteine, and 5.45 ±1 3.96% with theophylline + N-acetylcysteine after contrast material injection (between group P = 0.072). Controlling for Mehran risk score, baseline serum creatinine, and contrast volume, the change in serum creatinine level was lower with theophylline compared with N-acetylcysteine (F = 4.79, P = 0.033), and with theophylline + N-acetylcysteine compared with N-acetylcysteine (F = 5.78, P = 0.020). CIN (increase in creatinine of ≥ 0.5 mg/dl or ≥ 25% from the baseline) was occurred in 20%, 21.9%, and 7.1% of patients in the theophylline, N-acetylcysteine, and theophylline + N-acetylcysteine groups, respectively (P = 0.260). CONCLUSION: Theophylline is superior to N-acetylcysteine in preventing contrast-induced renal dysfunction, but the combination with N-acetylcysteine is not superior to theophylline alone in this regard. Further trials with larger sample of patients are warranted.

Linguistic Validation of the M. D. Anderson Symptom Inventory in Persian-Speaking Iranian Cancer Patients.

CONTEXT: Various symptoms frequently affect cancer patients' quality of life. Appropriate assessment of these symptoms provides valuable data for cancer management. OBJECTIVES: This study aimed to validate the Persian version of the M. D. Anderson Symptom Inventory (MDASI-P). METHODS: This cross-sectional study was conducted at four cancer treatment centers in two cities in Iran. Breast cancer and colorectal cancer patients aged 18 years and older were consecutively included in the study. The standard forward-backward translation method was applied. Patients completed the MDASI-P along with the previously validated Persian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Construct validity (factor analysis), criterion validity (against the EORTC QLQ-C30), and reliability (Cronbach's alpha) were analyzed. RESULTS: A total of 146 breast cancer and 94 colorectal cancer patients were studied. Factor analysis for the symptom severity items resulted in a three-factor solution, further reduced to a two-factor solution: general symptoms and gastrointestinal symptoms. Correlation of the MDASI-P symptom severity items with corresponding EORTC QLQ-C30 symptom items (r = 0.48-0.75) and MDASI-P interference items with corresponding EORTC QLQ-C30 functioning domains (r = -0.46 to -0.23) supported the criterion validity. Cronbach's alpha was 0.90, 0.88, and 0.77 for the total questionnaire, symptom severity items, and the interference subscale, respectively. CONCLUSION: The MDASI-P is a feasible, valid, and reliable instrument for evaluation of symptoms in Persian-speaking cancer patients and can be used to improve symptom management in these patients.

Linguistic Validation of the LupusQoL for the Assessment of Quality of Life in Iranian Patients with Systemic Lupus Erythematosus.

Objectives. We evaluated the psychometric properties of the Persian LupusQoL for the evaluation of quality of life in Iranian systemic lupus erythematosus (SLE) patients. Methods. The LupusQoL was translated to Persian language. Patients with SLE (n = 78) completed the LupusQoL and the Short-Form Health Survey (SF-36). Disease activity and cumulative disease damage were assessed with standard indices. The psychometric properties of the scale were evaluated. Results. The Cronbach's alpha was 0.97 for the total LupusQoL (above 0.8 for subscales). There were strong corrected item-total (r > 0.4), item-subscale (r ≥ 0.5), and subscale-total correlations (r > 0.6), as well as intersubscale correlations (r > 0.5). Patients with active disease and patients with disease damage index of ≥1 had lower scores in domains of planning, emotional health, burden to others, and body image than patients with inactive disease and those with no disease damage, respectively (P < 0.05). The LupusQoL and the SF-36 correlated well regarding comparable domains (r > 0.4). Conclusion. The psychometric characteristics of the Persian version of LupusQoL questionnaire are acceptable in Iranian population. This instrument can be used to evaluate quality of life in Iranian SLE patients.

The effect of Helicobacter pylori eradication on liver enzymes in patients referring with unexplained hypertransaminasemia.

BACKGROUND: Evidence has shown an association of Helicobacter pylori infection with liver dysfunction and damage. We investigated if H. pylori eradication affects liver enzymes in patients referring with unexplained hypertransaminasemia. MATERIALS AND METHODS: Patients with mild unexplained hypertransaminasemia accompanied with dyspepsia and confirmed H. pylori infection were studied. Viral, metabolic, autoimmune, and drug/toxin induced hepatitis as well as fatty liver were all ruled-out by appropriate tests. Patients received bismuth-containing quadruple-therapy for 2 weeks. Serum levels of liver enzymes (alanine transaminase (ALT) and aspartate transaminase (AST)) and successful eradication (with stool antigen test) were evaluated 4 weeks after the medication. RESULTS: A total number of 107 patients (55 males, mean age = 35.0 ± 8.4 years) were studied. Eradication was successful in 93 patients (86.9%). Serum levels of AST (6.3 ± 19.6 IU/L, P = 0.002) and ALT (7.8 ± 24.9 IU/L, P = 0.001) were significantly decreased after eradication. Levels of AST and ALT decreased to normal range respectively in 46.6% and 45.7% of the cases who had baseline levels above the normal range. CONCLUSION: This study showed a decrease in liver enzymes after receiving eradication regimen of H. pylori, suggesting a role for H. pylori infection in at least some of patients with mild unexplained hypertransaminasemia. Further studies are warranted to find the underlying mechanisms by which H. pylori infection affects the liver and clinical importance of such effects.

A novel treatment strategy for eyebrow transplantation in an ectodermal dysplasia patient.

BACKGROUND: Ectodermal dysplasia (ED) is a hereditary syndrome which affects the ectodermal layer and thus appendages originating from this layer like hair, teeth, and sweet glands. The hairs of the scalp and eyebrows are sparse and broken and sometimes absent in ED patients. We reported a case of ED who underwent successful hair transplantation for her eyebrows. CASE REPORT: A 17-year-old female with previously known Ed referred to our clinic because of absent lateral eyebrow hairs. She also had hypodontia (she lacked incisor teeth) and hypohydrosis. We designed a hair transplantation procedure for the lateral third of her eyebrows with follicular unit transplantation (FUT) method. We selected the occipital part of the scalp as the donor. After 6 months and 2 years follow-up, the patient was quite satisfied with her appearance. CONCLUSIONS: The facial appearance of ED patients could be corrected well enough by hair transplantation methods.