Gender Disparities in Psychological Disturbances and Quality of Life Among Adolescent and Adult Patients with Thalassemia: A Review.

Thalassemia is a chronic disease caused by impaired globin chain synthesis, leading to ineffective erythropoiesis, hemolysis, and chronic anemia. The treatment of patients with thalassemia, including blood transfusion combined with chelation therapy has progressed and improved their survival and prognosis. However, thalassemia-related psychological problems and impaired health-related quality of life (QoL) challenges still exist. Gender is one of the factors that has been suggested, to contribute to the disparities in psychological outcomes. This review article examined the evidence for gender differences in psychological disturbances and QoL in adolescent and adult patients with thalassemia. A non-systematic search of the literature was conducted in PubMed and Google Scholar for English full-text available from 2013 to 2023. We identified 23 studies with a sample size ≥ 100 that examined gender disparities in anxiety, depression, and QoL in adolescent and adult patients with thalassemia (mean prevalence of female = 53.1%; mean age = 28 years). Our review shows that there are gender disparities in psychological distress and QoL in adolescent and adult patients with thalassemia. Statistically significant gender differences were demonstrated in 62% of the psychological and QoL outcomes from 16 studies. Female patients had a higher prevalence of anxiety, depression, and poorer QoL in some studies. However, further studies with sufficient power and design are necessary to confirm the existence of gender disparities in psychological disturbances and QoL outcomes.

Medication Use and Associated Factors Among Indonesian Pregnant Women: A Cross-Sectional Study.

Purpose: Medication use during pregnancy should be considered carefully due to its potential harm to the fetus. Data on prescribed medication and self-medication among Indonesian pregnant women is lacking. This study aimed to assess the prevalence and factors related to medication use among pregnant women attending antenatal care services at community health posts in Soreang, a suburban area in Indonesia. Patients and Methods: A cross-sectional community-based study was conducted. Data on medication use, excluding supplements, were collected. Medication was categorized using the former United States Food and Drug Administration (US FDA) pregnancy risk classification system. Proportions of pregnant women using prescribed medication and self-medication during pregnancy and associated factors were calculated. Results: A total of 439 pregnant women were enrolled. There were 155 (35.5%) subjects who used at least one medication during pregnancy. These subjects had medical problems as the reasons for medication use. Among medication users, prescribed medication and self-medication were demonstrated in 138 (89.0%) and 17 (11.0%) pregnant women, respectively. There was a pregnant woman who was exposed to category D medication. Self-medication among pregnant women was less likely when health insurance was available (adjusted OR = 0.11, 95% CI: 0.027-0.413, P = 0.001). Conclusion: The prevalence of medication use among Indonesian pregnant women is high. The presence of health insurance was protective against self-medication among pregnant women. Safe and effective practices in prescribing have to be ensured for pregnant women.

Potency of Origanum vulgare and Andrographis paniculata extracts on growth performance in poultry.

The objective of this study was to investigate the effect of phytobiotics combination of Origanum vulgare and Andrographis paniculata water extracts (FOA) mixed into the feed of broiler and specific-pathogen-free chickens as an alternative to Antibiotics Growth Promoter (AGP). Performance, intestinal bacteria characteristic, and oocysts of Eimeria spp. in feces were measured and compared with the AGP-added group. The first experiment in broiler chickens compared FOA, Zinc Bacitracin (ZB, as an AGP group), and negative control. On day 28, FOA group and ZB group showed significantly higher body weight than the control group (P < 0.05). The FCR of ZB group was better than FOA group. However, FOA group displayed better microbiota profile than ZB group and negative control, with more Lactobacillus spp. and Bacillus spp., and less Escherichia coli and Salmonella spp. isolated from intestines. The second experiment in specific-pathogen-free chickens showed the anticoccidial effect of FOA addition to reduce the number of oocysts per gram (OPG) from live coccidia vaccine. FOA group and Amprolium group showed OPG reduction (82.53% and 92.02%, respectively) after 7 days of treatment. In conclusion, the combination of Origanum vulgare and Andrographis paniculata extract can function as an AGP replacement in feed.

Pulmonary tuberculosis cases in pregnancy: perinatal outcomes and health promotion challenges in Indonesia.

Tuberculosis remains a serious health problem in pregnant women. Tuberculosis during pregnancy is related to poor perinatal outcomes, including low birth weight, insufficient growth relative to gestational age, perinatal mortality, and maternal morbidity and mortality. Additionally, diabetes mellitus in pregnant women with tuberculosis is associated with a higher risk of maternal and fetal complications such as preeclampsia, preterm birth, hypoglycemia, and giant baby. We report two perinatal outcomes of (1) pregnancy during tuberculosis treatment and (2) tuberculosis in a pregnant woman with diabetes mellitus. Both women completed anti-tuberculosis treatments. This report emphasizes the importance of health promotion through family planning among women with tuberculosis. This case report also underscores the increased risk of developing tuberculosis in pregnant women with diabetes mellitus. Early diagnosis of tuberculosis in pregnant women is vital as it affects the health of both mother and child.

