[Therapeutic approaches to comorbid pathology in episodic migraine and tension-type headache]. / Terapiya komorbidnoi patologii pri epizodicheskoi migreni i golovnoi boli napryazheniya.

OBJECTIVE: To assess the severity of anxiety, depression, insomnia and asthenia in patients with episodic migraine and tension-type headache before and after treatment. MATERIAL AND METHODS: 104 patients aged 18 to 74 years were examined. Patients were divided into two groups: the 1st - 41 patients diagnosed with episodic migraine, the 2nd - 63 patients with episodic tension-type headache. The intensity of headache was assessed using the visual analog scale (VAS). The Hospital Anxiety and Depression Scale (HADS), the Levin questionnaire, and the Multidimensional Fatigue Inventory scale (MFI-20) were used to identify comorbid affective pathology, insomnia, and asthenia, respectively. RESULTS: Headache severity according to VAS in the 1st group was higher (5.8±1.3 points) than in 2nd (3.8±1.2 points). Clinical anxiety was detected in 66.3% of patients without statistically significant differences between groups. The mean HADS anxiety score was 13.9±3.5 in 1st group, 12.7±3.7 - in 2nd. Clinical depression was detected in 45.2% of patients, more often in the 2nd group - 50.8% than in the 1st (36.6%). The mean depression score according to HADS was 9.0±4.4 and 9.7±3.6 in the 1st and 2nd groups respectively. The intensity of headache was statistically significantly higher in patients with clinical anxiety. Both groups were found to have insomnia and asthenia. The majority of patients - 67.3% had myofascial pain syndrome. When re-evaluating the severity of disorders after treatment (using anxiolytics, antidepressants, muscle relaxants, magnesium and neurometabolics), a significant positive trend was noted. Reducing the intensity of headaches to 3.2±0.9 points (according to VAS scale) was in patients with migraine and 1.9±0.8 points in 2nd group. Relief of anxiety and depressive disorders was observed (HADS) in 1st (4.3±3.9) and 2nd (4.5±3.3) groups, the severity of depression (HADS) - 2.1±2.2 in 1st and 2.8±3.2 in 2nd groups, as well as a decrease in asthenia and normalization of sleep. The decrease in the severity of asthenia during treatment was more significant in patients treated with Cytoflavin. CONCLUSION: Identification and treatment of comorbid pathology leads to positive results in the treatment of primary headaches such as episodic migraine and TTH.

[Frequency of selected chronic noncommunicable diseases in older patients with senile asthenia syndrome.]

An important area of medical and social research is prospective studies of a cohort of older patients with chronic non-communicable diseases aimed at studying the level of mortality, taking into account the presence/absence of senile asthenia syndrome. A prospective clinical and epidemiological study was conducted on 1 261 people aged 80 years and older receiving medical care on an outpatient basis. Three groups of patients were formed: without senile asthenia syndrome (7,6%), in a state of pre-asthenia (23,5%), with senile asthenia (68,9%). After a calendar year, an analysis was made of the causes of death of respondents in all three groups. A high statistically significant incidence of chronic diseases in patients with senile asthenia syndrome compared with those without signs of this syndrome was noted in arterial hypertension, chronic heart failure, osteoarthritis, age-related macular degeneration, chronic kidney disease, dementia, cancer, anemia, uncomplicated diabetes mellitus. In the structure of causes of death in patients aged 80 years and older, diseases of the circulatory system, nervous system, neoplasms, liver diseases, and diabetes mellitus predominated. The odds ratio of the risk of dying within a year in patients without frailty syndrome is 0,32 (compared to patients with frailty, in which the risk is taken as 1).

[Pharmacoepidemiological analysis of antihypertensive therapy in older age groups with senile asthenia syndrome].

