RESUMEN
Anal fistulas often cause significant impairment to patients' health-related quality of life (HRQOL). This cross-sectional study aimed to compare the HRQOL between patients with anal fistulas with inflammatory bowel disease (IBD) and those without, hypothesizing significant differences in HRQOL scores between these groups. The secondary objectives were to identify specific aspects of life quality most affected and explore potential variables influencing HRQOL. The study was conducted at the Clinical Emergency Hospital "Pius Brinzeu" in Timisoara, Romania, using a convenience sample of 175 adult patients diagnosed with anal fistulas, stratified into IBD and non-IBD groups. Quality of life was evaluated at initial hospital admission and three months post-treatment using four questionnaires: SF-36, GIQLI, HADS, and the WHOQOL-BREF. Initial SF-36 scores were marginally lower in the IBD group, with mean physical and mental scores of 52.0 and 54.5, respectively. Both groups showed an improvement after intervention, but the mean difference was higher in the IBD group, with an increase of 1.1 in physical score. Initial GIQLI scores were significantly lower in the IBD group (110) compared to the non-IBD group (116). Post-intervention, the mean scores increased to 116 and 121, respectively. HADS scores suggested higher anxiety levels in the non-IBD group (7.5 vs. 6.1), although depression scores were similar. Post-intervention, anxiety scores decreased more substantially in the non-IBD group (-0.9 vs. -0.3). The WHOQOL-BREF scores were lower across all domains for the IBD group at the initial test (physical health: 12.4, psychological health: 14.9, social relationships: 14.4, environment: 13.0). Post-intervention, scores increased marginally in the IBD group (physical health: 12.7, psychological health: 15.9, social relationships: 14.1, environment: 13.8) but varied in the non-IBD group. HRQOL, as measured by multiple questionnaires, is impacted differently in anal fistula patients with and without IBD. These findings highlight the importance of a tailored approach to managing this patient population to improve their quality of life post-treatment.
RESUMEN
Antiphospholipid antibody (aPL)-associated thrombophilia has been implicated in various adverse pregnancy outcomes, including preterm birth and impaired fetal development. This systematic review aimed to elucidate the relationship between aPL-associated thrombophilia and these outcomes, as well as to identify potential modifiers of this relationship such as maternal age, coexisting maternal medical conditions, type of aPL antibodies involved, and the timing of thrombophilia diagnosis during gestation. We conducted a comprehensive literature search in PubMed, Web of Science, Cochrane, and Scopus in May 2023, covering literature published within the last 10 years. Eight articles, involving 2935 patients, were eligible for inclusion in the review. Single aCL was the most common type of aPL found in patients, with rates up to 61.0% in some studies, followed by single LA and single ab2GPI. Multiple aPL antibody positivity was found to be associated with a higher risk of preterm birth, with odds ratios ranging from 1.29 to 9.61. Patient characteristics and previous pregnancy history varied significantly across the studies. Risk factors such as diabetes mellitus, thrombosis, and systemic lupus erythematosus were also variable across the studies, but presence of these risk factors did not consistently affect the risk of preterm birth. Furthermore, although a triple positive aPL test was the most important risk factor for preterm birth, it was observed that thrombophilia treatment during pregnancy significantly reduced the risk by 2.44 times (95% CI = 1.18-6.20). This review supports the evidence for aPL-associated thrombophilia being a significant contributor to preterm birth and fetal developmental abnormalities. Further research is required to investigate the exact mechanisms and to determine the best clinical management for patients with aPL-associated thrombophilia during pregnancy.
RESUMEN
Lung cancer is the leading cause of cancer-related deaths worldwide. This study aimed to compare the bronchial microbiota of patients with lung cancer and patients with benign pulmonary diseases undergoing bronchoscopy, and to assess the stress levels associated with invasive diagnostic lung tests. A cross-sectional study was conducted at the "Victor Babes" Hospital for Infectious Diseases and Pulmonology in Timisoara, Romania. A total of 33 patients with histologically diagnosed bronchopulmonary cancer and 33 control patients with benign lung pathologies underwent bronchoscopy. Bronchial microbiota was analyzed by multiplex PCR, culture media, and cytology. Anxiety and depression levels were assessed using the ECOG performance status scale, Karnofsky scale, GAD-7, PHQ-9, and HADS questionnaires. There were no significant differences in the presence of common microbial species between the two groups, except for Acinetobacter spp. Which was identified in 15.2% of patients with lung cancer and 0.0% in the control group, Candida spp. Was more prevalent in the benign group (24.2% vs. 6.1%), and the Parainfluenza virus was detected only in the malignant group (21.1% vs. 0.0%). Cytology results showed a higher prevalence of atypical and tumoral cells in the malignant group (39.4% and 30.0%, respectively), as well as higher lymphocyte levels in the benign group (69.7% vs. 24.2%). Patients with lung cancer had significantly lower performance status on the ECOG scale (2.34 vs. 1.92), lower Karnofsky scores (71.36 vs. 79.43), and higher GAD-7 and PHQ-9 scores at the initial evaluation compared to the benign group. At the 90-day follow-up, ECOG and Karnofsky scores remained significantly different from the initial evaluation, but only GAD-7 scores showed a significant difference between the two groups. There were differences in the bronchial microbiota between patients with lung cancer and benign pulmonary diseases, with a higher prevalence of Candida spp. in the benign group and exclusive detection of Acinetobacter spp. and Parainfluenza virus in the malignant group. Patients with lung cancer exhibited higher stress levels, more severe anxiety, and depression symptoms, which persisted during follow-up. Further research is needed to understand the role of bronchial microbiota in lung cancer and the impact of stress on patient outcomes.
