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Marrie, Ruth Ann, Gary R. Cutter, and Tuula Tyry. "Substantial burden of dizziness in multiple sclerosis." Multiple Sclerosis and Related Disorders 2, no. 1 (January 2013): 21–28. http://dx.doi.org/10.1016/j.msard.2012.08.004.
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Neuhauser, Hannelore K., Andrea Radtke, Michael von Brevern, Franziska Lezius, Maria Feldmann, and Thomas Lempert. "Burden of Dizziness and Vertigo in the Community." Archives of Internal Medicine 168, no. 19 (October 27, 2008): 2118. http://dx.doi.org/10.1001/archinte.168.19.2118.
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Prell, Tino, Sigrid Finn, Hannah M. Zipprich, and Hubertus Axer. "What Predicts Improvement of Dizziness after Multimodal and Interdisciplinary Day Care Treatment?" Journal of Clinical Medicine 11, no. 7 (April 3, 2022): 2005. http://dx.doi.org/10.3390/jcm11072005.
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Background: Vertigo and dizziness are common in community-dwelling people and can be treated in specialized multidisciplinary settings. To develop tailored interventions, however, we have to explore risk factors for favorable and unfavorable outcomes. Methods: We prospectively investigated patients with chronic vertigo and dizziness subjected to our 5-day multimodal and interdisciplinary day care treatment in the Center for Vertigo and Dizziness of Jena University Hospital, Germany. The Vertigo Severity Scale (VSS), the Body Sensations Questionnaire (BSQ), the Hospital Anxiety and Depression Scale (HADS), the Agoraphobic Cognitions Questionnaire (ACQ), the Mobility Inventory (MI), and the burden and intensity of dizziness (using a visual analogue scale) were assessed at baseline (n = 754) and after 6 months (n = 444). In addition, 14 Likert-scaled questions were used to quantify the change in personal attitude and behavior towards the complaints after 6 months. Results: Dizziness-related burden and intensity improved with a large effect size. The largest improvement was seen in the attitudes towards dizziness, the understanding of somatic causes, and the perceived ability to influence dizziness. However, the ability to work and to carry out professional activity was improved to a lesser extent. The overall improvement of dizziness was associated with the absence of a depressive mood, a short duration of vertigo, a lower VSS, a lower perceived intensity of vertigo, and distinct vertigo diagnoses, namely Meniere’s disease, vestibular migraine, vestibular neuritis, vestibular paroxysmia, and vestibular schwannoma. Worsening of dizziness/vertigo was associated with depressive symptoms, permanent vertigo, distinct vertigo diagnoses (central vertigo, multisensory deficit), and a higher perceived burden due to vertigo. Conclusion: The six-month outcome of patients with dizziness presented to a specialized outpatient clinic appears to be favorable. Nevertheless, people with the abovementioned risk factors at baseline have less benefit and probably need adapted and tailored vertigo interventions to improve long-term outcome.
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Smulligan, Katherine L., Corrine N. Seehusen, Mathew J. Wingerson, Julie C. Wilson, and David R. Howell. "POST-CONCUSSION DIZZINESS SEVERITY PREDICTS DAILY STEP COUNT DURING RECOVERY AMONG ADOLESCENT ATHLETES." Orthopaedic Journal of Sports Medicine 10, no. 5_suppl2 (May 1, 2022): 2325967121S0040. http://dx.doi.org/10.1177/2325967121s00405.
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Background: Physical activity after concussion is an important aspect of appropriate management and may help to improve recovery time. However, symptom burden or functional deficits may be self-limiting and reduce activity level in the first weeks following a concussion. Purpose/Hypothesis: To examine dizziness and postural stability as potential predictors of physical activity level after concussion. We hypothesized that increased dizziness severity and more postural instability would predict lower step count acutely post-concussion. Methods: We initially evaluated athletes ages 12-18 years within 14 days of concussion using questionnaires and clinical tests to assess overall symptom burden, dizziness, and postural stability. Athletes were provided with an activity monitor that tracked daily step count for the subsequent two weeks after their initial care visit. Our primary outcome variable was daily step count (mean steps/day) during this two-week period. Potential predictor variables included participant characteristics (sex, age, time since injury, and history of: concussion, musculoskeletal injury, migraine, ADD, anxiety, depression), Post-Concussion Symptom Inventory (PCSI) total symptom burden, specific PCSI ratings of dizziness and balance impairment, and postural stability assessments [single and dual-task tandem gait (TG) and modified balance error scoring system (mBESS)]. To examine clinical predictors of activity we calculated Pearson correlation coefficients between mean steps/day and each potential predictor, and then included significantly correlated variables in a multiple linear regression model. Results: Athletes who participated in the study (n=35, mean 15.2±1.7 years of age, 49% female, mean steps/day=9195±3779) were initially evaluated a mean of 7.3±3.0 days post-concussion. PCSI dizziness rating (Pearson R=-0.49, p=0.003; Figure 1) and sex (mean difference=2449 steps/day, p=0.05) were associated with daily step count upon univariable evaluation and included in the multiple linear regression model. No other participant characteristics, symptom ratings, or objective balance or postural stability measures were significantly associated with steps/day (Table 1). In the multivariable model, PCSI dizziness rating (β=-1035; 95% CI: -191, -1880; p=0.018), but not sex, predicted average steps/day in the two weeks after initial clinical care visits. Conclusion: Self-reported dizziness severity assessed within 14 days of concussion predicted daily step count in the subsequent two weeks, while other measures of overall symptom severity and postural stability did not. Given the importance of physical activity for concussion recovery, identifying individuals with acute post-concussion dizziness may facilitate timely treatment of dizziness, potentially reducing a barrier to physical activity to improve recovery trajectories. [Figure: see text][Table: see text]
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Bisdorff, Alexandre, Colette Andrée, Michel Vaillant, and Peter S. Sándor. "Headache-associated dizziness in a headache population: Prevalence and impact." Cephalalgia 30, no. 7 (March 12, 2010): 815–20. http://dx.doi.org/10.1177/0333102409353617.
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Headache is an underestimated burden on general health and social functioning. Accompanying symptoms of headache episodes might influence this impact. In a survey in a headache population in Luxembourg on the social and emotional impact of headaches, accompanying symptoms of headache episodes were evaluated. In 1909 participants with episodic (<15 days per month) headaches (77.1% women), visual symptoms (52.4%) and dizziness (51.1%) were frequent accompanying symptoms of headache episodes. Visual symptoms and dizziness were each independently associated with migraine in both genders and independently associated with greater headache-related disability (scored on the Migraine Disability Scale [MIDAS]), more severe depression, and higher disability as measured by the disease-independent World Health Organization Disability Assessment Schedule (WHODAS). We found that dizziness is a frequent accompanying symptom of headache, particularly in migraine. The presence of dizziness was found to have an exacerbating impact on disability and depression associated with headaches. The effect of dizziness was comparable in magnitude and independent from the presence of visual symptoms.
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Smulligan, Katherine, Mathew Wingerson, Corrine Seehusen, Julie Wilson, and David R. Howell. "Examining Initial Post-Concussion Dizziness and Postural Stability as Potential Recovery Predictors." Neurology 98, no. 1 Supplement 1 (December 27, 2021): S17.1—S17. http://dx.doi.org/10.1212/01.wnl.0000801892.78481.b1.
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ObjectiveTo examine the association between acute post-concussion dizziness, initial symptom severity, and postural stability with time to symptom resolution among adolescents.BackgroundIdentifying early post-concussion symptoms and functional deficits that predict symptom resolution can guide treatment strategies. Dizziness is among the most common concussion symptoms, and existing literature investigating the association between dizziness and recovery time is mixed.Design/MethodsParticipants underwent initial evaluation = 14 days post-concussion, and self-reported symptom severity using the Post-Concussion Symptom Inventory (PCSI). We used PSCI dizziness ratings to group participants: a difference between current and pre-injury dizziness ≥3 = dizzy; difference <3 = not dizzy. We evaluated postural stability using modified Balance Error Scoring System (mBESS) and tandem gait (TG). Patients were followed until symptom resolution, and our primary outcome of interest was time from concussion to symptom resolution. Using a univariable Cox proportional hazard model, we examined the association of dizziness and symptom resolution time. We then used a multivariable Cox proportional hazard model to adjust for variables that differed between groups.ResultsWe examined 89 participants, grouped as dizzy (n = 34; age = 14.7 ± 2.7 years; 7.1 ± 3.4 days post-injury; symptom resolution time = 40.8 ± 5.7 days) or not dizzy (n = 55; age = 14.4 ± 2.3 years; 7.2 ± 3.1 days post-injury; symptom resolution time = 23.3 ± 3.2 days). Upon univariable examination, dizziness was independently associated with symptom resolution time (HR = 0.49; 95% CI: 0.28, 0.83; p = 0.009). After adjusting for potential confounding variables (initial symptom severity, mBESS tandem stance errors, TG time, and loss of consciousness) multivariable model results indicated initial symptom severity was the only variable associated with symptom resolution time (HR = 0.98; 95% CI: 0.96, 0.997; p = 0.025).ConclusionsTotal symptom severity, but not dizziness or postural stability, was significantly associated with symptom resolution time among adolescents following concussion. Individuals with moderate to severe post-concussion dizziness had higher average symptom scores indicating self-reported dizziness should be interpreted in the context of total concussion symptom burden.
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Kordafshari, Gholamreza, Mohammad Reza Shams Ardakani, Mansoor Keshavarz, Mohammad Mehdi Esfahani, Esmaeil Nazem, Maryam Moghimi, Arman Zargaran, and Hoorieh Mohammadi Kenari. "The Role of Phlebotomy (Fasd) and Wet Cupping (Hijamat) to Manage Dizziness and Vertigo From the Viewpoint of Persian Medicine." Journal of Evidence-Based Complementary & Alternative Medicine 22, no. 3 (October 20, 2016): 369–73. http://dx.doi.org/10.1177/2156587216672757.
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Dizziness and vertigo are the most common complaints of patients that has a high economic burden on the health system. In modern medicine, treatment for dizziness and vertigo consists of chemical pharmacological therapy. Although these drugs are useful in controlling the disease, their side effects and inefficiency in full control of the disease require the use of complementary medicine in this field. Persian medicine consists of valuable experiences of Persian medicine scholars based on the theory of humors and temperaments. In Persian medicine, 2 types of disease are presented: dizziness ( sadar) and vertigo ( dovar). Persian medicine physicians expressed a different mechanism of action than modern medicine for these diseases. They believed that accumulation of abnormal humors, reeh (normal bloating) or causative pathologic substances, is the basic cause of sadar and dovar and that the most important treatment is cleansing the body, particularly the head from accumulated substances by bloodletting methods.
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Hunt, *Danielle L., Jessie Oldham, Stacey E. Aaron, Can Ozan Tan, William P. Meehan, and David R. Howell. "DIZZINESS, PSYCHOSOCIAL FUNCTION, AND GAIT ASSESSMENT FOLLOWING SPORT-RELATED CONCUSSION." Orthopaedic Journal of Sports Medicine 9, no. 7_suppl3 (July 1, 2021): 2325967121S0005. http://dx.doi.org/10.1177/2325967121s00059.