AIM: To conduct a pharmacoepidemiological study to determine the characteristics of antihypertensive therapy in older patients with senile asthenia syndrome (SSA) and compliance of this therapy with modern clinical recommendations. MATERIALS AND METHODS: The study included 146 patients diagnosed with stage I-III hypertension who underwent inpatient treatment in the therapeutic department of the Krasnoyarsk Regional Hospital for War Veterans, the subjects were divided into two groups. The first group included 55 elderly patients (WHO, 2012) with hypertension and SSA. The second group included 35 elderly patients (WHO, 2012) with hypertension and SSA. The comparison group consisted of 56 patients aged 60 to 84 years with hypertension without SSA. Evaluation of the pharmacotherapy was carried out based on extracts from the medical histories of inpatient patients. RESULTS: The most commonly taken groups of antihypertensive drugs in patients of older age groups with hypertension and SSA according to the study are diuretics and ß-blockers. Diuretics were taken by 88.6% of elderly patients and 83.6% of senile patients. The main combinations of antihypertensive drugs in patients with hypertension and SSA were: a two-component scheme of combination of an ACE inhibitor and a diuretic, a three-component scheme of combination of an ACE inhibitor, a ß-blocker and a diuretic, four-component schemes of combination of an ACE inhibitor, a ß-blocker, a calcium channel blocker and a diuretic, as well as a combination of an angiotensin II receptor blocker, a ß-blocker, calcium channel blocker and diuretic with combined medications. CONCLUSION: The prescribed antihypertensive therapy in patients of older age groups with hypertension and SSA in most cases is represented by a combination of several drugs. Many patients take three-component antihypertensive therapy regimens. There were no statistically significant differences between patients of older age groups with hypertension and SSA, as well as patients of older age groups with hypertension without SSA. Therefore, it can be concluded that the presence of senile asthenia syndrome does not affect the tactics of treatment of hypertension and regardless of the presence or presence of SSA, patients receive the same hypotensive therapy, which contradicts existing clinical guidelines.

[The role of routine clinical examination in the selection of patients for screening of geriatric syndromes.]

The great complexity of complex geriatric assessment makes it relevant to search for methods that facilitate the selection of patients who really need it. The article presents the results of studying the possibility of using a routine clinical examination to select elderly cardiological patients with an increased risk of senile asthenia. The study involved 52 elderly patients with heart and vascular pathology. All of them underwent a generally accepted clinical and laboratory-instrumental examination, the results of which were compared with the data of the questionnaire «Age is not a hindrance¼. To identify the relationships between the parameters of clinical and geriatric status, analysis of variance and correlation analysis were used; summary frequency tables were built and analyzed. The significance threshold (p-value) was less than 5% (p<0,05). As a result of the study, it was found that the general condition of patients differing from satisfactory, complaints of shortness of breath, headaches, the presence of peripheral edema, lack of pulse on the dorsalis pedis arteries and posterior tibial arteries indicate an increased likelihood of senile asthenia in the subjects (p<0.05).

Real-world safety and effectiveness of regorafenib in metastatic colorectal cancer: the French CORRELATE cohort.

Aim: We report real-world evidence with regorafenib in previously treated metastatic colorectal cancer from the French cohort of the international, prospective, observational CORRELATE study. Patients & methods: Patients receiving regorafenib according to French health authority approval were included. The primary end point was treatment-emergent adverse events. Overall survival and progression-free survival were secondary end points. Results: Two hundred and forty-two patients (61% male, median age: 66 years) were enrolled. The most common grade ≥3 drug-related treatment-emergent adverse events were hand-foot skin reaction (10.3%), asthenia/fatigue (9.9/1.2%) and hypertension (6.2%). Median overall survival and progression-free survival were 6.8 (95% CI: 6.3-7.6) and 2.8 months (95% CI: 2.6-3.0), respectively. Conclusion: The real-world safety and effectiveness data of regorafenib in metastatic colorectal cancer in France align with findings from Phase III clinical trials and the global CORRELATE population.

Patient Reported Outcome Measures of Health-Related Quality of Life and Asthenia after Thyroidectomy.

