RESUMEN
BACKGROUND: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) evaluates an individual's functioning and disability within the conceptual framework of the ICF. The present study examines the measurement properties of the WHODAS 2.0 in patients with bipolar disorder using Mokken scaling analysis (i.e., monotone homogeneity and double monotonicity models) and the graded response model. No previous studies applying these models to this instrument were found. METHODS: A sample of 291 patients with bipolar disorder (42.6% males) was tested. RESULTS: The WHODAS 2.0 domains showed strong unidimensionality, with no items being omitted. In addition, the analysis of invariant item ordering showed that the items of each domain formed a hierarchical scale, with the exception of the 'Life activities' items for employed persons or students and item D4.5 'Sexual activities' in the 'Getting along' domain. The WHODAS 2.0 domains and the whole scale also showed excellent reliability in bipolar disorder. LIMITATIONS: Although the study was limited to patients in Spain, the use of non-sample dependent procedures minimizes this limitation since the results are independent of the sample used. CONCLUSIONS: The WHODAS 2.0 contains six strong unidimensional domains that are hierarchical and reliable for detecting disability in bipolar disorder, although caution should be exercised with regard to some items.
Asunto(s)
Trastorno Bipolar/complicaciones , Evaluación de la Discapacidad , Actividades Cotidianas , Adulto , Personas con Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , España , Estudiantes , Organización Mundial de la SaludRESUMEN
BACKGROUND: Rosacea is a disease of complex pathogenesis and variable response to various therapeutic methods. Aim of the work To evaluate and compare the efficacy, safety and side effects of some topical lines of treatment of rosacea. PATIENTS AND METHODS: The study included 24 patients (23 females and 1 male) with rosacea on the face. They were classified into three groups--each including eight patients (16 face sides)--and treated with one of three topical agents (azelaic acid 20% cream, metronidazole 0.75% cream or permethrin 5% cream) on one side of the face and another one on the other side twice daily for 15 weeks. RESULTS: There was a significant improvement of lesions after 15 weeks of topical treatment with the three agents. Azelaic acid cream was significantly more effective on inflammatory lesions but not erythema than the other two creams. Side effects--mostly transient--were observed with topical creams with no significant difference. They included itching, burning sensation, oedema and scales. Patients who used azelaic acid 20% cream were more satisfied than with other modalities. CONCLUSION: Azelaic acid 20% cream provides an effective and safe alternative to metronidazole 0.75% cream or permethrin 5% cream with the added benefit of increased patient satisfaction.
Asunto(s)
Ácidos Dicarboxílicos/uso terapéutico , Metronidazol/uso terapéutico , Permetrina/uso terapéutico , Rosácea/tratamiento farmacológico , Adulto , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A standard sleep questionnaire was given to the parents of 26 infants with protein-energy malnutrition who underwent polysomnographic evaluation. These investigations were repeated approximately 2 months after enrolment in a nutritional rehabilitation programme based on World Health Organization guidelines. Anthropometric values and serum serotonin levels were also measured. After nutritional rehabilitation there was a significantly higher percentage of non-rapid eye movement (REM) sleep; 2nd REM time, and latency times for sleep and REM sleep increased. Percentages of REM sleep and serum serotonin levels decreased significantly. Protein-energy malnutrition seems to affect the sleep-wake cycle; disturbed serotonin levels may be among the factors responsible.
Asunto(s)
Trastornos de la Nutrición del Lactante/complicaciones , Trastornos de la Nutrición del Lactante/rehabilitación , Desnutrición Proteico-Calórica/complicaciones , Desnutrición Proteico-Calórica/rehabilitación , Parasomnias del Sueño REM/etiología , Trastornos del Sueño del Ritmo Circadiano/etiología , Antropometría , Estatura , Peso Corporal , Estudios de Casos y Controles , Niño , Edema/etiología , Egipto , Femenino , Hemoglobinas/metabolismo , Humanos , Lactante , Trastornos de la Nutrición del Lactante/diagnóstico , Evaluación Nutricional , Apoyo Nutricional , Polisomnografía , Guías de Práctica Clínica como Asunto , Desnutrición Proteico-Calórica/diagnóstico , Parasomnias del Sueño REM/sangre , Parasomnias del Sueño REM/diagnóstico , Parasomnias del Sueño REM/epidemiología , Serotonina/sangre , Albúmina Sérica/metabolismo , Trastornos del Sueño del Ritmo Circadiano/sangre , Trastornos del Sueño del Ritmo Circadiano/diagnóstico , Trastornos del Sueño del Ritmo Circadiano/epidemiología , Estadísticas no Paramétricas , Encuestas y CuestionariosRESUMEN
A standard sleep questionnaire was given to the parents of 26 infants with protein-energy malnutrition who underwent polysomnographic evaluation. These investigations were repeated approximately 2 months after enrolment in a nutritional rehabilitation programme based on World Health Organization guidelines. Anthropometric values and serum serotonin levels were also measured. After nutritional rehabilitation there was a significantly higher percentage of non-rapid eye movement [REM] sleep; 2nd REM time, and latency times for sleep and REM sleep increased. Percentages of REM sleep and serum serotonin levels decreased significantly. Protein-energy malnutrition seems to affect the sleep-wake cycle; disturbed serotonin levels may be among the factors responsible
Asunto(s)
Desnutrición Proteico-Calórica , Serotonina , Organización Mundial de la Salud , Sueño REMRESUMEN
