Positive and negative affective states and disease activity in ankylosing spondylitis.

The aim of the study was to explore the influence of psychological affective states such as cheerfulness and bad mood on self-reported disease activity in patients with ankylosing spondylitis (AS) while controlling for demographic and clinical variables. Patients attending a biological therapy unit were selected for a cross-sectional study if they met the criteria for AS and were already receiving treatment. Their psychological affective state was assessed with the state version of the State-Trait Cheerfulness Inventory. Clinical variables included were patient-reported disease activity using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and acute-phase reactants. We performed univariate and multivariate analyses to verify the robustness of the relationship between psychological affective states and disease activity. We also explored whether disease activity, measured either by self-report or by acute-phase reactants, was influenced by patient's overall affective state. In the recruited 31 patients with AS, overall affective state contributed significantly to the variance in BASDAI scores, adding 21.8% to the overall R-square of the predictive power of clinical and demographic variables (combined R-square = 17%). A higher positive affective state was associated with lower values of C-reactive protein (p < 0.05). Results of a bootstrapping procedure showed that the relationship between C-reactive protein levels and BASDAI scores was mediated by overall affective state. In patients with AS, affective state can induce variability in self-reported disease activity. Patients' overall affective state can explain the relationship between acute-phase reactants and self-reported scores. These findings suggest interesting possibilities for the monitoring of disease activity in AS.

Role of perioperative intravenous iron therapy in elderly hip fracture patients: a single-center randomized controlled trial.

BACKGROUND: The main objective of this study was to determine the efficacy of intravenous (IV) iron sucrose therapy reducing transfusion requirements in elderly patients undergoing hip fracture surgery. STUDY DESIGN AND METHODS: This study was a prospective randomized controlled trial involving 200 patients undergoing hip fracture surgery. Group A (100 patients) received standard treatment, while Group B (100 patients) received iron sucrose (600 mg IV). The primary endpoint was the number of patients that were transfused postoperatively. The secondary endpoints were the rate of red blood cell units used, hematimetric variables of blood tests, mortality, infection rates, length of hospital stay, and appearance of side effects. RESULTS: Differences in the percentage of patients requiring transfusion (Group A 41.3% vs. Group B 33.3%) and in the number of concentrates transfused (0.87±1.21 for Group A vs. 0.76±1.16 for Group B) were not significant for the patient group as a whole, but were significant for patients with intracapsular fractures (45.7% required transfusion in Group A vs. 14.3% in Group B; p<0.005) and in patients with a baseline hemoglobin (Hb) level of 12 g/dL or more (35.2% required transfusions in Group A vs. 19% in Group B; p<0.05). CONCLUSIONS: Transfusion requirements in patients with intracapsular fracture or baseline Hb level of 12 g/dL or more appear to be reduced by IV iron sucrose therapy, but there was no difference in morbidity, mortality, or length of hospital stay. The treatment is safe and hastens recovery from blood loss.

Overnight Pulse Oximetry to Determine Prognostic Factors in Subjects With Amyotrophic Lateral Sclerosis.

BACKGROUND: The objective of the current study was to determine whether overnight pulse oximetry in patients with amyotrophic lateral sclerosis is prognostic of the onset of awake respiratory failure and hospital admissions. METHODS: This was an observational study in a cohort of subjects with amyotrophic lateral sclerosis. The study included subjects with a baseline [Formula: see text] ≥ 94% on home overnight pulse oximetry testing. Patients age ≥ 80 y and those with comorbidities and with poor short-term prognosis or sleep apnea were excluded. The subjects were classified as nocturnal desaturators according to percentage of sleep time with [Formula: see text] < 90% (T90) > 10%. RESULTS: A total of 76 subjects were included: 40 men (53%), mean ± SD age 60 ± 14.4 y, mean ± SD body mass index 25.7 ± 4.60 kg/m2, and spinal presentation in 63.2%. After overnight pulse oximetry, 20 subjects (26%) were classified as desaturators and 56 (74%) as non-desaturators. In the first year, the subjects with nocturnal desaturation had respiratory failure more often compared with the subjects without desaturation (35% vs 10.91%; P = .02) and had a higher risk of developing respiratory failure during the course of the study (hazard ratio 2.48; P = .030). The desaturator group also had a higher rate of ≥ 1 admission (40% vs 7.3%; P = .01) and a higher likelihood of respiratory-related hospitalization (hazard ratio 2.41; P = .02). Median survival was almost 1 year less if T90 > 10% was observed in the overnight pulse oximetry: 21 months versus 32 months survival if T90 was ≤ 10%. CONCLUSIONS: In subjects with amyotrophic lateral sclerosis, nocturnal desaturation conferred a higher risk of respiratory failure and poorer prognosis. Even in the absence of other clinical criteria, early pulse oximetry should be performed and the need for nocturnal ventilatory support assessed.