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Background: Dizziness after concussion can be detrimental to both the physical and psychosocial wellbeing of patients. Vestibular symptoms, in particular, can amplify postural instability, which may create a greater sense of mental and physical abnormality post-concussion. Purpose: To examine the three-way association between self-reported dizziness with concussion symptoms, depression and anxiety severity, and gait deficits within two weeks post-concussion. We hypothesized that participants who endorsed a moderate/severe level of dizziness would report a more severe concussion symptom burden, more severe depression and anxiety, and worse postural stability. Methods: For this cross-sectional study, participants ages 14-21, were recruited from either a regional sports concussion clinic or emergency department, and tested within 14 days of a diagnosed concussion. Participants completed the Dizziness Handicap Inventory (DHI), Post-Concussion Symptom Inventory (PSCI), and Hospital Anxiety and Depression Scale (HADS).They also completed an instrumented single/dual-task gait assessment (three trials per condition). The gait assessment included walking at a self-selected pace towards a target 8m ahead, then returning to the start line. Dual task trials included a cognitive task (months in reverse order, serial 7’s, and spelling a 5-letter word backwards) while walking. Descriptive statistics, independent t-tests, and Mann Whitney U tests were used to compare between those with moderate/severe dizziness (DHI score ≥36) and those with mild/no dizziness (DHI score <36), p<0.05. Results: 40 participants completed the study. 19 self-reported moderate/severe dizziness (63% female, 17.1±2.4 years of age, average DHI score 48.4±12.6) and 21 mild/no dizziness (38% females, 16.5±1.9 years of age, average DHI score 18.7±9.3). Those with moderate/severe dizziness reported significantly more severe symptoms (PSCI: 43.0±20.6 vs. 22.8±15.7, p=0.001), and had higher median HADS anxiety (6 vs. 2, p<0.001) and depression (6 vs. 1, p=0.001) scores than those with no/minimal dizziness. During steady-state gait, the moderate/severe dizziness group walked with significantly lower single-task cadence (Figure 1B) and dual-task cadence (Figure 1E) than the no/mild dizziness group. Conclusion: Participants who self-reported a moderate to severe level of dizziness within 14 days of a concussion reported worse symptom severity, anxiety, and depression than those with no/mild dizziness. Further, cadence during gait is negatively affected by the level of dizziness reported. Clinicians should be aware of the psychosocial and physical effects dizziness symptoms may play in a patient’s recovery. Gait deficits in the moderate/severe dizziness group further indicate the importance of evaluating how the feeling of postural instability affects gait following concussion. Word Count: 389/400 [Figure: see text]
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Andresen, Nicholas S., Tiffany McIntyre, Bryan K. Ward, Melanie Dawn Nelson, Amir Kheradmand, Lydia H. Pecker, Sophie M. Lanzkron, and Eboni I. Lance. "Sickle Cell Disease and Vestibular Dysfunction." Blood 138, Supplement 1 (November 5, 2021): 4183. http://dx.doi.org/10.1182/blood-2021-153514.
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Abstract Introduction: Sickle cell disease (SCD), a common genetic disease involving red blood cell structure and function, is associated with cerebral vasculopathy and increased risk of ischemic events that may also affect the inner ear. Individuals with SCD are at increased risk for hearing loss; however, little is known regarding the effects of SCD on the vestibular system or the relationship between hearing loss and vestibular symptoms in these patients. Vestibular dysfunction affects 15-20% of the general population can lead to significant morbidity through falls, fall-related injuries, missed work, and overall reduction in quality of life. Methods: To assess the burden of vestibular dysfunction amongst individuals with SCD, we surveyed individuals with SCD who answered questions about symptoms of dizziness, imbalance, and hearing loss. The survey also captured demographic information, current symptoms of dizziness/imbalance, symptoms of hearing loss, and history of falls. Fisher's exact test was performed to test for associations between clinical characteristics including SCD genotype, hearing loss, dizziness or imbalance, and headache history. Results: Twenty-six participants, ages 20 to 73 years (median 37.5 years) completed the survey. All participants were Black or African-American. Five participants (19.2%) were male, 15 (58%) had hemoglobin SS, 8 (32%) hemoglobin SC, and 3 (12%) S-β + thalassemia. Three (11.5%) participants reported hearing loss. Twelve (46.2%) participants reported dizziness or imbalance, of which 8 (66%) reported recent falls. Of the 12 participants experiencing dizziness, 9 (75%) reported having dizziness for 1 to 3 days a month, 2 reported having dizziness for 4 to 9 days a month, and 1 reported having dizziness for more than 15 days a month. Three participants reported their dizziness symptoms resolved within seconds, 7 within minutes, and 2 within hours. Eleven (42.3%) participants reported headaches. Self-reported dizziness or imbalance was not associated with hearing loss (X 2=0.57; p=0.45), SCD genotype (X 2=0.75; p=0.68), or sex (X 2=0.09; p=0.76). Headache history was associated with dizziness or imbalance (X 2=9.76; p=0.002). Conclusions: In this small pilot study, 46% of individuals with SCD reported dizziness or imbalance, which is twice the rate reported amongst the general population. Headache history is associated with dizziness and imbalance amongst individuals with SCD. Further investigation is warranted to determine the specific effects of SCD on the vestibular end-organs. Disclosures Lanzkron: Imara: Research Funding; Pfizer: Current holder of individual stocks in a privately-held company; GBT: Research Funding; Shire: Research Funding; Teva: Current holder of individual stocks in a privately-held company; Novartis: Research Funding; Novo Nordisk: Consultancy; Bluebird Bio: Consultancy; CSL Behring: Research Funding. Lance: Novartis: Other: participated in research advisory board in 2020.
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Pradhan, Sara. "Psychological burden of anaphylaxis and the fight for an EpiPen." BMJ Case Reports 14, no. 9 (September 2021): e243838. http://dx.doi.org/10.1136/bcr-2021-243838.
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A university student with a background of atopy presented to her general practitioner (GP) 2 weeks following an episode of throat tightening and dizziness occurring after touching cashew nut to her lip. She took antihistamine medication immediately and went to sleep, fearing for her life. On waking, she felt astounded to be alive. Her symptoms resolved gradually over the following week. She waited 2 weeks for an appointment with her GP, who referred her to allergy clinic. Eight months later, she was still waiting for her clinic appointment, and was left fearing a future fatal reaction, having been provided with no interim treatment. Not all patients who have severe allergic reactions present to the emergency department. Living with the constant fear of anaphylaxis can be overwhelming for patients and their families, and it can negatively impact mental health. Therefore, we advise early allergy counselling and early EpiPen prescription.
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Mueller, Martin, Ralf Strobl, Klaus Jahn, Birgit Linkohr, Annette Peters, and Eva Grill. "Burden of disability attributable to vertigo and dizziness in the aged: results from the KORA-Age study." European Journal of Public Health 24, no. 5 (November 8, 2013): 802–7. http://dx.doi.org/10.1093/eurpub/ckt171.
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Fox, Apollonia, Kristal Riska, Chin-Lin Tseng, Kelly McCarron, Serena Satcher, Omowunmi Osinubi, and Drew Helmer. "Dizziness, Vertigo, and Mental Health Comorbidity in Gulf War Veterans." Journal of the American Academy of Audiology 30, no. 09 (October 2019): 764–71. http://dx.doi.org/10.3766/jaaa.17122.
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AbstractGulf War Illness (GWI) is a chronic condition involving symptoms across multiple body systems. Previous research has implicated the vestibular system as a potential underlying factor in the symptoms experienced by veterans with GWI, due in part to exposure to potentially ototoxic chemicals and events.To characterize the presence of vertigo and dizziness symptoms in a sample of veterans with GWI using validated self-report instruments, accounting for mental health comorbidities.This is a case series, follow-up, prospective interview of clinical veterans; results presented are purely descriptive.Our sample of 50 veterans was a follow-up to a case series of clinical Gulf War veterans evaluated at the War Related Illness and Injury Study Center.Veterans participated in a 70-min phone interview where the following questionnaires were administered: Vertigo Symptom Scale (VSS), Patient Health Questionnaire (depression scale), Patient Health Questionnaire (somatization scale), Beck Anxiety Inventory, Posttraumatic Stress Disorder (PTSD) Checklist, Defense and Veterans Brain Injury Center Traumatic Brain Injury Questionnaire, and GWI (Kansas) Questionnaire. We used descriptive (mean/median, standard deviation, interquartile range, and percentage) statistics to describe our sample and illuminate possible relationships between measures.Our primary finding is a substantial report of vertigo symptoms in our sample, according to the VSS. Ninety percent of participants scored above the VSS threshold (>12), suggesting “severe dizziness.” The most commonly endorsed symptom on the VSS was “headache or pressure in the head.”We conclude that there is significant burden of vertigo symptoms in veterans with GWI, suggesting a need for objective tests of vestibular function in this population. Furthermore, the relationship between symptoms of vertigo and dizziness, vestibular function, and PTSD warrants further exploration using objective measures.
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Xiao, Zhijian, Robyn M. Emanuel, Amylou C. Dueck, Zefeng Xu, Yue Zhang, Xiujuan Sun, Junqing Xu, et al. "Symptom Burden Characteristics Among Chinese Patients with Myeloproliferative Neoplasms (MPNs)." Blood 120, no. 21 (November 16, 2012): 1739. http://dx.doi.org/10.1182/blood.v120.21.1739.1739.
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Abstract Abstract 1739 BACKGROUND: Differences in symptom burden characteristics between persons of European and non-European descent with BCR-ABL negative MPNs including essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (MF) are not studied. We reported significant clinical and laboratory differences between these populations age at diagnosis and survivals (Blood 2011;119: 2469–73) which could affect symptom burden. Given China represents one-fifth of the global population, we aimed to evaluate MPN symptom burden among a cohort of Chinese MPN patients. METHODS: Data were collected from Chinese with MPNs and their physicians and compared these to a previously collected data from a cohort of subjects of predominately European descent (N=1488). Subject data included MPN-SAF (Blood 2011;118:401-8) and BFI score (Cancer 1999;85: 1186–96), demographics, and disease-related features. Statistical methods included ANOVA, chi-squared tests, and multiple regressions. RESULTS: Demographic and Disease Characteristics: 397 Chinese subjects were prospectively enrolled with a distribution of 172 (43%) ET, 102 (26%) PV, and 123 (31%) MF (of which 103 [84%] were PMF, 14 [11%] were post-ET MF, and 6 [5%] were post-PV MF). Median age (56.0 y) was younger in Chinese than in the European-descent cohort (63.0 y, p<0.001) despite relative gender equality. Laboratory abnormalities including anemia (76%, p<0.001) and disease features including bleeding (1%, p<0.001), were more common and present at a significantly higher incidences in the European-descent cohort than amongst Chinese. Chinese Symptom Severity and Incidence by MPN type: When comparing across MPN types, symptoms of worst fatigue, early satiety, abdominal discomfort, inactivity, concentration, depression, cough, night sweats, weight loss, and total MPN-SAF TSS score varied significantly (p<0.05) with MF being most severe for each symptom. Chinese versus European-descent Symptom Severity: After adjusting for age and MPN type, Chinese subjects had significantly higher mean severity for fever, sexual difficulties, and quality of life (Table 1). Symptoms of worst fatigue, early satiety, abdominal discomfort and overall BFI score had a significantly higher mean severity in the European descent cohort. Chinese versus European-descent Symptom Incidence: The European-descent cohort had significantly greater incidence of worst fatigue (90% vs 81%, p<0.001), abdominal pain (47% vs 35%, p<0.001), early satiety (65% vs 57%, p=0.005), concentration problems (64% vs 58%, p=0.04), numbness (63% vs 56%, p=0.02), insomnia (68% vs 58%, p<0.001), and depression (62% vs 56%, p=0.02) compared to Chinese subjects. In contrast, symptoms of dizziness (63% vs 57%, p=0.04), sexual difficulties (72% vs 61%, p<0.001), and fever (23% vs. 18%, p=0.03) were significantly worse amongst Chinese. CONCLUSION: We found a significant divergence in severity and incidence of key symptom burdens including QOL, fever, sexuality, dizziness, abdominal pain, early satiety, and fatigue between Chinese and persons of European descent with MPNs. Biological and cultural factors likely account for these differences and should be considered when interpreting outcomes of clinical trials of diverse populations. When the target of therapy is reversing symptoms, the best strategy may require revision for different populations. Disclosures: Mesa: Incyte: Research Funding; Lilly: Research Funding; Sanofi: Research Funding; NS Pharma: Research Funding; YM Bioscience: Research Funding.