Characteristics of sleep-disordered breathing in children with down syndrome - A comparison with typically developing children.

Background: Compared with typically developing control children (CC), children with Down syndrome (DS) frequently exhibit sleep-disordered breathing (SDB) and unusual sleep postures (USPs). No studies have directly compared SDB-related signs and symptoms, SDB-related parameters, and USPs between children with DS and CC. This study aimed to evaluate the prevalences of SDB and USPs in children with DS and CC. Methods: We analyzed SDB-related parameters measured via overnight pulse oximetry and questionnaires administered to parents on SDB-related signs and symptoms, including sleeping postures. Estimated SDB was defined as a 3% oxygen desaturation index (ODI) ≥5 dips/h. Results: Fifty-one children with DS (4-5 years: N = 12, 6-10 years: N = 23, 11-15 years: N = 16) and sixty-three CC (4-5 years: N = 18, 6-10 years: N = 27, 11-15 years: N = 18) were included. The prevalence of estimated SDB and observed USPs was higher in children with DS than in CC (p < 0.0001). Among children aged 11-15 years old, but not those aged 4-5 and 6-10 years old, frequency of arousal and apnea (p = 0.045 and p = 0.01, respectively) were higher in children with DS than in CC. Multivariate analyses showed that DS was associated with SDB-related signs and symptoms, estimated SDB, 3% ODI, average oxygen saturation (SpO2), and nadir SpO2, while USPs were associated only with higher values of SpO2 <90%. Conclusions: Estimated SDB tended to increase in children with DS but decreased in CC with growth. USPs were more frequent in children with DS than in CC, especially in older children. USPs might indicate severe hypoxemia due to SDB in DS.

Iron Overload in Transfusion-Dependent Indonesian Thalassemic Patients.

Thalassemia is a genetic disease caused by disruption of globin chain synthesis leading to severe anemia and thus regular blood transfusion is necessary. However, there have been known transfusions-related consequences, including iron overload and multi-organ damage. The aims of this study were to evaluate liver and cardiac function in youth and adult transfusion-dependent Indonesian thalassemic patients and to assess its correlation with serum ferritin levels, as well as T2 ∗ magnetic resonance imaging (MRI). Transfusion-dependent thalassemic (TDT) outpatients (n = 66; mean age, 21.5 ± 7.2 years) were carried out for the complete assessment consisting of blood test including liver enzyme and serum ferritin, followed by electrocardiography (ECG) and echocardiography. Subjects were also divided by serum ferritin levels into three groups: < 2500 ng/mL, 2500-5000 ng/mL, and >5000 ng/mL. Additionally, subgroup analysis in patients with T2∗ MRI assessment was conducted. In terms of age of first blood transfusion, subjects with ferritin >5000 ng/mL were the youngest among others. The alanine aminotransferase (ALT) levels in group with serum ferritin >5000 ng/mL were significantly higher than those of the group with serum ferritin <2500 ng/mL. Additionally, youth and adult TDT patients whose serum ferritin >5000 ng/mL had significantly lower tricuspid annular plane systolic excursion (TAPSE) when compared with those who had serum ferritin <2500 ng/mL. Similarly, TAPSE in patients with moderate cardiac siderosis based on cardiac T2∗ MRI was significantly lower than those without cardiac siderosis. There was significant, but only moderate correlation between serum ferritin and cardiac T2∗ MRI. Based on these findings, it is important to routinely monitor iron accumulation-related complications, including liver and cardiac damage in youth and adult TDT patients.

Correlation between Serum Fatty Acid Binding Protein 4 (FABP4) Levels and Cardiac Function in Patients with Thalassemia Major.

BACKGROUND: Patients with thalassemia major may suffer from complications due to iron overload. It has been suggested that several adipokines may play a potential role in the development of complications in thalassemia. Fatty acid-binding protein 4 (FABP4) is one of the adipokines, bridging several aspects of metabolic and inflammatory pathways. Little is known about the relationship between this adipokine and cardiac and liver function, especially in patients with thalassemia major. AIMS: This study is aimed at determining serum FABP4 levels in patients with thalassemia major and whether its concentration correlated with serum ferritin levels, as well as cardiac and liver function. METHODS: Thalassemia major outpatients (n = 48) completed laboratory examination, echocardiography, and electrocardiography. RESULTS: The mean age was 21.9 ± 8.0 years. A negative and weak correlation between serum ferritin and FABP4 was observed (r = -0.291, p < 0.05). In addition, there was moderate and positive correlation between left atrial volume index (LAVI) and FABP4 (r = 0.316, p < 0.05). CONCLUSIONS: Serum FABP4 correlated with serum ferritin and cardiac function in patients with thalassemia major. FABP4 may be a potential clinical biomarker for cardiac dysfunction via metabolic and inflammatory pathways due to iron accumulation and toxicity in patients with thalassemia major.