Is spinal mobility in patients with spondylitis determined by age, structural damage, and inflammation?

OBJECTIVE: To explore the association between mobility, inflammation, and structural damage in ankylosing spondylitis (AS). METHODS: Patients with AS were included in a cross-sectional study in which spinal mobility was measured by the Bath Ankylosing Spondylitis Metrology Index (BASMI) and by the University of Córdoba Ankylosing Spondylitis Metrology Index (UCOASMI), based on an automated motion analysis. Structural damage was measured by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), and activity by the Ankylosing Spondylitis Disease Activity Score (ASDAS) and the Bath Ankylosing Spondylitis Disease Activity (BASDAI). We analyzed the correlations between variables, as well as interaction by multiple linear regression models to reach a predictive equation. RESULTS: Fifty AS patients, mainly men in their mid-40s and with moderate levels of disease activity and structural damage, were included in the study. BASMI and UCOASMI scores showed a strong correlation (r = 0.89). UCOASMI scores correlated stronger than BASMI with structural damage (r = 0.72 versus r = 0.67) and patient's age (r = 0.68 versus r = 0.56). Correlations of mobility were weaker with disease activity by the ASDAS (r = 0.38) and BASDAI (r = 0.49), and disease duration (r = 0.40). Multiple linear regression showed that factors associated to mobility by UCOASMI were age, the BASDAI, mSASSS, ASDAS (0:<2.1, 1:≥2.1), and disease duration >15 years. The largest weight in the equation corresponded to the mSASSS. The association between the ASDAS and UCOASMI is dependent on disease duration. CONCLUSION: Mobility in AS is influenced by both structural damage and activity, but definitely also by age and disease duration. Improved mobility should be a relevant target in AS, even more prominently than activity, given its closer relation to structural damage.

Characterization and adequacy of the use of radiotherapy and its trend in time.

BACKGROUND AND PURPOSE: Characterization of radiotherapy activity and its trend over time. Gathering of parameters for future planning of our resources, applicable to similar population areas. Performing a clinical audit of appropriate use of radiotherapy. MATERIAL AND METHODS: Analysis of 9782 patients treated between 1998 and 2008. Descriptive statistics of pathologies and social/demographic characteristics. Intention of treatment. The rate of radiotherapy utilization was estimated and compared with those considered optimal. Rate of reirradiation. RESULTS: The average global rate of radiotherapy utilization for the period was 32.7%. It increased by 23% between 1998 and 2008, while the population of the area rose by 1.04%, equaling an average 1.13 irradiations/1000 inhabitants/year. Radiation treatment has increased by 13.6, 2.3, 1.6 and 1.06 times in patients with prostate, breast, rectal and lung cancer, respectively. Eight percent of radiotherapy treatments involve concurrent chemotherapy. The proportion of treatments with palliative intent was 18.2%. The overall underutilization of radiation therapy in our environment was an estimated 13.4%. CONCLUSIONS: The grade of adequacy of radiation rates in relation with scientific evidence was globally considered suboptimal, especially in lung cancer. There was an upward trend of irradiation in breast and prostate cancer, tending toward rates considered optimal.