BACKGROUND: After thyroidectomy some patients experience a chronic fatigue syndrome called asthenia. The purpose of this study was to determine the post-operative health related quality of life (HRQOL) and risk of asthenia in patients undergoing thyroidectomy. METHODS: A single institution prospective observational cohort study of adults undergoing thyroidectomy from September 2016 to July 2019 with four HRQOL surveys: preoperative baseline, 2 wk-, 6 mo- and 12 mo-postoperatively. Patients were surveyed using the Short Form 36 version 2 and Brief Fatigue Inventory. Asthenia was defined as Brief Fatigue Inventory > 60 at 12 mo. HRQOL was compared between patients undergoing thyroid lobectomy (TL) or total thyroidectomy (TT) with benign (-B) or malignant (-Ca) final pathology. RESULTS: A total of 182 patients were included: 67 (37%) with TL-B, 32 (17%) with TL-Ca, 40 (22%) with TT-B, and 43 (24%) with TT-Ca. The incidence of asthenia was 42% for TT and 4% for TL. In the TL-B group, 2 patients (3%) developed asthenia, compared with 2 patients (6.25%) in the TL-Ca group, 14 patients (35%) in the TT-B group, and 21 (48.8%) in the TT-Ca group (P = 0.0001). The odds ratio of asthenia for TT compared to TL was 10.4 (95% CI 3.86-28.16) and for patients with malignancy compared to benign disease was 2.05 (95% CI 1.17-3.61). CONCLUSIONS: Patients undergoing TT have a higher risk of developing asthenia than those undergoing TL, particularly if the final pathology shows malignancy.

Clinical features of patients who had two COVID-19 episodes: a European multicentre case series.

OBJECTIVE: To investigate the clinical features of patients who had two demonstrated coronavirus disease 2019 (COVID-19) episodes. METHODS: Data of patients with both COVID-19 episodes were recruited from 22 March to 27 December 2020. The following outcomes were studied: epidemiological, comorbidities, prevalence and severity of general and otolaryngological symptom, olfactory, aroma, and gustatory dysfunctions. A comparison between first and second episodes was performed. RESULTS: Forty-five patients reported having two confirmed COVID-19 episodes. The majority of patients had mild infections in both episodes. The second clinical episode was significantly similar to the first. The symptom duration of the second episode was shorter than the first. The occurrence of loss of smell was unpredictable from the first to the second episode. CONCLUSION: The recurrence of COVID-19 symptoms is associated with a similar clinical picture than the first episode in patients with initial mild-to-moderate COVID episode. The pathophysiological mechanisms underlying the development of second episode remain uncertain and may involve either true reinfection or virus reactivation from sanctuaries.

Follow-up of adults with noncritical COVID-19 two months after symptom onset.

OBJECTIVES: To describe the clinical evolution and predictors of symptom persistence during 2 months' follow-up in adults with noncritical coronavirus disease 2019 (COVID-19). METHODS: We performed descriptive clinical follow-up (day (D) 7, D30 and D60) of 150 patients with noncritical COVID-19 confirmed by real-time reverse transcriptase PCR at Tours University Hospital from 17 March to 3 June 2020, including demographic, clinical and laboratory data collected from the electronic medical records and by phone call. Persisting symptoms were defined by the presence at D30 or D60 of at least one of the following: weight loss ≥5%, severe dyspnoea or asthenia, chest pain, palpitations, anosmia/ageusia, headache, cutaneous signs, arthralgia, myalgia, digestive disorders, fever or sick leave. RESULTS: At D30, 68% (103/150) of patients had at least one symptom; and at D60, 66% (86/130) had symptoms, mainly anosmia/ageusia: 59% (89/150) at symptom onset, 28% (40/150) at D30 and 23% (29/130) at D60. Dyspnoea concerned 36.7% (55/150) patients at D30 and 30% (39/130) at D60. Half of the patients (74/150) at D30 and 40% (52/130) at D60 reported asthenia. Persistent symptoms at D60 were significantly associated with age 40 to 60 years old, hospital admission and abnormal auscultation at symptom onset. At D30, severe COVID-19 and/or dyspnoea at symptom onset were additional factors associated with persistent symptoms. CONCLUSIONS: Up to 2 months after symptom onset, two thirds of adults with noncritical COVID-19 had complaints, mainly anosmia/ageusia, dyspnoea or asthenia. A prolonged medical follow-up of patients with COVID-19 seems essential, whatever the initial clinical presentation.

