Prejudice impairing quality of life in sickle cell disease patients in a developing country: faces of suffering.

INTRODUCTION: The perception of prejudice against, and stigmatization of, sickle cell disease (SCD) leads the patient to perceive a different treatment, due to the disease stigma and may be related to a worse quality of life (QoL). OBJECTIVES: Describe and evaluate the perception of the prejudice against the disease and its impact on the quality of life of patients with sickle cell disease. METHODS: This is a cross-sectional study conducted between March 2019 and February 2020, with patients diagnosed with SCD. Patients were questioned about the perception of prejudice in any kind of situation, choosing between "Yes" or "No", not differentiating situations related to prejudice. To assess the QoL and impact of the disease, the volunteers answered a version of the SF-36 questionnaire translated and validated into Brazilian Portuguese. RESULTS: In this study, 113 patients with SCD were followed up, 92% were classified as HbSS and the rest, divided between HbSC and HbS-ß-0. Regarding the SF-36, the worst scores were in the summary of the physical components (mean 48.19 ± 21.51) and the physical aspect had the lowest mean (30.75 ±€42.65). When questioned if they had already perceived any kind of prejudice, including the SCD, 32.74% answered "Yes". For this comparison, there was a significant difference in the summary of the physical and mental components, with worse QoL for those who had already suffered prejudice. CONCLUSION: Patients diagnosed with SCD who reported perception of prejudice had statistically significant worse QoL, revealing the negative impact, that might lead to sadness and social isolation.

Is There a Difference in Fear-Avoidance, Beliefs, Anxiety and Depression Between Post-Surgery and Non-Surgical Persistent Spinal Pain Syndrome Patients?

Introduction: Patients with post-surgery persistent spinal pain syndrome (PSPS) or non-surgical PSPS might be affected by sustained fear-avoidance beliefs (FAB), anxiety and depression. In this scenario, this study aimed to describe those aspects in patients with post-surgery PSPS and non-surgical PSPS. Methods: This study included patients with PSPS, and non-surgical PSPS, over 18 years, with quarterly evaluations at the Chronic Pain Clinic. After evaluation, demographic and clinical characteristics were obtained. The Beck Depression Inventory-II, Beck Anxiety Inventory, Douleur neuropathique 4 questions, Visual Analog Pain Scale, and Fear-Avoidance Beliefs Questionnaire-Brazilian Version (FABQ-Brazil) were used to evaluate psychological aspects. Results: Forty-six patients were included, 23 patients with post-surgery PSPS and 23 with non-surgical PSPS. Both groups had high scores in the physical and work domains of the FABQ, high rates of absenteeism and most patients in these groups had moderate-to-severe neuropathic pain and some degree of anxiety and/or depression. The groups showed no statistically significant difference (p > 0.05) when comparing all questionnaires. Discussion: This is one of the first studies to evaluate FAB and other associated psychological factors, such as anxiety and depression, in patients with post-surgery PSPS in a follow-up several years after surgery and compare with patients diagnosed with non-surgical PSPS. In this study, most patients in both groups had high scores in the FABQ domains, not having statistically relevant difference between groups. Conclusion: Even though there was no statistically relevant difference between the PSPS patient with or without surgical history in terms of the assessed outcome measures, the described scores for fear-avoidance beliefs, pain, anxiety and depression were high, showing an interference in the daily life activities of those patients.

Comparative Study of Clinical and Ultrasound Parameters for Defining a Difficult Airway in Patients with Obesity.

INTRODUCTION: Patients with obesity have anatomical changes due to increased adipose tissue that negatively affect airway accessibility, making it difficult to establish an advanced airway through orotracheal intubation. This article aims to evaluate the correlation of clinical and sonographic parameters as predictors of difficult airway management (DAM) in patients with obesity and to establish the predictive value of the skin-epiglottis distance as an indicator of a probable DAM. METHODS: This is an observational, prospective study of 100 patients with obesity who underwent bariatric surgery over a 12-month period. The patients were categorized into the easy airway and the difficult airway groups, according to the Cormack-Lehane classification in the laryngoscopy evaluation, and the clinical and sonographic variables collected were statistically evaluated to obtain the relation with the presence of DAM, according to the Cormack-Lehane classification. RESULTS: The mouth opening (p = 0.010) and the skin-epiglottis distance (p = 0.019) were statistically significant when comparing the easy airway and the difficult airway groups of the Cormack-Lehane classification. The predictive value of the skin-epiglottis distance for difficult airway assessment was 29.3 mm. The neck circumference (p = 0.225), the Mallampati index (p = 0.260), and the other clinical variables showed no statistical relevance when compared in isolation with the Cormack-Lehane groups. CONCLUSION: The ultrasound method as a predictor of difficult intubation is promising in anesthetic practice when used according to standardized measurements evaluation and cutoff values.