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Gorup, Eva, Janez Rifel, and Marija Petek šter. "Anticholinergic burden and most common anticholinergic-acting medicines in older general practice patients." Slovenian Journal of Public Health 57, no. 3 (June 21, 2018): 140–47. http://dx.doi.org/10.2478/sjph-2018-0018.
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AbstractIntroductionAnticholinergic burden in older adults has been correlated with cognitive decline, delirium, dizziness and confusion, falls and hospitalisations. Nevertheless, anticholinergic-acting medications remain commonly prescribed in up to a third of older adults in primary care population. Our aim was to study the anticholinergic burden in older adults in Slovenian ambulatory setting and explore the most commonly involved medications which could be avoided by the physicians.MethodsA cross-sectional study was conducted in 30 general practices in Slovenia as part of a larger trial. Data on prescribed medications were collected for randomly chosen adults of over 65 years of age visiting general practice, who were taking at least one regularly prescribed medication. Anticholinergic burden was calculated using Duran’s scale and Drug Burden Index.ResultsAltogether, 622 patients were included, 356 (57.2%) female, average age of 77.2 (±6.2), with an average of 5.6 medications. At least one anticholinergic medication was present in 78 (12.5 %) patients. More than half (N=41, 52.6%) of anticholinergic prescriptions were psychotropic medications. Most common individual medications were diazepam (N=10, 1.6%), quetiapine (N=9, 1.4%) and ranitidine (N=8, 1.3%).ConclusionsThough the prevalence of anticholinergic medications was low compared to international research, the most commonly registered anticholinergic prescriptions were medications that should be avoided according to guidelines of elderly prescriptions. It would be probably clinically feasible to further decrease the anticholinergic burden of older adults in Slovenian primary care setting by avoiding or replacing these medications with safer alternatives.
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Menant, Jasmine C., Americo A. Migliaccio, Daina L. Sturnieks, Cameron Hicks, Joanne Lo, Mayna Ratanapongleka, Jessica Turner, et al. "Reducing the burden of dizziness in middle-aged and older people: A multifactorial, tailored, single-blind randomized controlled trial." PLOS Medicine 15, no. 7 (July 24, 2018): e1002620. http://dx.doi.org/10.1371/journal.pmed.1002620.
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Lam, David Ming Hon, Cherry Wang, Aaron Kin Ho Lee, Yu Fai Chung, Tak Wing Lau, Christian Fang, Frankie Leung, and Timmy Chi Wing Chan. "Multi-Component Care Bundle in Geriatric Fracture Hip for Reducing Post-Operative Delirium." Geriatric Orthopaedic Surgery & Rehabilitation 12 (January 1, 2021): 215145932110045. http://dx.doi.org/10.1177/21514593211004530.
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Background: Delirium in elderly orthopaedic patients poses an enormous medical, social and financial burden to the healthcare system, and causes significant distress to patients and their caregivers. We examined whether a Multi-component Care Bundle (MCB) could reduce the incidence of post-operative delirium (POD) in fractured hip patients. Methods: An observational study was conducted, analyzing 154 patients (mean age ± SD, 85 ± 7.8, 68% women) admitted to Queen Mary Hospital with hip fracture. Half of the patients were cared for in the control group before MCB was introduced, which included installation of orientation aids, introduction of a Caregiver Empowerment Program, and incorporation of ultrasound-guided Fascia Iliaca Block (FIB) into the analgesia protocol. Results: There were fewer patients with POD in the MCB group, compared with the control group (18/76, 23.4% v 34/76, 44.2%, p = 0.006). Patients in MCB group consumed less opioid ( 4/77 v 13/77, p = 0.048), experienced less post-operative dizziness (2/77, 2.6% v 13/77, 16.9%, p = 0.003) and had a shorter median day to start walking post-operatively (day 1 [IQR 1-2] vs day 2 [IQR 2-3]; p = 0.001) than the control group. Length of stay was not affected. Conclusion: MCB effectively reduces POD, postoperative dizziness, opioid consumption, and days to start mobilization postoperatively.
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Mazza, Gina L., Carolyn Mead-Harvey, John Mascarenhas, Abdulraheem Yacoub, Ronald Hoffman, Heidi E. Kosiorek, Josef T. Prchal, et al. "Symptom Burden and Quality of Life in High-Risk Essential Thrombocythemia and Polycythemia Vera Patients Receiving Hydroxyurea or Pegylated Interferon Alfa-2a: Results of Myeloproliferative Neoplasms Research Consortium (MPN-RC) 111 and 112 Trials." Blood 136, Supplement 1 (November 5, 2020): 19–21. http://dx.doi.org/10.1182/blood-2020-142817.
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Introduction Essential thrombocythemia (ET) and polycythemia vera (PV) patients suffer from various symptoms that worsen quality of life (QOL), yet serial data on symptom changes resulting from therapy are sparse in the literature. Patient questionnaires from 2 large multicenter trials (MPN-RC 111, 112) were used to assess change in symptom burden and QOL over 12 months and impact of baseline symptom burden on subsequent change in ET / PV patients on hydroxyurea (HU) or pegylated interferon alfa-2a (PEG). Methods Trials MPN-RC 111 was a single-arm, open-label, phase II trial evaluating response to PEG in high-risk ET / PV patients with HU resistance/intolerance or splanchnic vein thrombosis (SVT; NCT01259817). MPN-RC 112 was a randomized, open-label, phase III trial comparing response to PEG versus HU in cytoreductive therapy naïve high-risk ET / PV patients diagnosed < 5 years ago (NCT01258856). Measures Patients reported disease-related symptoms via the validated Myeloproliferative Neoplasms Symptom Assessment Form (MPN-SAF), QOL via the European Organisation for the Research and Treatment of Cancer Core QOL Questionnaire (EORTC QLQ-C30), and (if applicable) PEG-related symptoms (flu-like symptoms, injection site irritation, blurry vision, vision change, flushing) at baseline, 3, 6, 9, and 12 months. Analysis Mixed models assessed mean changes from baseline in the MPN-SAF Total Symptom Score (TSS), MPN-SAF items, QOL, and PEG-related symptoms in MPN-RC 111, 112 PEG, and 112 HU patients. Mixed models also assessed the impact of baseline symptom burden (high [TSS ≥ 20] versus low) on subsequent change in PEG (MPN-RC 111 and 112) and HU patients. Results Patients Of the 135 enrolled MPN-RC 111 patients, 20 with SVT and 1 with no questionnaires were excluded. Of the remaining 114, 64 (56%) / 50 (44%) had ET / PV. Patients were 51% / 48% female. Median age was 65 / 64 years, and median time since diagnosis was 38 / 55 months. 31% / 22% had prior thrombosis, and 19% / 56% had splenomegaly. Of the 168 enrolled MPN-RC 112 patients (82 PEG, 86 HU), 2 with no questionnaires were excluded. Of the remaining 166, 79 (48%) / 87 (52%) had ET / PV. Patients were 50% / 33% female. Median age was 60 / 62 years, and median time since diagnosis was 3 / 3 months. 25% / 29% had prior thrombosis, and 11% / 37% had splenomegaly. Symptoms Questionnaire completion rates ranged from 90 - 99%, 87 - 100%, and 75 - 96% for on-treatment MPN-RC 111, 112 PEG, and 112 HU patients. At baseline, TSS (0 [absent] - 100 [worst imaginable]) and QOL (0 [very poor] - 100 [excellent]) means (SDs) were 19.5 (18.4) and 71.6 (20.1) for MPN-RC 111, 17.0 (13.6) and 67.9 (24.3) for MPN-RC 112 PEG, and 14.6 (11.4) and 73.8 (18.8) for MPN-RC 112 HU patients. On average, MPN-RC 111 patients had significant improvement of TSS, fatigue, abdominal pain, abdominal discomfort, dizziness, numbness, night sweats, and fever; MPN-RC 112 PEG patients had significant worsening of fever; and MPN-RC 112 HU patients had significant worsening of inactivity (no mean changes indicating improvement were observed). PEG patients had significant worsening of PEG-related symptoms. The greatest improvements occurred in the 46 (40%), 27 (33%), and 23 (28%) MPN-RC 111, 112 PEG, and 112 HU patients with high baseline symptom burden. On average, PEG patients with high baseline symptom burden had significant improvement of TSS, fatigue, early satiety, abdominal pain, abdominal discomfort, inactivity, headache, concentration, dizziness, numbness, insomnia, cough, night sweats, itching, bone pain, fever, weight loss, and QOL, while those with low baseline symptom burden had significant worsening of TSS, early satiety, headache, itching, and bone pain. On average, HU patients with high baseline symptom burden had significant improvement of TSS, early satiety, abdominal discomfort, headache, dizziness, numbness, insomnia, itching, and weight loss, while those with low baseline symptom burden had significant worsening of TSS, early satiety, abdominal discomfort, inactivity, concentration, and sexual desire/function (Figures 1 and 2). Conclusions Although no statistical comparisons were made across trials, overall improvements were seen in MPN-RC 111 but not 112. Patients with high baseline symptom burden experienced the greatest improvements in symptom burden and QOL during treatment with PEG or HU, which may explain the improvements seen in the more advanced patients in MPN-RC 111 compared to 112. Disclosures Mascarenhas: Celgene, Prelude, Galecto, Promedior, Geron, Constellation, and Incyte: Consultancy; Incyte, Kartos, Roche, Promedior, Merck, Merus, Arog, CTI Biopharma, Janssen, and PharmaEssentia: Other: Research funding (institution). Yacoub:Dynavax: Current equity holder in publicly-traded company; Ardelyx: Current equity holder in publicly-traded company; Cara Therapeutics: Current equity holder in publicly-traded company; Hylapharm: Current equity holder in private company; Incyte: Speakers Bureau; Agios: Honoraria, Speakers Bureau; Novartis: Speakers Bureau; Roche: Other: Support of parent study and funding of editorial support. Hoffman:Protagonist: Consultancy; Forbius: Consultancy; Novartis: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Dompe: Research Funding. Silver:PharmaEssentia: Speakers Bureau. Mesa:Bristol Myers Squibb: Research Funding; Incyte: Research Funding; AbbVie: Research Funding; Samus Therapeutics: Research Funding; Genentech: Research Funding; CTI BioPharma: Research Funding; Promedior: Research Funding; Sierra Oncology: Consultancy; LaJolla Pharmaceutical Company: Consultancy; Novartis: Consultancy.