Ninety days post-hospitalization evaluation of residual COVID-19 symptoms through a phone call check list.

An observational and descriptive study including patients discharged for COVID-19 was carried out by the COVID-19 Working Group of the Hospital Clínico San Carlos (HCSC). We aimed to identify the main symptoms after 90 days of hospital discharged. A structured interview was conducted, through a "checklist" that included symptoms within the 90 days post-discharge. A total of 134 patients were enrolled. The most frequently referred symptoms were asthenia, dyspnea and weight loss. Anxiety was the most frequent psychological symptom found through the GAD-7 scale.

Clinical relevance of Zika symptoms in the context of a Zika Dengue epidemic.

BACKGROUND: The clinical characteristics of the most frequent arbovirosis (Dengue, Zika, Chikungunya) are very similar, which is a diagnostic challenge for clinicians. OBJECTIVE: To identify the presence of clinical characteristics related to Zika virus infection confirmed by the laboratory in patients during an epidemic of co-infection with Zika and Dengue viruses. METHOD: Cross-sectional descriptive study of patients with clinical - epidemiological suspicion of Zika virus infection, who were admitted in the Hospital "Joaquín Albarrán" (La Habana, Cuba), during June 1 to October 31 of 2017. Demographic and symptoms and signs were recorded. By PCR for Zika virus (in blood or urine) the disease was confirmed. RESULTS: 1541 patients were studied. The most frequent symptoms and signs were rash (93.8%), pruritus (77.9%), arthralgia (60.0%), headache (50.8%), myalgia (46.1%), fever (34.7%), asthenia (31.7%), and conjunctivitis (27.9%). Zika virus infection was confirmed in 279 patients (18.1%). Greater frequency of arthralgia, asthenia, and diarrhea was demonstrated in Zika confirmed patients. CONCLUSION: Minor clinical relevance was observed in the symptoms or signs of arboviral disease to support the clinical diagnosis of Zika virus infections by clinician during a Zika-Dengue epidemic. The assessment of the temporality of the onset of Zika and Dengue symptoms of these infections is recommended to assist clinicians in the differential diagnosis.

Aflibercept Plus FOLFIRI in the Real-life Setting: Safety and Quality of Life Data From the Italian Patient Cohort of the Aflibercept Safety and Quality-of-Life Program Study.

BACKGROUND: Aflibercept combined with FOLFIRI (folinic acid, 5-fluorouracil, irinotecan) as second-line treatment of metastatic colorectal cancer (mCRC) significantly improved survival compared with FOLFIRI alone in the pivotal VELOUR (aflibercept vs. placebo in combination with irinotecan and 5-fluorouracil in the treatment of patients with metastatic colorectal cancer after failure of an oxaliplatin-based regimen) trial. No quality-of-life assessment was performed in VELOUR; therefore, the ASQoP (Aflibercept Safety and Quality-of-Life Program) trial was designed to capture the safety and health-related quality of life (HRQL). PATIENTS AND METHODS: ASQoP was an international, open-label, single-arm trial evaluating the safety and HRQL of aflibercept combined with FOLFIRI administered in a real-life setting to 781 patients with mCRC, pretreated with an oxaliplatin-based regimen with or without bevacizumab. The Italian subset of ASQoP enrolled 200 patients from 28 institutions. The primary endpoint was safety; HRQL was a secondary endpoint, assessed by validated questionnaires (European quality of life 5-dimension instrument 3-level; European Organization for Research and Treatment for Cancer Quality of Life Questionnaire Core 30, version 3; and EORTC-CR29) at baseline, during treatment, and at the end of treatment. RESULTS: The median age of the Italian ASQoP population was 63 years; the median number of aflibercept and FOLFIRI cycles was 7. Treatment-emergent adverse events were reported in 97.5% of patients. Hypertension (28.5%), neutropenia (27.5%; from laboratory data), asthenic conditions (20.0%), diarrhea (17.0%), and stomatitis (13.0%) were the most frequent (incidence, ≥ 5%) grade 3/4 toxicities. One toxic death occurred during the study period due to sepsis, without neutropenic complications. No significant worsening of HRQL was shown during treatment. CONCLUSION: Aflibercept combined with FOLFIRI was well tolerated when administered as second-line treatment for patients with mCRC in a real-life setting. It did not affect HRQL and showed similar rates of treatment-emergent adverse events as those observed in the VELOUR trial. No new safety signals were identified.