BACKGROUND AND OBJECTIVES: The pathogenesis of different malnutrition diseases was suggested to affect the heart. This study was designed to detect cardiac affection in protein energy malnutrition (PEM) patients, whether clinically or by electrocardiogram (ECG) and echocardiogram, and to assess the value of the cardiac marker troponin I in patients at risk of myocardial injury with special emphasis on the effect of nutritional rehabilitation. PATIENTS AND METHODS: The present study was carried out on 30 PEM infants (16 nonedematous - 14 edematous) and 10 apparently healthy age and sex-matched infants acting as the control group. All studied infants were subjected to full history taking laying stress on dietetic history, thorough clinical and anthropometric measurements. Echocardiography and ECG were also performed. Laboratory investigations were performed including complete blood count, CRP, total proteins, albumin, liver and kidney functions as well as estimation of troponin-I in blood by immulite. Following initial evaluation, all malnourished infants were subjected to nutritional rehabilitation program for approximately 8 weeks, after which the patients were re-evaluated using the same preinterventional parameters. RESULTS: The results of the present study demonstrated that electrical properties of myocardium assessed by ECG showed significant decrease of R wave and QTc interval in patients compared to controls with significant improvement after nutritional rehabilitation. Echocardigraphic changes showed that cardiac mass index was significantly lower in both groups of malnourished cases compared to the controls with significant increase after nutritional rehabilitation. The study showed that the parameters of left ventricular (LV) systolic function which are the ejection fraction, fractional shortening and velocity of circumferential fiber shortening were not significantly reduced in patients compared to the controls. The diastolic function also showed no significant difference in the E wave/A wave (e/a) ratio between patients and controls. However, the systolic time interval showed significantly higher LV pre-ejection index in patients in comparison to controls. Edematous and nonedematous cases did not show any significant differences in ECG and echocardigraphic data before or after nutritional rehabilitation. The hearts of two severely affected patients uniquely demonstrated marked decrease of LV end diastolic diameter (LEVDd) together with the detection of troponin-I in their sera. CONCLUSION: We can conclude that malnutrition, regardless of its type, has a definite effect on cardiac volume, muscle mass, as well as the electrical properties of the myocardium. The systolic functions of the heart are affected more than the diastolic functions and this affection becomes manifest only in severe cases and may constitute a bad prognostic parameter thus necessitating more intense management and strict follow-up of such cases.
Asunto(s)
Edema/fisiopatología , Corazón/fisiología , Miocardio/metabolismo , Desnutrición Proteico-Calórica/dietoterapia , Desnutrición Proteico-Calórica/fisiopatología , Troponina I/sangre , Preescolar , Diástole , Ecocardiografía , Edema/dietoterapia , Electrocardiografía , Femenino , Corazón/anatomía & histología , Hemodinámica , Humanos , Lactante , Masculino , Estado Nutricional , Sístole/fisiologíaRESUMEN
BACKGROUND: Pancreatic exocrine dysfunction has been frequently recorded in protein energy malnutrition (PEM) because the pancreas requires optimal nutrition for enzyme synthesis. This pancreatic enzyme insufficiency may play a role in the continuation of PEM. OBJECTIVE: This study was designed to assess the pancreatic head size and exocrine pancreatic functions, namely serum amylase and lipase, in PEM and its subtypes and correlate any defect present with the various clinical and laboratory data of the PEM patients with special emphasis on the effect of nutritional rehabilitation. PATIENTS AND METHODS: A total of 33 cases of PEM; 15 marasmus, 10 kwashiorkor (KWO) and eight marasmic kwashiorkor (MKWO) were recruited from Ain Shams University children's hospital, together with 12 matched controls. The mean age of patients was 11.87 +/- 7.8 months and that of the controls was 14.83 +/- 7.7 months. Detailed history taking and thorough clinical examination with special emphasis on anthropometric measurements were taken for each studied infant as well as laboratory investigations which included; complete blood count, liver and kidney functions and serum amylase and lipase. Ultrasonographic assessment of pancreatic head size was performed for the cases and controls. Nutritional rehabilitation program was carried out for 3-6 months followed by reassessment of the cases. RESULTS: The pancreatic head size values were significantly lower in all subtypes of PEM (1.52 +/- 0.6, 2.73 +/- 0.12 and 3.00 +/- 0.54 cm(3) in the marasmus, KWO and MKWO respectively) compared to the controls (5.13 +/- 2.33 cm(3)). The serum amylase and lipase were also significantly lower in all subgroups of PEM when compared to the controls with significant improvement following nutritional rehabilitation coupled by a significant increase in pancreatic head size too. No significant differences were recorded when we compared the subgroups together except for a significant higher rate of change in serum amylase in edematous patients compared to nonedematous ones. The length of nutritional rehabilitation period, age of the patient, weight and serum albumin were the most determinant factors for pancreatic head size as evident from the multiple regression analysis study. CONCLUSION: The potentially correctable exocrine pancreatic insufficiency in cases of PEM should be carefully thought of when planning the nutritional rehabilitation program for such patients as it could be responsible for the serious continued morbidity issues that they face. We thus recommend that estimation of pancreatic head size and exocrine function should be included in the evaluation of PEM patients and they could also be used as a prognostic parameter. SPONSORSHIP: The patients enrolled were among those admitted and managed freely in the children's Hospital Faculty of Medicine Ain Shams University, including the use of the ultrasound apparatus, while the kits have been purchased by authors who contributed in financing the study.