Three nights leg thermal therapy could improve sleep quality in patients with chronic heart failure.

Sleep quality is often impaired in patients with chronic heart failure (HF), which may worsen their quality of life and even prognosis. Leg thermal therapy (LTT), topical leg warming, has been shown to improve endothelial function, oxidative stress, and cardiac function in patients with HF. However, its short-term influence to sleep quality has not been evaluated in HF patients. Eighteen of 23 patients with stable HF received LTT (15 min of warming at 45 °C and 30 min of insulation) at bedtime for 3 consecutive nights and 5 patients served as control. Subjective sleep quality was evaluated by St. Mary's Hospital Sleep Questionnaire, Oguri-Shirakawa-Azumi Sleep Inventory, and Epworth sleepiness scale, and also objectively evaluated by polysomnography. LTT significantly improved subjective sleep quality indicated by depth of sleep (p < 0.01), sleep duration (p < 0.05), number of awaking (p < 0.01), nap duration (p < 0.01), sleep quality (p < 0.05), and sleep satisfaction (p < 0.05). It was also objectively affirmed by a slight but significant decrease of sleep stage N1 (p < 0.01), and increase in sleep stage N2 (p < 0.05). No significant changes occurred in the controls. Hence, the short-term LTT could improve subjective and objective sleep quality in patients with HF. LTT can be a complimentary therapy to improve sleep quality in these patients.

Assessment by airway ellipticity on cine-MRI to differentiate severe obstructive sleep apnea.

INTRODUCTION: The severity of obstructive sleep apnea (OSA) is assessed by the apnea-hypopnea index (AHI) determined from polysomnography (PSG). However, PSG requires a specialized facility with well-trained specialists and takes overnight. Therefore, simple tools, which could distinguish severe OSA, have been needed before performing PSG. OBJECTIVES: We propose the new index using cine-MRI as a screening test to differentiate severe OSA patients, who would need PSG and proper treatment. METHODS: Thirty-six patients with suspected OSA (mean age 54.6 y, mean AHI 52.6 events/h, 33 males) underwent airway cine-MRI at the fourth cervical vertebra level during 30 s of free breathing and PSG. The minimum airway ellipticity (AE) in 30 s duration was measured, and was defined as the severity of OSA. Patients were divided into severe OSA, not-severe OSA, and normal groups, according to PSG results. The comparison of AE between any two of the three groups was performed by Wilcoxon rank-sum test. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off of AE for identifying severe OSA patients. RESULTS: The minimum AE for severe OSA was significantly lower than that for not-severe OSA and normal (severe, 0.17 ± 0.16; not severe, 0.31 ± 0.17; normal, 0.38 ± 0.19, P < .05). ROC analysis revealed that the optimal cutoff of the minimum AE 0.21 identified severe OSA patients, with an area under the curve of 0.75, 68% sensitivity, and 83% specificity. CONCLUSION: AE is a feasible quantitative index, and a promising screening test for detecting severe OSA patients.

Evaluation of water content around airway in obstructive sleep apnea patients using peripharyngeal mucosal T2 magnetic resonance imaging.

INTRODUCTION: Obstructive sleep apnea (OSA) is common sleep disorder characterized by repetitive episodes of airway closure which usually occurs in the retropalatal region of the oropharynx. It has been known that upper airway mucosa in OSA patients is described as edematous, but not fully clarified. OBJECTIVES: This study aimed to investigate and establish magnetic resonance imaging (MRI) parameter to estimate tissue water content at retropalatal level and its relationship with sleep parameters in OSA patients. METHODS: Forty-eight subjects with OSA underwent overnight polysomnography and cervical MRI with 1.5-tesla [mean (SD) age 55 (14) years and apnea-hypopnea index (AHI) 45.2 (26.1) events/hour, 79.2% male]. On the axial T2-weighted images from epipharynx to oropharynx, the signal intensities of masseter muscle and peripharyngeal mucosa [T2 mucous-to-masseter intensity ratio (T2MMIR)], was used as water content estimation in the retropalatal region. Partial correlation analysis was performed to examine the correlation between T2MMIR and polysomnography parameters. RESULTS: We found that there were strong and positive correlations between the T2MMIR and AHI (r = 0.545, P < 0.05), supine AHI (r = 0.553, P < 0.05) and REM AHI (r = 0.640, P < 0.01) by partial correlation analysis. Besides, in patients with less efficient sleep who had more stage 1 sleep, significantly higher T2MMIR was noted (r = 0.357, P < 0.05). CONCLUSIONS: This study confirmed that peripharyngeal T2MMIR can be a simple parameter representing peripharyngeal tissue water contents related to severe OSA.