[Systemic sclerosis and occupational difficulties: Results of a prospective study]. / Sclérodermie systémique et difficultés professionnelles : résultats d'une enquête prospective.

Between 9000 and 14000 people have systemic sclerosis (ScS) in France. The work is often affected. Our study aims to assess the frequency of professional difficulties (DP) of scleroderma patients, identify these DP, the symptoms involved and the solutions used. A heteroquestionnaire was offered to scleroderma patients the Lille University Hospital. Data were cross-checked with the clinical database of the National Observatory of scleroderma patients. We used 104 questionnaires of which 84% are women. A total of 62.5%, (95% CI [52.5 to 71.8]) patients had experienced DP related to SSc, 55% reported symptoms worsened at work, 41% lower efficiency and a 19% job loss. Symptoms responsible for their DP were mainly asthenia, Raynaud syndrome, arthralgias and finger ulcerations. Only 40% of patients in difficulty were initiating steps with the county home for disabled people and 45% in informing their doctor at work (MT). The MT information absence was related to a misunderstanding of possible aid in 45% of cases, 57% of patients had not found a solution, 41% of them have lost their jobs and 31% of patients in the cohort experienced a drop in income. The impact of SSc the work is important. The aid job retention devices are under-used due to lack of knowledge of steps to take and the role of MT. Taking into account the symptoms responsible for PD must be improved to participate in this retention.

A Phase Ib Dose-Escalation Study of the Safety, Tolerability, and Pharmacokinetics of Cobimetinib and Duligotuzumab in Patients with Previously Treated Locally Advanced or Metastatic Cancers with Mutant KRAS.

LESSONS LEARNED: Cobimetinib and duligotuzumab were well tolerated as single agents and in combination with other agents.The cobimetinib and duligotuzumab combination was associated with increased toxicity, most notably gastrointestinal, and limited efficacy in the patient population tested. BACKGROUND: KRAS-mutant tumors possess abnormal mitogen-activated protein kinases (MAPK) pathway signaling, leading to dysregulated cell proliferation. Cobimetinib blocks MAPK signaling. The dual-action antibody duligotuzumab (MEHD7945A) inhibits ligand binding to both epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 3 (HER3). Blockade of EGFR/HER3 and inhibition of mitogen-activated protein kinase (MEK) in KRAS-mutant tumors may provide additive benefit. METHODS: Patients with KRAS-mutant solid tumors were eligible for this phase Ib dose-escalation study with a planned expansion phase. Duligotuzumab was given intravenously (IV) at 1,100 mg every 2 weeks (q2w), while cobimetinib was given orally in a standard 3 + 3 design to identify the recommended phase II dose (RP2D). The primary objective was to evaluate the safety and tolerability of this combination. RESULTS: Twenty-three patients were enrolled. Dose-limiting toxicities (DLTs) included grade 4 hypokalemia and grade 3 mucosal inflammation, asthenia, and dermatitis acneiform. Seventy percent of patients experienced grade 3 or worse adverse events (AEs). Five (22%) and 12 (52%) patients missed at least 1 dose of duligotuzumab and cobimetinib, respectively, and 9 (39%) patients required a cobimetinib dose reduction. Three (13%) patients discontinued due to an AE. Best response was limited to 9 patients with stable disease and 13 patients with progressive disease. CONCLUSION: Given the limited tolerability and efficacy of this combination, the study did not proceed to expansion stage and closed for enrollment.