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Zullo, Andrew R., Matthew Olean, Sarah D. Berry, Yoojin Lee, Jennifer Tjia, and Michael A. Steinman. "Patient-Important Adverse Events of β-blockers in Frail Older Adults after Acute Myocardial Infarction." Journals of Gerontology: Series A 74, no. 8 (August 20, 2018): 1277–81. http://dx.doi.org/10.1093/gerona/gly191.
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Abstract Background We evaluated the burden of adverse events caused by β-blocker use after acute myocardial infarction (AMI) in frail, older nursing home (NH) residents. Methods This retrospective cohort study used national Medicare claims linked to Minimum Data Set assessments. The study population was individuals aged ≥65 years who resided in a U.S. NH for ≥30 days, had a hospitalized AMI between May 2007 and March 2010, and returned to the NH. Exposure was new use of β-blockers versus nonuse post-AMI. Orthostasis, general hypotension, falls, dizziness, syncope, and breathlessness outcomes were measured over 90 days of follow-up. Odds ratios (ORs) with 95% confidence intervals (CIs) for outcomes were estimated using multinomial logistic regression models after 1:1 propensity score-matching of β-blocker users to nonusers. Results Among the 10,992 NH propensity score-matched residents with an AMI, the mean age was 84 years and 70.9% were female. β-blocker users were more likely than nonusers to be hospitalized for hypotension (OR = 1.20, 95% CI 1.03–1.39) or experience breathlessness (OR = 1.10, 95% CI 1.01–1.20) after AMI. With the exception of falls, other outcome estimates, though imprecise, were compatible with a potential elevated risk of orthostasis (OR = 1.14, 95% CI 0.96–1.35), syncope, (OR = 1.24, 95% CI 0.55–2.77), and dizziness (OR = 1.28, 95% CI 0.82–1.99) among β-blocker users. Conclusions Considered alongside prior evidence that β-blockers may worsen functional outcomes in NH residents with poor baseline functional and cognitive status, our results suggest that providers should exercise caution when prescribing for these vulnerable groups, balancing the mortality benefit against the potential for causing adverse events.
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Möhwald, Ken, Stanislavs Bardins, Hans-Helge Müller, Klaus Jahn, and Andreas Zwergal. "Protocol for a prospective interventional trial to develop a diagnostic index test for stroke as a cause of vertigo, dizziness and imbalance in the emergency room (EMVERT study)." BMJ Open 7, no. 10 (October 2017): e019073. http://dx.doi.org/10.1136/bmjopen-2017-019073.
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IntroductionIdentifying stroke as a cause of acute vertigo, dizziness and imbalance in the emergency room is still a clinical challenge. Many patients are admitted to stroke units, but only a minority will have strokes. This imposes a heavy financial burden on the healthcare system. The aim of this study is to develop a diagnostic index test to identify patients with a high risk of having a stroke as the cause of acute vertigo and imbalance.Methods and analysisPatients with acute onset of vertigo, dizziness, postural imbalance or double vision within the last 24 hours lasting for at least 10 min are eligible to be included in the study. Patients with clinically proven peripheral or central aetiology will be excluded. In the emergency room, all enrolled patients will undergo standardised neuro-ophthalmological/physiological testing (including video-oculography, mobile posturography, measurement of subjective visual vertical) (EMVERT block 1). Within 10 days, standardised MRI will be performed as a reference test to identify stroke (EMVERT block 2). Data from EMVERT block 2 will be compared with results from block 1 in order to devise a diagnostic index test with a high specificity and sensitivity to predict the risk of stroke in the emergency room.Ethics and disseminationThe study was approved by the ethics committee of the University of Munich and will be conducted according to the Guideline for Good Clinical Practice, the Federal Data Protecting Act and the Helsinki Declaration of the World Medical Association in its recent version. Study results are expected to be published in international peer-reviewed journals and will be presented at international conferences.Trial registration numberGerman Clinical Trial Register: DRKS00008992; Universal trial number: U1111-1172-8719); pre-results.
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Alafyouni, Maisa, Derrick Huang, Shanna Jones, and Scott Kleiman. "Acute Bilateral Ischemic Stroke in a Young Adult without risk factors." Translation: The University of Toledo Journal of Medical Sciences 6 (December 3, 2019): 29–31. http://dx.doi.org/10.46570/utjms.vol6-2019-331.
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Cerebrovascular accidents (CVA) remain a leading cause of death as well as a major burden from both a quality of life and disability standpoint.1,2 This is particularly problematic for younger CVA patients who may be disabled during their most productive years of life.2,3 Although CVAs in younger patients are rare, incidence of CVAs among young adults continues to remain stable and these patients often present atypically, such as with headache and dizziness, highlighting a persistent concern for care providers.4-7 Furthermore, CVAs may be misdiagnosed as seizures and the sequelae of CVAs may themselves precipitate traumatic accidents, further obscuring assessment. These difficulties complicate differential diagnoses and result in the potential for misdiagnosis and delayed time-sensitive CVA treatment.5,8 We describe a case of a healthy young patient presenting to the ED initially as a trauma resuscitation and subsequently converting to a stroke resuscitation outside the window for tPA treatment.
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Baloh, Robert W. "Vestibular Migraine I: Mechanisms, Diagnosis, and Clinical Features." Seminars in Neurology 40, no. 01 (January 14, 2020): 076–82. http://dx.doi.org/10.1055/s-0039-3402735.
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AbstractVestibular migraine (VM), also known as migrainous vertigo or migraine-associated vertigo, is characterized by recurrent vestibular attacks often accompanied by migraine headaches and other migraine symptoms. It is one of the most common presenting complaints to physicians in primary care, otolaryngology, and neurology. Epidemiologic data suggest that VM may affect 1 to 3% of the general population and 10 to 30% of patients seeking treatment for dizziness. Attacks typically last minutes to hours and range from spontaneous and positional vertigo to extreme sensitivity to self and surround motion. As with headaches, nausea, and vomiting, phonophobia and photophobia are common accompanying symptoms. The clinical spectrum of VM and its underlying pathophysiological mechanisms are just being identified, with much debate about the causal relationship of vestibular symptoms and headache, no evidence-based guidelines for clinical management, limited characterization of its disease burden, and little information about its negative impact on health-related quality of life.
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Scordo, Kristine A. "Mitral Valve Prolapse Syndrome and Magnesium Supplementation: A Review of the Literature." Clinical Scholars Review 1, no. 2 (November 2008): 101–9. http://dx.doi.org/10.1891/1939-2095.1.2.101.
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Mitral valve prolapse (MVP) is the most common valvular heart disease frequently associated with a constellation of symptoms unrelated to structural valvular changes. Patients’ self-reports reflect a variety of frightening symptoms, including chest pain, shortness of breath, palpitations, migraine headaches, lightheadedness, fatigue, dizziness on standing, mood swings, and anxiety or panic attacks. Individuals with these symptoms repeatedly seek help in emergency rooms, urgent care centers, and primary care offices, contributing to the economic burden of health care. Treatment measures are directed toward symptom relief. Although traditional medications such as beta-adrenergic blockers, calcium channel blockers, and anxiolytics are widely used to treat MVP symptoms, these medications are reportedly ineffective for many people. An appreciable number use one or more alternative therapies to control symptoms—most notable among these are magnesium supplements, which are known to influence cardiac function. This article’s purpose is to review the literature on what is known about MVP syndrome and magnesium supplementation.
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Doxtader, Erika E., Sydney C. Butts, James W. Holsapple, and Christine E. Fuller. "Aggressive Pediatric Meningioma with Soft Tissue and Lymph Node Metastases: A Case Report." Pediatric and Developmental Pathology 12, no. 3 (May 2009): 244–48. http://dx.doi.org/10.2350/08-07-0501.1.
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Metastatic meningioma is extremely rare, occurring in an estimated 0.1% of cases. We report a case of pediatric meningioma metastatic to cervical soft tissue and lymph nodes. An 8-year-old boy presented with headaches, dizziness, and involuntary eye flickering. Magnetic resonance imaging (MRI) revealed a 7.5-cm parasagittal, dural-based mass with venous sinus encasement. Therapeutic embolization was followed by bilateral craniotomy, achieving subtotal resection. Histopathologic examination revealed an atypical meningioma with regions of hypercellularity, small cell morphology, sheeting architecture, increased mitoses, and brain invasion. Surveillance MRI studies showed growth of residual tumor and enlarging cervical soft tissue masses with posterior triangle lymphadenopathy. Radiation and surgical resection were employed for the intracranial tumor burden; resection of the soft tissue masses revealed metastatic meningioma, with soft tissue infiltration and metastasis to 8 lymph nodes. This case demonstrates the aggressive biologic potential of pediatric meningiomas, with potential for distant spread via cerebrospinal fluid leakage and lymphatic invasion.
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Chacko, Thomas V., Prabha Thangaraj, and Muhammad G. M. "Epidemiology of fall and its risk factors among elders in a rural area of Coimbatore, India." International Journal Of Community Medicine And Public Health 4, no. 10 (September 22, 2017): 3864. http://dx.doi.org/10.18203/2394-6040.ijcmph20174265.
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Background: Global reports show that falls are the major cause of disability injuries among the elders. Developing countries lack the required epidemiological data on the burden of falls and factors that contribute to it.The objectives of the study were to find the burden of fall and its distribution in time, place and person among elders and to identify risk factors associated with fall among elders. Methods: A community–based cross-sectional study of 655 elders (≥ 60 years) was done in a rural area of Coimbatore District by two stage sampling technique. History of fall within the past 6 months was included in the study. Semi-structured pre-tested questionnaire was used to assess factors contributing to falls. The burden of falls was expressed as proportions and percentages. Logistic regression analysis was done to identify risk factors for fall. Results: 26% (95%CI: 22.59-29.32) elders experienced at least one fall. Of the total falls 50.2% occurred outside home and the remaining inside home. Most of the falls occurred during ambulation and at the morning hours (39.1%). Age ≥80 years (OR: 3.28, 95%CI: 1.28-5.98) and dizziness (OR: 3.27, 95%CI: 1.00-10.06) were only found to be significantly associated with fall on multivariate analysis. Conclusions: The occurrence of fall was found to be almost similar to that identified in western countries where fall preventive measures have been implemented. Similar efforts are yet to be initiated here and so this study provides the evidence for the need. Prospective studies through more frequent home visits are needed to confirm the enormity of the problem to suggest policy recommendation.
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Boccia, Ralph V., Brady Stein, Ruben A. Mesa, Ahmad B. Naim, Joseph A. Cordaro, Wei Peng, Hao Sun, Shreekant V. Parasuraman, and Alison Moliterno. "Burden of Phlebotomy in Patients with Polycythemia Vera in the United States: Baseline Data from the REVEAL Study." Blood 126, no. 23 (December 3, 2015): 5187. http://dx.doi.org/10.1182/blood.v126.23.5187.5187.
