Cardiac autonomic neuropathy: The hidden cardiovascular comorbidity in elderly patients with chronic obstructive pulmonary disease attending primary care settings.

AIM: To quantify the prevalence of chronic comorbidities including cardiac autonomic neuropathy among elderly patients with chronic obstructive pulmonary disease (COPD). METHODS: A cross-sectional study was carried out on 175 elderly male patients with COPD attending Ain Shams University Hospital, Cairo, Egypt. The comorbidities that might alter cardiac autonomic function in patients with COPD were identified. The patients without reported comorbidities underwent arterial blood gas analysis, pulmonary function tests and autonomic function assessment using cardiovascular reflexes. RESULTS: A total of 69.14% of the participants presented with comorbidities (group 1), whereas 30.85% of the participants reported no comorbidity (group 2). Among the participants, the most prevalent comorbid diseases were hypertension (34.20%), cor pulmonale (31.42%), ischemic heart disease (20.00%), diabetes (18.28%) and congestive heart failure (13.70%). In group 2, 29.60% and 22.20% of the patients had early and definite cardiac autonomic neuropathy (CAN) respectively. CAN occurred early in the course of the disease with 40.90% of mild COPD cases being affected. The patients with definite CAN had the highest resting heart rate. The presence of CAN was related to hypercapnia, but not hypoxemia or COPD severity. CONCLUSION: COPD has a complex spectrum of comorbidities. Cardiac autonomic neuropathy in elderly male patients with COPD correlated with hypercapnia, but not hypoxemia or the disease severity.

Cross-cultural adaptation of an Arabic version of the 10-item hearing handicap inventory.

OBJECTIVE: The purpose of this study was to translate and culturally adapt an Arabic version of the hearing handicap inventory for the elderly - screening (HHIE-S). DESIGN: The HHIE-S was translated following cross-cultural adaptation guidelines, and pretested in 20 elderly patients with hearing impairment. Next, the adapted Arabic HHIE-S underwent psychometric evaluation. The results were confirmed by pure-tone audiometer (PTA) examination. The patients completed the HHIE-S again after one hour. The validation of the questionnaire using Cronbach's alpha (internal consistency), (construct validity), and intraclass correlation coefficients (repeatability) was performed. STUDY SAMPLE: Twenty elderly subjects with hearing impairment were recruited for the pretesting stage, and 100 elderly subjects were recruited for the psychometric evaluation stage. Patients with acute illness, functional dependency, cognitive impairment, and previous users of hearing aids were excluded. RESULTS: The adapted Arabic HHIE-S showed good internal consistency (α = 0.902). Construct validity was good, as high correlations were found between the scale and the PTA outcome (r = 0.688, p = 0.000). Repeatability was high (ICC = 0.986). CONCLUSIONS: This study showed that the adapted Arabic HHIE-S is a valid and reliable questionnaire for the assessment of handicapping hearing impairment in Egyptian elderly patients.

Association of high-sensitivity C-reactive protein with carotid artery intima-media thickness in hypertensive older adults.

Hypertension is a major traditional risk factor for atherosclerosis. Increased carotid artery intima-media thickness (IMT) is considered to be a noninvasive marker of global atherosclerotic disease. The aim of this study is to assess the association between C-reactive protein (CRP) and carotid artery IMT among hypertensive older adults. A case-control study was done on 90 adults age 60 years and older, of which 60 were hypertensive (30 males and 30 females) and 30 were matched healthy controls. Measurements included conventional cardiovascular risk factors including obesity parameters, blood pressure, lipid profiles, smoking habits, the serum concentrations of high-sensitivity CRP (hs-CRP), and the carotid artery IMT. Hypertensive patients had higher body mass index, Total cholesterol, low-density lipoprotein, and hs-CRP level (P < .001) than the control group. Carotid artery IMT was significantly higher among the hypertensive group (P < .001). hs-CRP and hypertension duration were positively correlated to carotid IMT among the hypertensive group. All of the other factors failed to show a significant relationship with the carotid IMT. These results suggest inflammation, as measured by hs-CRP level, is associated with carotid artery IMT among hypertensive adults rather than other traditional risk factors.