The prevalence of post-thyroidectomy chronic asthenia: a prospective cohort study.

PURPOSE: Chronic asthenia (CA) is complained by some patients that have undergone thyroid surgery. We evaluate its impact in patients undergoing unilateral or bilateral thyroidectomy, the trend during a 1-year follow-up, and the possible risk factors. METHODS: A prospective, cohort study was carried out on 263 patients scheduled for thyroidectomy from 2012 and 2014. Exclusion criteria were as follows: Graves' disease, malignancies requiring radioiodine therapy, post-surgical hypoparathyroidism, laryngeal nerve palsy, abnormal pre- and post-operative thyroid hormone levels, and BMI outside the normal range. Demographics; smoking and alcoholism addiction; cardiac, pulmonary, renal, and hepatic failure; diabetes; anxiety; and depression were recorded. The Brief Fatigue Inventory (BFI) was used to evaluate CA and its possible association with these comorbidities 6 and 12 months after thyroidectomy. RESULTS: One hundred seventy-seven patients underwent total thyroidectomy (TT), 54 hemithyroidectomy (HT). Thirty-two patients were not recorded because of the onset of exclusion criteria. In the 6 months after thyroidectomy, in the TT group, 64 patients (36.16%) reported an impairment in the BFI score and only 1 in the TL group. The mean BFI score changed from 1.663(±1.191) to 2.16 (±11.148) in the TT group, from 1.584 (±1.371) to 1.171 (±1.093) in the TL group (p < 0.001). No further significant variations in BFI were reported 1 year after surgery. CONCLUSIONS: CA worsened after TT, but not after HT. Apart from operative procedure itself, no other risk factor was found be significantly associated with post-thyroidectomy asthenia. Further investigation is needed to determine the causes of CA.

Declines in Strength and Mortality Risk Among Older Mexican Americans: Joint Modeling of Survival and Longitudinal Data.

BACKGROUND: Grip strength is a noninvasive method of risk stratification; however, the association between changes in strength and mortality is unknown. The purposes of this study were to examine the association between grip strength and mortality among older Mexican Americans and to determine the ability of changes in strength to predict mortality. METHODS: Longitudinal data were included from 3,050 participants in the Hispanic Established Population for the Epidemiological Study of the Elderly. Strength was assessed using a hand-held dynamometer and normalized to body mass. Conditional inference tree analyses were used to identify sex- and age-specific weakness thresholds, and the Kaplan-Meier estimator was used to determine survival estimates across various strata. We also evaluated survival with traditional Cox proportional hazard regression for baseline strength, as well as with joint modeling of survival and longitudinal strength change trajectories. RESULTS: Survival estimates were lower among women who were weak at baseline for only 65- to 74-year-olds (11.93 vs 16.69 years). Survival estimates were also lower among men who were weak at baseline for only ≥75-year-olds (5.80 vs 7.39 years). Lower strength at baseline (per 0.1 decrement) was significantly associated with mortality (hazard ratio [HR]: 1.10; 95% confidence interval [CI]: 1.01-1.19) for women only. There was a strong independent, longitudinal association between strength decline and early mortality, such that each 0.10 decrease in strength, within participants over time, resulted in a HR of 1.12 (95% CI: 1.00-1.25) for women and a HR of 1.15 (95% CI: 1.04-1.28) for men. CONCLUSIONS: Longitudinal declines in strength are significantly associated with all-cause mortality in older Mexican Americans.

Sorafenib use in elderly patients with hepatocellular carcinoma: caution about use of platelet aggregation inhibitors.