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Abstract Background: Phlebotomy to maintain hematocrit <45% is considered one of the cornerstones for the management of polycythemia vera (PV). However, phlebotomy procedures may be inconvenient for or poorly tolerated by some patients, and often result in iron deficiency, which may be associated with additional quality-of-life burden, such as fatigue, impaired cognitive function and restless leg syndrome. The REVEAL study (ClinicalTrials.gov, NCT02252159) is being conducted to describe contemporary demographics, burden of disease, clinical management, patient-reported outcomes, and healthcare resource utilization among patients with PV in the US. This early analysis describes the patient self-reported burden of phlebotomy at the time of enrollment. Methods: REVEAL is a multicenter, noninterventional, nonrandomized, prospective, observational study of adult patients with PV who are currently under the care of a US physician. REVEAL collects physician assessments and patient-reported outcomes during a 36-month observation period. Phlebotomy-related burden is being assessed with a new 21-item phlebotomy burden questionnaire (PBQ-21) at enrollment and every 90 days thereafter; it assesses patient-reported phlebotomy frequency, practice setting, time required for phlebotomy, inconvenience, and phlebotomy-related adverse effects. Phlebotomy-related effects and bother/inconvenience (if experienced within 24 hours after a phlebotomy procedure) are graded on a 4-point scale of 1 (not at all) to 4 (extremely). Analyses of these preliminary data were descriptive. Results: At the time of data cutoff, 865 patients were enrolled (total planned enrollment, n=2000). Median age was 67 (range, 22-95) years, 55.5% were male, and 89.5% were white. Median time from PV diagnosis to study enrollment was 53 months. Overall, 748 patients completed the PBQ-21 at enrollment and 400 (53.5%) had received a phlebotomy within 3 months prior to enrollment. Mean number of phlebotomies in the past 3 months was 2.2 (SD, 1.7). Phlebotomy was most commonly performed at a doctor's office during a regular medical visit (37.8%), at an infusion center or special cancer care center (26.8%), or at a hospital (18.3%). Patients who had phlebotomy procedures within 90 days before enrollment reported a mean total treatment time of 4.2 (SD, 4.7) hours per phlebotomy procedure; for employed patients, the mean amount of work time missed was 4.6 (SD, 15.6) hours per procedure. Fatigue, bruising, dehydration, and dizziness were among the most commonly reported adverse effects of phlebotomy (Table 1). Twenty percent of patients reported that phlebotomy procedures were moderately or extremely bothersome, inconvenient (18.3%), or painful or physically uncomfortable (16.3%). Furthermore, some patients (8.8%) reported that their family and friends were moderately or severely inconvenienced by phlebotomy procedures. Conclusion: The PBQ-21 collects important and relevant patient-reported information to systematically assess the impact of phlebotomy on patients and caregivers. From the early view of REVEAL enrollment data, a considerable proportion of patients reported fatigue, bruising, dehydration, and dizziness resulting from phlebotomy procedures. Furthermore, patients reported spending a considerable amount of time (4 hours on average) per phlebotomy procedure, which is a sizeable burden for patients who are employed. In addition, some patients reported that phlebotomy procedures may be inconvenient, painful or uncomfortable, and bothersome. REVEAL provides important information for providers to understand and address when to prescribe phlebotomy for patients with PV. Disclosures Boccia: Incyte Corporation: Honoraria. Stein:Incyte Corporation: Consultancy, Membership on an entity's Board of Directors or advisory committees. Mesa:Genentech: Research Funding; Promedior: Research Funding; NS Pharma: Research Funding; CTI Biopharma: Research Funding; Gilead: Research Funding; Incyte Corporation: Research Funding; Novartis Pharmaceuticals Corporation: Consultancy; Pfizer: Research Funding. Naim:Incyte Corporation: Employment, Equity Ownership. Cordaro:Incyte Corporation: Employment, Equity Ownership. Peng:Incyte Corporation: Employment, Equity Ownership. Sun:Incyte Corporation: Employment, Equity Ownership. Parasuraman:Incyte Corporation: Employment, Equity Ownership. Moliterno:Incyte Corporation: Membership on an entity's Board of Directors or advisory committees.
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Norman, Jonna, Michael Fu, Inger Ekman, Lena Björck, and Kristin Falk. "Effects of a mindfulness-based intervention on symptoms and signs in chronic heart failure: A feasibility study." European Journal of Cardiovascular Nursing 17, no. 1 (June 22, 2017): 54–65. http://dx.doi.org/10.1177/1474515117715843.
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Aims: Despite treatment recommended by guidelines, many patients with chronic heart failure remain symptomatic. Evidence is accumulating that mindfulness-based interventions (MBIs) have beneficial psychological and physiological effects. The aim of this study was to explore the feasibility of MBI on symptoms and signs in patients with chronic heart failure in outpatient clinical settings. Methods: A prospective feasibility study. Fifty stable but symptomatic patients with chronic heart failure, despite optimized guideline-recommended treatment, were enrolled at baseline. In total, 40 participants (median age 76 years; New York Heart Association (NYHA) classification II−III) adhered to the study. Most patients ( n=17) were randomized into MBI, a structured eight-week mindfulness-based educational and training programme, or controls with usual care ( n=16). Primary outcome was self-reported fatigue on the Fatigue severity scale. Secondary outcomes were self-reported sleep quality, unsteadiness/dizziness, NYHA functional classification, walking distance in the six-minute walk test, and heart and respiratory rates. The Mann–Whitney U test was used to analyse median sum changes from baseline to follow-up (week 10±1). Results: Compared with usual care (zero change), MBI significantly reduced the self-reported impact of fatigue (effect size −8.0; p=0.0165), symptoms of unsteadiness/dizziness ( p=0.0390) and breathlessness/tiredness related to physical functioning (NYHA class) ( p=0.0087). No adverse effects were found. Conclusions: In stable but symptomatic outpatients with chronic heart failure, MBI alleviated self-reported symptoms in addition to conventional treatment. The sample size is small and further studies are needed, but findings support the role of MBI as a feasible complementary option, both clinically and as home-based treatment, which might contribute to reduction of the symptom burden in patients diagnosed with chronic heart failure.
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Iglebekk, Wenche, Carsten Tjell, and Peter Borenstein. "Treatment of chronic canalithiasis can be beneficial for patients with vertigo/dizziness and chronic musculoskeletal pain, including whiplash related pain." Scandinavian Journal of Pain 8, no. 1 (July 1, 2015): 1–7. http://dx.doi.org/10.1016/j.sjpain.2015.02.002.
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AbstractBackground and aimChronic musculoskeletal pain, e.g. whiplash associated disorders (WAD), fibromyalgia and myalgia, causes significant burden on both the individual and on society as a whole. In a previous study, the authors concluded that there is a likely connection between chronic benign paroxysmal positional vertigo (BPPV)/canalithiasis and headache, neck pain, generalized pain, fatigue, cognitive dysfunctions as well as tinnitus. The balance dysfunction in BPPV/canalithiasis is dynamic and not static. This leads to a perpetual postural mismatch. The vicious cycle of a disturbed equilibrium control system may be the driving force behind the vicious cycle of pain. The aim of this study is to investigate if otolith-repositioning manoeuvres in patients with chronic BPPV/canalithiasis can be beneficial.MethodsDuring a period of about two years a prospective observational study on patients with chronic musculoskeletal pain referred for physiotherapy was performed. Those with a Dizziness Handicap Inventory (DHI) inquiry score above 20 underwent further investigations to diagnose chronic BPPV/canalithiasis. Diagnostic criteria: (A) The diagnosis of BPPV/canalithiasis was confirmed with the following: (1) specific history of vertigo or dizziness provoked by acceleration/deceleration, AND (2) nystagmus and symptoms during at least one of the test positions; (B) the disorder had persisted for at least one year. Specific otolith repositioning manoeuvre for each semi-circular canal (SCC) was performed. Symptom questionnaire (“yes” or “no” answers during a personal interview) and a follow-up questionnaire were used.ResultsThe responders of the follow-up questionnaire constituted the study group. Thirty-nine patients responded (i.e. 87%) (31 females, 8 males) with a median age of 44 years (17–65). The median duration of the disease was5 years. Seventy-nine percent had ahistory ofhead or neck trauma. The DHI median score was 48 points (score >60 indicates a risk of fall). The video-oculography confirmed BPPV/canalithiasis in more than one semi-circular canal in all patients. In the present study the frequency of affected anterior semi-circular canal (SSC) was at a minimum of 26% and could be as high as 65%. Ninety-five percent suffered from headache, 92% from neck pain, 54% had generalized pain, and 56% had temporo-mandibular joint region pain. Fatigue (97%), aggravation by physical exertion (87%), decreased ability to concentrate (85%) aswellas visual disturbances (85%) were the most frequently reported symptoms, and 49% suffered from tinnitus. The median number of otolith repositioning manoeuvres done was six (2–29). Median time span between finishing otolith repositioning manoeuvres and answering the questionnaire was 7 months.Effects of treatment and conclusionThe present study has shown that repositioning of otoliths in the SCCs in nearly all patients with chronic BPPV/canalithiasis ameliorated pain and other symptoms. The correlation between vertigo/dizziness and the majority of symptoms was significant. Therefore, there is strong evidence to suggest that there is a connection between chronic BPPV/canalithiasis and chronic pain as well as the above-mentioned symptoms.ImplicationsPatients with unexplained pain conditions should be evaluated withthe Dizziness Handicap Inventory-questionnaire, which can identify treatable balance disorders.
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Andersen, Christen Lykkegaard, Mary Frances McMullin, Robyn M. Emanuel, Amylou C. Dueck, David Bareford, Claire N. Harrison, Hans Hansselbalch, Steven Knapper, Holly Lynn Geyer, and Ruben A. Mesa. "Symptom Burden Among PV and ET Patients Receiving A Novel Histone Deacetylase Inhibitor: Findings From a Open-Label Phase II Study." Blood 120, no. 21 (November 16, 2012): 1736. http://dx.doi.org/10.1182/blood.v120.21.1736.1736.