Influence of primary and secondary prevention indications on anxiety about the implantable cardioverter-defibrillator.

BACKGROUND: Implantable cardioverter-defibrillators (ICDs) have been established for primary and secondary prevention of fatal arrhythmias. However, little is known about the influence of ICD indications on quality of life (QOL) and psychological disturbances. This study aimed to examine whether there were differences in QOL and psychological distress in patients that have an ICD for primary or secondary prevention of fatal arrhythmias. METHODS: A multicenter survey of 179 consecutive outpatients (29.1% primary prevention) with ICD implantations completed the Short Form-8 (SF-8), Beck Depression Inventory (BDI), Impact of Event Scale-Revised (IES-R), State-Trait Anxiety Inventory (STAI), and Worries about ICD (WAICD). RESULTS: Patients with an ICD for primary prevention had a higher trait anxiety score and worries about ICD score than patients with an ICD for secondary prevention (41.7±12.4 vs. 34.7±12.3, p=0.001 and 39.6±18.0 vs. 30.0±18.9, p=0.002, respectively), even after adjusting for demographic and clinical characteristics. In multivariable analysis of variance, primary prevention ICD recipients reported a poorer QOL on the vitality subscale of the SF-8. CONCLUSIONS: In our study population, which mostly consisted of New York Heart Association (NYHA) class I and II subjects, primary prevention ICD recipients were more prone to experience worries about their ICD, anxiety, and a poorer QOL compared to secondary prevention ICD recipients. In clinical practice, primary prevention ICD patients should be closely monitored. If warranted, they should be offered psychological intervention, as anxiety and low QOL were predictors of mortality.

A nationwide cross-sectional study on congenital heart diseases and symptoms of sleep-disordered breathing among Japanese Down's syndrome people.

OBJECTIVE: It is well known that people with Down's syndrome (DS) frequently complicate with congenital heart diseases (CHDs). Patients with heart diseases often have sleep-disordered breathing as a co-morbidity (SDB) which worsens the heart diseases. However, the relationship between SDB and CHDs in DS people has not yet been fully elucidated. The aim of this study was to establish the association between SDB and CHDs in DS people using data from a large nationwide questionnaire survey in Japan. METHODS: We conducted a cross-sectional questionnaire survey of a randomly selected sample of 2,000 DS people and their caregivers throughout Japan to examine the associations between observed signs of SDB and CHDs in DS people. The questionnaire included the presence of SDB symptoms (snoring, apnea, arousal, nocturia, and napping) and CHDs (the presence and types of CHDs). RESULTS: Of the 1,222 replies received from the caregivers, 650 reported complications of some type of CHDs. The observed apnea tended to be higher among DS people with CHDs than those without CHDs (OR=1.28, 95% CI=0.97-1.70, p=0.09). DS people with tetralogy of Fallot reported significantly more frequent apnea than those without CHDs (OR=3.10, 95% CI=1.36-7.05, p<0.01). CONCLUSION: SDB prevailed among DS people with severe CHDs, such as tetralogy of Fallot. Careful attention to the signs of SDB in such patients may lead to earlier clinical intervention removing the vicious cycle between SDB and CHDs.

Gender disparities in quality of life and psychological disturbance in patients with implantable cardioverter-defibrillators.

BACKGROUND: Implantable cardioverter-defibrillator (ICD) has improved prognosis in fatal arrhythmia and the number of ICD implantations has increased. ICD-related psychological problems and impaired quality of life (QOL), however, have been observed. This study examined whether gender differences exist in QOL and psychological disturbances in ICD patients. METHODS AND RESULTS: Consecutive outpatients (n=179; mean age, 60.5±15.9 years; 81% male) with ICD implantations completed questionnaires consisting of the Short Form-8 (SF-8), Beck Depression Inventory, Impact of Event Scale-Revised (IES-R), State-Trait Anxiety Inventory, and Worries about ICD. One-way multivariate analysis of variance (MANOVA) showed women to have impaired QOL on the role physical functioning (F15,157=4.57, P<0.05) and bodily pain (F15,157=5.26, P<0.05) subscales of the SF-8. More women reported depression (F15,157=5.37, P<0.05) and worry about ICD than men (F15,157=6.62, P<0.05). Moreover, women also had higher IES-R scores indicating post-traumatic stress disorder (PTSD) than men (F15,157=5.87, P<0.05). CONCLUSIONS: Women reported poorer QOL on 2 subscales: role physical functioning and bodily pain. There was a significant relationship between gender and depression, worry about ICD, and PTSD, but not for anxiety. Female patients need more psychological interventions following ICD implantation.