PURPOSE: Sorafenib is the standard of care for advanced hepatocellular carcinoma (HCC). The peak incidence of HCC is around 70 years. We aimed to evaluate safety and efficacy of sorafenib in the elderly population. METHODS: We retrospectively reviewed data from patients treated with sorafenib for HCC at our institution. We compared safety and efficacy data across different age groups. RESULTS: Since 2005, 129 patients were treated, 78 (60.5 %) were <70 years old and 51 (39.5 %) were ≥70. The frequency of dose reduction was similar between the two groups (48.7 vs. 58.8 %), as was the occurrence of severe toxicities (41.0 vs. 51.0 %) and hospitalization due to toxicity (9.0 vs. 13.7 %). However, asthenia and bleeding were more frequent in the elderly. The higher frequency of bleeding was explained by concomitant antiplatelet treatments, and major asthenia was frequent in PS1 elderly patients. There was a trend toward less frequent interruption of treatment in the younger group (25.6 vs. 39.2 %) and significantly less frequent definitive discontinuation of treatment due to toxicity (24.4 vs. 45.1 %). Median progression-free survival was 5.6 months in both age groups, while median overall survival was 9.6 months in the younger age group and 12.6 months in the older age group. CONCLUSION: Sorafenib showed similar results in terms of safety and efficacy in the elderly and younger HCC populations. Careful baseline evaluation is needed for patient's selection in the elderly population, including discussion about antiplatelet therapy discontinuation and caution in PS1 patients, as well as active management of toxicity.

Comparison of self-report-based and physical performance-based frailty definitions among patients receiving maintenance hemodialysis.

BACKGROUND: A well-accepted definition of frailty includes measurements of physical performance, which may limit its clinical utility. STUDY DESIGN: In a cross-sectional study, we compared prevalence and patient characteristics based on a frailty definition that uses self-reported function to the classic performance-based definition and developed a modified self-report-based definition. SETTING & PARTICIPANTS: Prevalent adult patients receiving hemodialysis in 14 centers around San Francisco and Atlanta in 2009-2011. INDEX TESTS: Self-report-based frailty definition in which a score lower than 75 on the Physical Function scale of the 36-Item Short Form Health Survey (SF-36) was substituted for gait speed and grip strength in the classic definition; modified self-report definition with optimized Physical Function score cutoff points derived in a development (one-half) cohort and validated in the other half. REFERENCE TEST: Performance-based frailty defined as 3 of the following: weight loss, weakness, exhaustion, low physical activity, and slow gait speed. RESULTS: 387 (53%) patients were frail based on self-reported function, of whom 209 (29% of the cohort) met the performance-based definition. Only 23 (3%) met the performance-based definition of frailty only. The self-report definition had 90% sensitivity, 64% specificity, 54% positive predictive value, 93% negative predictive value, and 72.5% overall accuracy. Intracellular water per kilogram of body weight and serum albumin, prealbumin, and creatinine levels were highest among nonfrail individuals, intermediate among those who were frail by self-report, and lowest among those who also were frail by performance. Age, percentage of body fat, and C-reactive protein level followed an opposite pattern. The modified self-report definition had better accuracy (84%; 95% CI, 79%-89%) and superior specificity (88%) and positive predictive value (67%). LIMITATIONS: Our study did not address prediction of outcomes. CONCLUSIONS: Patients who meet the self-report-based but not the performance-based definition of frailty may represent an intermediate phenotype. A modified self-report definition can improve the accuracy of a questionnaire-based method of defining frailty.

Evaluación multidimensional de la astenia relacionada con el cáncer / Cancer related fatigue: a multidimensional evaluation

La astenia en el paciente con cáncer es definida como una sensación abrumadora y persistente de cansancio o agotamiento relacionado con el cáncer o el tratamiento de este, que disminuye o impide la capacidad para el trabajo mental o físico en el contexto de su actividad diaria y a pesar de un buen descanso. Es uno de los primeros síntomas que puede presentarse en el paciente con cáncer, afectando de manera importante a la calidad de vida. El objetivo de esta revisión es detallar las diferentes causas que influyen en la astenia y describir las escalas de medida que más frecuentemente se utilizan para estudiarla. La metodología empleada en esta revisión es narrativa. En esta revisión describimos cómo la astenia es un concepto multidimensional, ya que casi siempre está provocada o influenciada por múltiples causas. Esta multidimensionalidad interviene también en la comprensión de la fisiopatología. Por esta razón en esta revisión diferenciaremos entre astenia primaria y secundaria definiendo y detallando cada una de ellas. Por otro lado, también analizamos el tipo de escalas empleadas para medir la astenia diferenciando entren las que miden la astenia de forma primaria o las que la miden desde un punto de vista multidimensional