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Abstract Abstract 1736 Background: Histone deacetylase inhibition (HDACi) has shown a potent inhibitory activity on the autonomous proliferation of hematopoietic cells of PV and ET patients carrying the JAK2V617F mutation (Leukemia. 2008;22(4):740–7). Hematological responses have been recorded during treatment with the HDACi givinostat in patients with PV and myelofibrosis (Blood. 2011; 118:a1748). Additionally, combinational use of givinostat and hydroxyurea (HU) have shown encouraging clinical response in PV (Br J Haematol. 2010;150:446–55). Recent laboratory studies of vorinstat-treated JAK2V617F knock-in mice have observed normalization of peripheral blood counts, markedly reduced splenomegaly and decreased mutant allele burden (Blood 2012; 119, 3779–89). Despite this evidence of hematologic response, to date no studies have evaluated specific changes in symptom burden among PV and ET patients treated with HDACi. METHODS ET and PV patients from the UK were enrolled in a non-randomized, open-label phase II multicenter study of the HDACi vorinostat (Haematologica 2011;96(s2):a1023). Patients were asked to complete the 18 item Myeloproliferative Neoplasm Assessment Form (MPN-SAF) (Blood 2011;118:401–408), 9 item Brief Fatigue Inventory (BFI) (Cancer 1999;85:1186–1196) and 30 item EORTC QLQ-C30 (J Natl Cancer Inst 1993; 85(5):365-76) at enrollment, week 12, week 24, and week 36. From weeks 1 through 24, participants were given 400mg of vorinostat daily and were observed from weeks 24 to 36. RESULTS Participant Demographics and Mutational Status: 15 PV and 10 ET patients were enrolled in the study. Median age of participants was 65 and 48% of participants were female. JAK2 mutations were present in 5/10 (50%) of ET and 14/15 (93%) of PV patients. Change in Symptom Severity with Vorinostat: Although most symptom severity changes did not reach statistical significance likely due to the small sample size, individual symptoms of headache (mean 1.6 baseline to 0.5 wk 36, mean maximum improvement 0.5 from baseline), dizziness (mean 1.6 baseline to 0.9 wk 36, mean maximum improvement 0.6 from baseline), sad mood (mean 2.6 baseline to 1.9 wk 36, mean max improvement 0.2 from baseline), and bone pain (mean 2.7 baseline to 0.8 wk 36, mean max improvement 0.7 from baseline) indicated consistent reductions in severity. Change in Symptom Incidence with Vorinostat: Non-sustained reductions in symptom incidence were seen with initiation of therapy for items of dizziness (50% baseline, 43% wk12, 55% wk 24, and 38% wk 36), numbness (65% baseline, 38% wk 12, 36% wk 24, 63% wk 36), sad mood (55% baseline, 47% wk 12, 40% wk 24, 50% wk 36), and itching (65% baseline, 50% wk 12, 40% wk 24, 75% wk 36). Change in MPN-SAF TSS Score with Vorinostat: Overall, MPN-SAF TSS did not vary significantly for the cohort over the course of the study (score change −.4 week 12, −0.5 week 24, −1.2 week 36, Figure 1). However, 9/17 participants who had a TSS of at least 6 at baseline had an overall improvement of at least 6 points (a moderate improvement) on at least one assessment after baseline. Of these, 5 of those 9 participants had an improvement of at least 10 points, which constitutes a large improvement in symptom burden based on a distributional definition of clinical significance using the standard deviation from a previous cohort. CONCLUSION This study represents the first analysis of symptom burden among PV and ET patients receiving vorinostat to date. In addition to previously identified changes in clinical and hematologic response, reductions in symptom burden including QOL and fatigue were observed in patients receiving vorinostat therapy which was most noticeable in patients with high baseline burden. The toxicity profile of vorinostat also suggests that better results might have observed if individualized assessment of clinicohematological responses including an integrated a marker for response into daily clinical practice and tailoring pharmacotherapy based on side effect profile (Leukemia. 2012;26(5):1148–9). Although further investigation among larger cohorts is needed, preliminary data is encouraging for successful therapeutic use of vorinostat in a clinical setting and with possible combinational therapy to reduce symptom burden among PV and ET patients. Disclosures: Harrison: Novartis: Honoraria, Research Funding, Speakers Bureau; YM Bioscience: Consultancy, Honoraria; Sanofi Aventis: Honoraria; Shire: Honoraria, Research Funding. Mesa:Incyte: Research Funding; Lilly: Research Funding; Sanofi: Research Funding; NS Pharma: Research Funding; YM Bioscience: Research Funding.
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Clark, S. L., D. E. Adkins, K. Aberg, J. M. Hettema, J. L. McClay, R. P. Souza, and E. J. C. G. van den Oord. "Pharmacogenomic study of side-effects for antidepressant treatment options in STAR*D." Psychological Medicine 42, no. 6 (November 1, 2011): 1151–62. http://dx.doi.org/10.1017/s003329171100239x.
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BackgroundUnderstanding individual differences in susceptibility to antidepressant therapy side-effects is essential to optimize the treatment of depression.MethodWe performed genome-wide association studies (GWAS) to search for genetic variation affecting the susceptibility to side-effects. The analysis sample consisted of 1439 depression patients, successfully genotyped for 421K single nucleotide polymorphisms (SNPs), from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Outcomes included four indicators of side-effects: general side-effect burden, sexual side-effects, dizziness and vision/hearing-related side-effects. Our criterion for genome-wide significance was a prespecified threshold ensuring that, on average, only 10% of the significant findings are false discoveries.ResultsThirty-four SNPs satisfied this criterion. The top finding indicated that 10 SNPs inSACM1Lmediated the effects of bupropion on sexual side-effects (p=4.98×10−7,q=0.023). Suggestive findings were also found for SNPs inMAGI2,DTWD1,WDFY4andCHL1.ConclusionsAlthough our findings require replication and functional validation, this study demonstrates the potential of GWAS to discover genes and pathways that could mediate adverse effects of antidepressant medication.
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Vasiljeva, I. A., and A. V. Smirnov. "EVALUATION OF QUALITY OF LIFE IN HEMODIALYSIS PATIENTS USING THE KDQOL-SFTM QUESTIONNAIRE." Nephrology (Saint-Petersburg) 22, no. 5 (October 8, 2018): 58–63. http://dx.doi.org/10.24884/1561-6274-2018-22-5-58-63.
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THE AIM.To assess quality of life (QOL) of hemodialysis (HD) patients using the Kidney Disease Quality of Life Short Form (KDQOL-SFTM) questionnaire including specific for dialysis therapy sections.PATIENTS AND METHODS. The KDQOL-SF questionnaire was administered to 192 HD patients. RESULTS. It was shown that HD patients experienced low satisfaction with the employment – 0,0 [0,0–50,0] (Me[IQR]) on the scale of «work status». A low score on the scale of "burden of kidney disease" was registered – 31,3 [18,8–50,0]. The highest scores were obtained on the scales of «cognitive functioning» 86,9 [66,7–93,3], «quality of social interaction» – 80,0 [66,7–93,3], «social functioning» – 62,5 [50,0–87,5], mental health – 60,8±18,1 (M±SD). Among the most significant stress factors – limited ability to travel and fluid restriction (74% and 66% of patients, respectively). The most bothersome problems were muscle soreness (50% pateients), fatigue (45%), dizziness (44%), itchy skin (41%), shortness of breath (40%), dry skin (34%).CONCLUSION. The KDQOL-SFTM questionnaire which takes about 20 minutes to complete provides important information about the limited opportunities and major concerns of dialysis patients.
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Alonso-Ventura, Vanesa, Javier Jimeno Sánchez, Elena Gambó Ruberte, David de las Cuevas León, Belén Peiró Aventín, Gabriel Hurtado Rodríguez, Teresa Simón Paracuellos, Pablo M. Corredoira, Carlos Ruben Lopez Perales, and Rodrigo Gallardo. "Premature ventricular complexes : Systematic review, evaluation and management." Cardiologia Hungarica 51, no. 3 (2021): 171–76. http://dx.doi.org/10.26430/chungarica.2021.51.3.171.
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Premature ventricular complexes (PVCs) are a common finding in general population and can be even considered physiologic in most cases. Nevertheless, very frequent isolated PVCs may lead to the development of a usually reversible left ventricular dysfunction or be a manifestation of an underlying cardiac condition that could be associated with more severe ventricular arrhythmias, heart failure or cardiac death. Three causative mechanisms of the PVCs have been proposed: abnormal automaticity, triggered activity and reentry supposing different diagnostic and therapeutic implications. Although many patients with PVCs remain completely asymptomatic, others may suffer from a wide range of symptoms like palpitations, fatigue, dyspnoea or dizziness of a variable degree. Proper characterisation of the PVCs, their burden and features, as well as the identification of their sites of origin and mechanisms should be pursued to establish the convenience of a conservative or therapeutic approach. Specific treatment with medical therapy or catheter ablation must be contemplated in symptomatic patients or in those who develop related systolic dysfunction or other kind of complications.
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Siplivii, Gregory N. "The Phenomenology of “Nothingness” by Martin Heidegger and Jean-Paul Sartre." Voprosy Filosofii, no. 6 (2021): 120–30. http://dx.doi.org/10.21146/0042-8744-2021-6-120-130.
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This article is devoted to the analysis of the phenomenology “Nothingness” by Martin Heidegger and Jean-Paul Sartre. Through research of existential phenomenology, the article also touches on the topic of “mood” as philosophical intentionality. Various kinds of “moods”, such as faintness (Verstimmung), ennui (Langeweile), burden (Geworden), inquisitiveness (Neugier), care (Sorge) and conscience (Gewissen), by Martin Heidegger’s and nausea (la nausée), anxiety (l’anxiété), dizziness (le vertige) by Jean-Paul Sartre, is considered in the context of what they may matter in an ontological sense. The phenomenologically understood “mood” as a general intentionality towards something is connected with the way in which the existing is able to ask about its own self. In addition, the article forms the concept of the original ontological and phenomenological “incompleteness” of any existential experience. It is this incompleteness, this “always-still-not” that provides an existential opportunity to realize oneself not only thrown into the world, but also different from the general flow of being. This “elusive emptiness” is interpreted in the article in accordance with the psychoanalytic category of “real” (Jacques Lacan).
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Garg, Alpana, Sachin Goyal, and Alejandro P. Comellas. "Post-acute COVID-19 functional movement disorder." SAGE Open Medical Case Reports 9 (January 2021): 2050313X2110393. http://dx.doi.org/10.1177/2050313x211039377.
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Movement disorders are rare compared to other neurological manifestations of COVID-19. Patients who have recovered from acute severe acute respiratory syndrome coronavirus-2 infection continue to have multiple debilitating symptoms months later. We report a case of 54-year-old man who presented with repetitive flexion movement of head which started 2 months after severe acute respiratory syndrome coronavirus-2 infection. Extensive work-up including neurological examination, neuroimaging, cerebrospinal fluid analysis, and electroencephalogram were normal. The self-reported questionnaires for depression and anxiety were suggestive of severe anxiety and depression. The patient continued to have the jerky movements besides cognitive impairment, frequent headaches, intermittent shortness of breath, sleeping difficulties, fatigue, and dizziness at 1-year follow-up. This case highlights the presentation of functional movement disorder as one of the manifestations of underlying neuropsychiatric condition. Our patient had significant effect on quality of life with high symptom burden which further highlights the struggle and unmet needs of the patients with multiple symptoms after severe acute respiratory syndrome coronavirus-2 infection.
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Menary, C., and K. Ridout. "A Review of the Potentially Inappropriate Prescribing in Frail Patients at The Mill Medical Practice." International Journal of Pharmacy Practice 29, Supplement_1 (March 26, 2021): i33—i34. http://dx.doi.org/10.1093/ijpp/riab015.040.
