Fear of Blindness in Patients Undergoing Cataract Surgery.

BACKGROUND: Fear is a negative emotion induced by the threat of danger, pain and harm. Cataract surgery is one of the most performed surgeries in the world. The aim of this study was to investigate and analyze the predominant fears in patients undergoing cataract surgery. SUBJECTS AND METHODS: In this cross-sectional study 152 patients were examined. Self-designed questionnaires to examine emotions of the fear, anxiety, nervousness frequency gratitude was used and insecurity immediately before cataract surgery. We also examined what the greatest fear during the cataract surgery was. The fear of blindness was compared with other life fears such as cancer, memory loss, AIDS, stroke and heart attack. The presence of fear was compared in patients having had previous cataract surgery with those undergoing their first cataract surgery. Including criteria were adults with senile cataract. Excluding criteria was ocular co-morbidity, psychiatric disorders, inability to read, deafness and surgery under general anesthesia. Completed questionnaires were analyzed. Pearson's chi-squared test was used. RESULTS: Fear was the most frequent emotion before cataract surgery, present in 60.5% patients. Fear of blindness was the greatest fear during cataract surgery in 55.3% of patients. There was no statistically significant difference in fear in patients having undergone their first cataract surgery and patients before their second cataract surgery (p<0.05). CONCLUSION: Fear is the predominant emotion before cataract surgery which is in correlation to the leading life fear - fear of blindness. Good preoperative preparation and a trusting doctor-patient relationship are important for reducing the fear of the procedure.

Klippel-Feil syndrome misdiagnosed as spondyloarthropathy: case-based review.

Spondyloarthropathy refers to any joint disease of the vertebral column, but the term is mainly used for a specific group of disorders called seronegative spondyloarthropathies (SpAs). The axial skeletal involvement, peripheral and extra-articular manifestations and an association with the major histocompatibility complex class I human leukocyte antigen-B27 (HLA B27) are commonly shared features of SpAs. Klippel-Feil syndrome (KFS) is a rare congenital disorder characterized by the fusion of one or more cervical vertebrae, accompanied by various skeletal and extra-skeletal anomalies. We report a case of an adult male patient with HLA B27 positivity presenting with chronic cervical spine pain accompanied by morning stiffness and periodic night pain, with radiologically confirmed ankylosis and fusion of several cervical segments. His medical history included urogenital abnormalities operated in childhood and mild mitral prolapse. Initially suspected diagnosis of an early axial form of SpA was rejected after thorough workup. Instead, the nature of vertebral defects along with the past medical history of urogenital and cardiac abnormalities pointed towards the diagnosis of KFS. HLA B27 presence can be a confounder in patients presenting with spinal pain and that is why the differential diagnosis of CSD-s and SpA can be challenging in some patients.

Correspondence of vitamin D status with functional scores and disease activity among Croatian patients with ankylosing spondylitis: a preliminary study.

BACKGROUND: Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease which primarily affects the axial spine and sacroiliac joints. Over the past several years Vitamin D has been recognized as a hormone with significant immunomodulatory effect due to the fact that it inhibits T-cell proliferation and decreases the production of interleukin-2, interferon-γ, and tumor necrosis factor-α. Therefore, vitamin D may play a role in the development and progression of inflammatory diseases. Our aim was to estimate and evaluate the correspondence of vitamin D status with functional scores, spinal mobility and disease activity among patients with AS in Croatia. SUBJECTS AND METHODS: One hundred and fifty (150) AS patients were prospectively enrolled and assessed for disease activity, spinal mobility and functional disability. Blood samples were obtained from all patients and 25(OH)D concentration and inflammatory markers were determined. All patients underwent bone mineral density measurement at the lumbar spine (L1-L4) and proximal femur (total hip and femoral neck) with dual-energy x-ray absorptiometry. RESULTS: The prevalence of 25(OH)D inadequacy considering cut-offs of 75, 50 and 30 nmol/L was 80, 46.7 and 16.7% respectively. The mean 25(OH)D serum concentration was 52.63±23.45 nmol/L. There was no significant difference in mean 25(OH)D concentration regarding patient's age, sex, smoking status, season change, disease activity, spinal mobility or functional scores. However, there was a trend towards lower 25(OH)D concentration in patients with higher disease activity, worse spinal mobility and worse functional scores. CONCLUSION: Our results showed that there is no significant association between serum 25(OH)D concentration and activity of AS. Given that significant proportion of our patients had inadequate vitamin D status, the role of vitamin D in pathophysiology of AS still remains to be elucidated.

Prevalence and Correlation of Depressive Symptoms with Functional Scores, Therapy and Disease Activity among Croatian Patients with Rheumatoid Arthritis: A Preliminary Study.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic, autoimmune and disabling disease that significantly affects the quality of life. Additionally, significant number of patients with RA suffer from depressive disorders, which are commonly underrecognised and undertreated. We aimed to estimate the prevalence of depressive symptoms in Croatian RA patients and to assess the relationship between them and clinical correlates. SUBJECTS AND METHODS: Fifty-four RA patients treated at the Clinic for Rheumatic Diseases and Rehabilitation at the University Hospital Centre Zagreb were prospectively enrolled in the study and evaluated for functional status using the Disease Activity Score 28 (DAS-28), Health Assessment Questionnaire (HAQ), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and Visual Analogue Scale (VAS) for pain and health related quality of life (HRQL) measurement. The depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II) questionnaire. RESULTS: Thirty RA patients (55.6%) had some sort of mood disorder, with 10 (18.5%) patients accounting as depressed. Positive correlation was found between depressive symptoms, higher disease activity and disablity during daily activities (τb=0.385, p=0.001 and τb=0.282, p=0.024 respectively). We found no significant association between depression and disease activity in the whole sample of RA patients, but for postmenopausal patients, the disease activity correlated with postmenopausal patients accounting as depressed (BDI-II score moderate or severe; τb=0.363, p=0.021). The use of biologic therapy correlated negatively with the disease acitivity, pain intensity and worse health related quality of life score (τb=-0.360, p=0.06; τb=-0.310, p=0.07; τb=-0.380, p=0.01 respectively). CONCLUSION: Considering the high prevalence of depressive sympoms in RA patients and the effect on functional disability and quality of life, we wanted to emphasize the importance of recognizing and optimizing depression treatment through multidisciplinary approach in RA patients.