Fatigue in cancer patients is defined as an unusual, persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning, despite good rest. Fatigue is one of the first symptoms that can appear in patients with cancer and quality of life is severely impacted by it. The main goal of this review is to describe the different causes that influence fatigue and the different ways to asses this symptom. The methodology we have used for this review is narrative. In this work we describe fatigue as a multidimensional concept that it is caused by multiple mechanisms. This multidimensionality is also involved in understanding the pathophysiologyFor that reason we are going to define fatigue as primary and secondary, and we are going to describe each of them. We are also going to analyse the type of scales used to measure fatigue; describing the differences between the ones that measure only fatigue and the ones that are used to asses fatigue from a multidimensional perspective

Association between farming and chronic energy deficiency in rural South India.

OBJECTIVE: To examine factors associated with chronic energy deficiency (CED) and anaemia in disadvantaged Indian adults who are mostly involved in subsistence farming. DESIGN: A cross-sectional study in which we collected information on socio-demographic factors, physical activity, anthropometry, blood haemoglobin concentration, and daily household food intake. These data were used to calculate body mass index (BMI), basal metabolic rate (BMR), daily energy expenditure, and energy and nutrient intake. Multivariable backward stepwise logistic regression was used to assess socioeconomic and lifestyle factors associated with CED (defined as BMI<18 kg/m²) and anaemia. SETTING: The study was conducted in 12 villages, in the Rishi Valley, Andhra Pradesh, India. SUBJECTS: Individuals aged 18 years and above, residing in the 12 villages, were eligible to participate. RESULTS: Data were available for 1178 individuals (45% male, median age 36 years (inter quartile range (IQR 27-50)). The prevalence of CED (38%) and anaemia (25%) was high. Farming was associated with CED in women (2.20, 95% CI: 1.39-3.49) and men (1.71, 95% CI: (1.06-2.74). Low income was also significantly associated with CED, while not completing high school was positively associated with anaemia. Median iron intake was high: 35.7 mg/day (IQR 26-46) in women and 43.4 mg/day (IQR 34-55) in men. CONCLUSIONS: Farming is an important risk factor associated with CED in this rural Indian population and low dietary iron is not the main cause of anaemia. Better farming practice may help to reduce CED in this population.

Malnutrition is associated with poor rehabilitation outcome in elderly inpatients with hospital-associated deconditioning a prospective cohort study.

OBJECTIVE: To investigate the association between nutritional status and rehabilitation outcome in elderly inpatients with hospital-associated deconditioning. DESIGN: A prospective cohort study. SUBJECTS/PATIENTS: One hundred sixty-nine consecutive elderly inpatients diagnosed with hospital-associated deconditioning. METHODS: Nutritional status at referral was assessed by the Mini Nutritional Assessment Short Form at the University Medical Center. Body mass index, haemoglobin, albumin, total lymphocyte count, C-reactive protein, cause of malnutrition, and feeding route were also investigated. Primary outcome was Barthel Index score at discharge. RESULTS: A total of 148 patients (87.6%) were malnourished, and 21 were at risk for malnutrition. There were no patients with normal nutritional status. Malnourished patients had a lower Barthel Index score at discharge than those at risk for malnutrition. Chronic disease-related malnutrition, oral intake, and parenteral nutrition were associated with the Barthel Index score at discharge. There were significant correlations between the Barthel Index score at discharge and nutritional score, albumin, and total lymphocyte count. In multiple regression analysis, Mini Nutritional Assessment Short Form, albumin, and chronic disease-related malnutrition were significantly associated with the Barthel Index score at discharge. CONCLUSION: Most elderly inpatients with hospital-associated deconditioning are malnourished. Nutritional status, albumin, and chronic disease-related malnutrition are associated with poor rehabilitation outcome in hospital-associated deconditioning.