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Abstract Introduction Elderly care is becoming increasingly complex due to the increasing age of the population leading to higher disease burden. The British Geriatric Society (BGS), defines frailty as a ‘distinctive health state related to the ageing process in which multiple body systems gradually lose built in reserves’ (1). Patients included in this study were both male and female selected at random. Age included those over the age of 65 with a frailty score over 0.25 to include moderately and severely frail. Aim To identify frail patients at The Mill Medical Practice and assess the appropriateness of their prescribed medication using statistically validated medication review tools. This included looking at STOP/START interventions, anti-cholinergic burden and frailty index. Methods Moderately and severely frail patients were categorised using the electronic frailty index within the emis system at the GP surgery. 20% of patients from each group were chosen at random to have their medication assessed using the review tools. The tools included: STOPP/START, Anticholinergic burden calculator, PrescQIPP falls risk, NICE guidelines, and adapted RiO scoring tool. Results In total, the medications of 113 patients were assessed using the review tools. 38% of patients had a STOPP intervention and 63% had a START intervention. The most commonly inappropriately prescribed medicine was Furosemide for both patient groups. It has an anticholinergic burden score of 1 and moderate falls risk. Overall, 16% of patients had a drop of one in anticholinergic burden score. Also, an increase in 23% of patients having a score of zero. Conclusion This study was successful in identifying those patients that could have changes made to their medication to improve quality of care. Anticholinergic burden can have detrimental effects in those frail patients leading to physical and cognitive changes. Decreasing anticholinergic burden in frail patients is clinically important due to the risk of these adverse effects such as confusion, dizziness which could result in injury. Even a small increase in in anticholinergic burden score can have serious effects for these frail patients resulting in a hospital admission (2). By decreasing the medicine burden on frail patient this can reduce issues associated with anticholinergic burden and other medicine related issues in turn improving quality of life. Despite the use of medication review tools which try to prevent inappropriate prescribing, this is still an occurrence within the frail population and primary care. This could be due to: lack of time, limited resources available, patients not wanting to change, prescriber willingness to change medication and availability of healthcare professionals to do medicine reviews. Future work could include looking in depth at the ideas explored in this study such as anticholinergic burden and the long terms effects of this on patients. References 1. British Geriatrics Society [BGS]. Introduction to Frailty, Fit for Frailty part 1. 2014. URL: https://www.bgs.org.uk/resources/introduction-to-frailty [25 November 2019]. 2. Ruxton K, Woodman RJ, Mangoni AA. Drugs with anticholinergic effects and cognitive impairment, falls and all-cause mortality in older adults: A systematic review and meta-analysis. Br J Clin Pharmacol. 2015;80(2):209–220.
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Ramesh Masthi, Nugehally Raju, and Manasa Avverahally Ravi. "Substance use among young adults in professional degree colleges of urban Bengaluru." Indian Journal of Community Health 32, no. 3 (September 30, 2020): 574–78. http://dx.doi.org/10.47203/ijch.2020.v32i03.019.
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Background: Substance use is a significant problem in our societies and is increasing day by day due to factors like easy availability, rapid socioeconomic changes, etc. The professional degree students are at risk as they are exposed to high levels of stress and competition. Aim & Objective: To find out the burden of substance use among young adults in professional degree colleges, to assess the effect of substance use on health among study subjects, to compare the health status between substance users and non-users. Settings and Design: This cross-sectional study was conducted among students studying in various professional degree colleges of Urban Bengaluru between July 2017 to December 2017. Methods and Material: A total of 1400 study subjects were included and administered a pre-tested, semi structured questionnaire and relevant information was obtained using Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST) V3.0 scale. Statistical analysis used: Data was entered using MS Excel 2016 and was analysed in Stata 12.1 (Stata Corp, Texas, USA). Z test for proportions, Univariate logistic regression and Multivariate logistic regression were used as appropriate. Results: The overall prevalence of substance use was 35%. Dizziness was the most common health symptoms observed in substance users. Male, students staying in hostels/ paying guest, foreign nationals, substance use in the family and presence of conflict were found to be significant risk factors for substance use. Conclusions: The burden of substance use was observed in about one third of the subjects. Substance use was significantly associated with health problems.
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Koroukian, Siran M., Nicholas K. Schiltz, David F. Warner, Jiayang Sun, Kurt C. Stange, Charles W. Given, and Avi Dor. "Multimorbidity: Constellations of Conditions across Subgroups of Midlife and Older Individuals, and Related Medicare Expenditures." Journal of Comorbidity 7, no. 1 (January 2017): 33–43. http://dx.doi.org/10.15256/joc.2017.7.91.
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Introduction: The Department of Health and Human Services’ 2010 Strategic Framework on Multiple Chronic Conditions called for the identification of common constellations of conditions in older adults. Objectives: To analyze patterns of conditions constituting multimorbidity (CCMM) and expenditures in a US representative sample of midlife and older adults (50–64 and ≥65 years of age, respectively). Design: A cross-sectional study of the 2010 Health and Retirement Study (HRS; n=17,912). The following measures were used: (1) count and combinations of CCMM, including (i) chronic conditions (hypertension, arthritis, heart disease, lung disease, stroke, diabetes, cancer, and psychiatric conditions), (ii) functional limitations (upper body limitations, lower body limitations, strength limitations, limitations in activities of daily living, and limitations in instrumental activities of daily living), and (iii) geriatric syndromes (cognitive impairment, depressive symptoms, incontinence, visual impairment, hearing impairment, severe pain, and dizziness); and (2) annualized 2011 Medicare expenditures for HRS participants who were Medicare fee-for-service beneficiaries ( n=5,677). Medicaid beneficiaries were also identified based on their self-reported insurance status. Results: No large representations of participants within specific CCMM categories were observed; however, functional limitations and geriatric syndromes were prominently present with higher CCMM counts. Among fee-for-service Medicare beneficiaries aged 50–64 years, 26.7% of the participants presented with ≥10 CCMM, but incurred 48% of the expenditure. In those aged ≥65 years, these percentages were 16.9% and 34.4%, respectively. Conclusion: Functional limitations and geriatric syndromes considerably add to the MM burden in midlife and older adults. This burden is much higher than previously reported.
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Ionova, Tatyana, and Tatyana Nikitina. "Challenges of Assessing Symptom Burden in Patients with Haematological Malignancies." Blood 128, no. 22 (December 2, 2016): 2369. http://dx.doi.org/10.1182/blood.v128.22.2369.2369.
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Abstract Clinicians frequently underestimate quality of life (QoL), level of depression, and the severity of important disease- and treatment-related symptoms in patients with haematological malignancies, while overestimating other aspects of disease. Better symptom control may result in improved treatment outcomes in this patients population. Adequate symptom assessment in routine clinical practice is very helpful to provide patient-centred care. The goal of the study was to assess symptom burden in adult patients with different haematological malignancies, namely malignant lymphomas (ML), multiple myeloma (MM) and chronic myeloid leukemia (CML), and identify similarities and differences in symptom burden across these tumor entities. In total, 224 patients, both inpatients and outpatients, were included in the observational real-world study: 106 ML (Non-Hodgkin's lymphoma - 45; Hodgkin's lymphoma - 61), mean age - 34.8 years old, male/female -43/62; 43 MM, mean age - 58 years old, male/female -21/22; 75 CML, mean age - 51.3 years old, male/female - 37/38. Patients were enrolled at different stages of the disease (remission, stable, or progression) and at different phases of treatment (before, during or after treatment).All the patients were asked to name symptoms related to malignancy and/or its treatment that they experienced during the last week. The list of symptoms experienced by at least 10% of patients in each tumor entity was formed. 30 patients with each tumor entity were asked to mark in the symptom list the symptoms that had significant negative burden on their everyday activities, to rank on numerical rating scale scored from "0" (no symptom) to "10" (most expressed symptom) the severity of each marked symptom and to fill out the SF-36. Selection of symptoms with the highest negative impact on QoL was made using correlation analysis between symptom severity and QoL index (Coefficient Spearman r ≥0.5). As the result, the list of symptoms with significant negative burden on patients' everyday activities was formed for each tumor entity: 17 symptoms for ML, 20 symptoms for MM, and 19 symptoms for CML (Coefficient Spearman r ≥0.5). Comparison of symptom burden in terms of similarities and differences across the diseases was conducted. For patients with ML, MM and CML there were revealed 12 common symptoms with significant burden on QoL: weakness/fatigue, easily getting tired after physical activity, sweating at rest/during mild physical activity, decreased work energy, feeling of constant tiredness, shortness of breath, palpitation, feeling of worry/anxiety, feeling of sadness, concentration loss, feeling afraid, nausea. Common symptoms with significant burden on QoL for ML and MM were memory loss, pain and drowsiness; for ML and CML - dizziness; for MM and CML - heat sensations. Specific symptoms with significant burden on QoL were as follows: for ML - chills; for MM - bloating, numbness, dry mouth and feeling thirsty; for CML - sleeping problems, numbness, headache, tingling and heart interruption. The impact of CML, lymphoma and multiple myeloma and their treatment on patients' symptoms was studied. Symptom burden in terms of QoL impairment across different haematological malignancies was examined. Common and disease specific symptoms with significant negative impact on QoL were identified. Assessment of the symptoms with significant burden on QoL in real-world haematological practice may be beneficial for patients and of value to hematologists ensure quality of care in these patient populations. Disclosures Ionova: MSD: Speakers Bureau; BMS: Research Funding. Nikitina:BMS: Research Funding.
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Sheybani, Fereshte, HamidReza Naderi, and Sareh Sajjadi. "The Optimal Management of Acute Febrile Encephalopathy in the Aged Patient: A Systematic Review." Interdisciplinary Perspectives on Infectious Diseases 2016 (2016): 1–13. http://dx.doi.org/10.1155/2016/5273651.
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The elderly comprise less than 13 percent of world population. Nonetheless, they represent nearly half of all hospitalized adults. Acute change in mental status from baseline is commonly seen among the elderly even when the main process does not involve the central nervous system. The term “geriatric syndrome” is used to capture those clinical conditions in older people that do not fit into discrete disease categories, including delirium, falls, frailty, dizziness, syncope, and urinary incontinence. Despite the growing number of elderly population, especially those who require hospitalization and the high burden of common infections accompanied by encephalopathy among them, there are several unresolved questions regarding the optimal management they deserve. The questions posed in this systematic review concern the need to rule out CNS infection in all elderly patients presented with fever and altered mental status in the routine management of febrile encephalopathy. In doing so, we sought to identify all potentially relevant articles using searches of web-based databases with no language restriction. Finally, we reviewed 93 research articles that were relevant to each part of our study. No prospective study was found to address how should AFE in the aged be optimally managed.
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Tian, Miao-Miao, Yu-Xiang Li, Shan Liu, Chun-Hao Zhu, Xiao-Bing Lan, Juan Du, Lin Ma, et al. "Glycosides for Peripheral Neuropathic Pain: A Potential Medicinal Components." Molecules 27, no. 1 (December 31, 2021): 255. http://dx.doi.org/10.3390/molecules27010255.
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Neuropathic pain is a refractory disease that occurs across the world and pharmacotherapy has limited efficacy and/or safety. This disease imposes a significant burden on both the somatic and mental health of patients; indeed, some patients have referred to neuropathic pain as being ‘worse than death’. The pharmacological agents that are used to treat neuropathic pain at present can produce mild effects in certain patients, and induce many adverse reactions, such as sedation, dizziness, vomiting, and peripheral oedema. Therefore, there is an urgent need to discover novel drugs that are safer and more effective. Natural compounds from medical plants have become potential sources of analgesics, and evidence has shown that glycosides alleviated neuropathic pain via regulating oxidative stress, transcriptional regulation, ion channels, membrane receptors and so on. In this review, we summarize the epidemiology of neuropathic pain and the existing therapeutic drugs used for disease prevention and treatment. We also demonstrate how glycosides exhibit an antinociceptive effect on neuropathic pain in laboratory research and describe the antinociceptive mechanisms involved to facilitate the discovery of new drugs to improve the quality of life of patients experiencing neuropathic pain.
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Yin, Zhijun, Yongtai Liu, Allison B. McCoy, Bradley A. Malin, and Patricia R. Sengstack. "Contribution of Free-Text Comments to the Burden of Documentation: Assessment and Analysis of Vital Sign Comments in Flowsheets." Journal of Medical Internet Research 23, no. 3 (March 4, 2021): e22806. http://dx.doi.org/10.2196/22806.
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Background Documentation burden is a common problem with modern electronic health record (EHR) systems. To reduce this burden, various recording methods (eg, voice recorders or motion sensors) have been proposed. However, these solutions are in an early prototype phase and are unlikely to transition into practice in the near future. A more pragmatic alternative is to directly modify the implementation of the existing functionalities of an EHR system. Objective This study aims to assess the nature of free-text comments entered into EHR flowsheets that supplement quantitative vital sign values and examine opportunities to simplify functionality and reduce documentation burden. Methods We evaluated 209,055 vital sign comments in flowsheets that were generated in the Epic EHR system at the Vanderbilt University Medical Center in 2018. We applied topic modeling, as well as the natural language processing Clinical Language Annotation, Modeling, and Processing software system, to extract generally discussed topics and detailed medical terms (expressed as probability distribution) to investigate the stories communicated in these comments. Results Our analysis showed that 63.33% (6053/9557) of the users who entered vital signs made at least one free-text comment in vital sign flowsheet entries. The user roles that were most likely to compose comments were registered nurse, technician, and licensed nurse. The most frequently identified topics were the notification of a result to health care providers (0.347), the context of a measurement (0.307), and an inability to obtain a vital sign (0.224). There were 4187 unique medical terms that were extracted from 46,029 (0.220) comments, including many symptom-related terms such as “pain,” “upset,” “dizziness,” “coughing,” “anxiety,” “distress,” and “fever” and drug-related terms such as “tylenol,” “anesthesia,” “cannula,” “oxygen,” “motrin,” “rituxan,” and “labetalol.” Conclusions Considering that flowsheet comments are generally not displayed or automatically pulled into any clinical notes, our findings suggest that the flowsheet comment functionality can be simplified (eg, via structured response fields instead of a text input dialog) to reduce health care provider effort. Moreover, rich and clinically important medical terms such as medications and symptoms should be explicitly recorded in clinical notes for better visibility.
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Findling, Oliver, Larissa Hauer, Thomas Pezawas, Paulus S. Rommer, Walter Struhal, and Johann Sellner. "Cardiac Autonomic Dysfunction in Multiple Sclerosis: A Systematic Review of Current Knowledge and Impact of Immunotherapies." Journal of Clinical Medicine 9, no. 2 (January 24, 2020): 335. http://dx.doi.org/10.3390/jcm9020335.
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Cardiac autonomic dysfunction (CAD) has been reported in patients with multiple sclerosis (MS). This systematic review summarizes the evidence for the types and prevalence of CAD in MS patients, as well as its association with MS type, disease characteristics, fatigue and immunotherapies used to treat MS. The analysis revealed that CAD is correlated with pathophysiological processes of MS, can trigger serious cardiovascular complications that may reduce life expectancy, and may have implications for treatment with immunotherapies, especially fingolimod. Numerous mainly small case–control or cohort studies have reported various measures of CAD (particularly heart rate variation) in MS patients, showing higher rates of abnormality versus controls. A smaller number of studies have reported on cardiac autonomic symptoms in MS, including orthostatic intolerance/dizziness in around 50% of patients. CAD also appears to be associated with disease duration and to be more common in progressive than relapsing–remitting MS. However, although a substantial evidence base suggests that assessing CAD in people with MS may be important, standardised methods to evaluate CAD in these patients have not yet been established. In addition, no studies have yet looked at whether treating CAD can reduce the burden of MS symptoms, disease activity or the rate of progression.
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Goweda, Reda, and Ahmed Faisal. "A STUDY OF CLINICAL FEATURES AND LABORATORY PROFILE OF DENGUE FEVER IN OUTPATIENT SETTING." Malaysian Journal of Public Health Medicine 20, no. 2 (October 1, 2020): 94–100. http://dx.doi.org/10.37268/mjphm/vol.20/no.2/art.422.
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Dengue fever (DF) is one of the common mosquito-borne viral diseases. It is transmitted by Aedes aegypti and Aedes albopictus.The aim to study the clinical and laboratory manifestations of serologically confirmed cases of DF in outpatient clinics.This cross-sectional study was carried out in outpatient setting. According to WHO criteria all patients above 14 years old who were suspected to have DF were tested by IgM dengue antibody test. Additionally all patients underwent history, clinical examination and investigation including complete blood count, liver function test and abdominal ultrasound. Data was analyzed using SPSS version 20.Out of 126 patients presented with acute febrile illness, 71 (56.3%) had seroreactivity for dengue IgM antibodies. Fever, headache and muscloskeletal pain were the most common clinical presentation (100%). Decreased appetite (92.9%) , retro-orbital pain (78.8%) and dizziness(64.7%) were the next common symptoms. 29(40.8%) had hepatomegally, 11 (15.4%) had splenomegally.Elevated serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were observed in 58(81.6%) and 53(74.6%) respectively. Lastly; Fever associated with headache, retro-orbital pain, along with thrombocytopenia and elevated liver transaminases should prompt a clinician on the possibility of DF. Increased community awareness and vector control measures need to be strengthened to reduce the burden of dengue cases.
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Saengsuwan, Jittima, Pathitta Suangpho, and Somsak Tiamkao. "Knowledge of Stroke Risk Factors and Warning Signs in Patients with Recurrent Stroke or Recurrent Transient Ischaemic Attack in Thailand." Neurology Research International 2017 (2017): 1–7. http://dx.doi.org/10.1155/2017/8215726.
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Stroke is a global burden. It is not known whether patients who are most at risk of stroke (recurrent stroke or recurrent transient ischaemic attack) have enough knowledge of stroke risk factors and warning signs. The aim of this study was to assess the knowledge of stroke risk factors and warning signs in this high-risk population. We performed a cross-sectional questionnaire-based study of patients with recurrent stroke or recurrent TIA admitted to Srinagarind Hospital and Khon Kaen Hospital, Thailand. A total of 140 patients were included in the study (age 65.6±11.3 years [mean ± SD], 62 females). Using an open-ended questionnaire, nearly one-third of patients (31.4%) could not name any risk factors for stroke. The most commonly recognized risk factors were hypertension (35%), dyslipidemia (28.6%), and diabetes (22.9%). Regarding stroke warning signs, the most commonly recognized warning signs were sudden unilateral weakness (61.4%), sudden trouble with speaking (25.7%), and sudden trouble with walking, loss of balance, or dizziness (21.4%). Nineteen patients (13.6%) could not identify any warning signs. The results showed that knowledge of stroke obtained from open-ended questionnaires is still unsatisfactory. The healthcare provider should provide structured interventions to increase knowledge and awareness of stroke in these patients.
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Phillips, Amanda, Margit Heier, Ralf Strobl, Birgit Linkohr, Rolf Holle, Annette Peters, and Eva Grill. "Exposure to anticholinergic and sedative medications using the Drug Burden Index and its association with vertigo, dizziness and balance problems in older people – Results from the KORA-FF4 Study." Experimental Gerontology 124 (September 2019): 110644. http://dx.doi.org/10.1016/j.exger.2019.110644.
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Kotapuri, Sumathi, Mahendranath Putta, and Sudharshanraj Chitgupikar. "Study of clinical and etiological profile of hypertensive emergencies in children admitted in pediatric emergency department." International Journal of Contemporary Pediatrics 8, no. 5 (April 27, 2021): 797. http://dx.doi.org/10.18203/2349-3291.ijcp20211665.
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Background: Hypertension (HTN) in children, all though an uncommon entity is associated with end-organ damage. With increasing prevalence of hypertension and obesity in children; hypertensive emergencies are also increasing over recent years and screening is must. The primary objective of this study was to determine the incidence of hypertensive emergencies, the clinical presentation and etiological diagnosis at different age groups and to access the real burden of primary hypertension in causing hypertensive emergencies in children.Methods: This study was a prospective, descriptive, analytical cohort study done on children attending the emergency department of pediatrics, government general hospital, a tertiary referral pediatric center attached to Kurnool medical college, Kurnool, over a period of 18 months i.e., from january2016 to June 2017. Data was collected in a pre-determined proforma after institutional ethical committee clearance and appropriate informed concerned.Results: Among 98 children with hypertension; 30 had hypertensive emergency. Incidence was 0.3%. Intrinsic renal and renal vascular causes were the commonest. Headache, dizziness and vomiting were the comment presentation. Half of them had encephalopathy. Younger children had more of secondary HTN and in children (older than 7 years) primary hypertension increased as did family history of hypertension.Conclusions: With increasing primary hypertension among older children, hypertensive emergencies are increasing. As most of the children with HTN are asymptomatic; detection of target organ damage is vital.
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Aderman, Michael J., Benjamin L. Brett, Steven R. Malvasi, Gerald McGinty, Jonathan C. Jackson, Steven J. Svoboda, Michael McCrea, et al. "Association Between Symptom Burden at Initiation of a Graduated Return to Activity Protocol and Time to Return to Unrestricted Activity After Concussion in Service Academy Cadets." American Journal of Sports Medicine 50, no. 3 (January 10, 2022): 823–33. http://dx.doi.org/10.1177/03635465211067551.
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Background: Current consensus and position statements recommend that concussed patients be asymptomatic upon the initiation of the graduated return to activity (RTA) protocol. However, a significant number of concussed patients are beginning their RTA protocols while endorsing symptoms. Purpose: To characterize symptom endorsement at the beginning of the RTA protocol and examine the association between symptom endorsement and RTA protocol duration in service academy cadets. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective cohort study was conducted with cadets at 3 US service academies. Postconcussion symptom inventories were recorded upon the initiation of an RTA protocol. The Sport Concussion Assessment Tool Symptom Inventory was used to classify participants into 3 groups (0 symptoms, 1 symptom, and ≥2 symptoms) upon the initiation of the RTA protocol. The primary outcome of interest was RTA protocol duration. Kaplan-Meier survival estimates were calculated to estimate RTA protocol duration by symptom endorsement, sex, varsity status, academic break, and time to graduated RTA initiation. Univariate and multivariable Cox proportional hazards models were used to estimate the association between symptom endorsement at the initiation of the RTA protocol and RTA protocol duration (α < .05). Results: Data were analyzed from 966 concussed cadets (36% women). Headache (42%) and faintness/dizziness (44%) were the most commonly endorsed symptoms on the Sport Concussion Assessment Tool-Third Edition and the Brief Symptom Inventory-18, respectively. Univariate results revealed a significant association between endorsing ≥2 symptoms and RTA protocol duration. In the multivariable model, endorsing ≥2 symptoms maintained a statistically significant association with RTA protocol duration. Significant associations were observed between RTA protocol duration and nonvarsity status (27% longer), women (15% longer), academic breaks (70% longer), and time to the initiation of the RTA protocol (1.1% longer daily incremental increase) after controlling for covariates. Conclusion: Symptom endorsement at the initiation of an RTA protocol was associated with RTA protocol duration. Cadets who had returned to preinjury baseline symptom burden or improved from baseline symptom burden and endorsed ≥2 symptoms at the initiation of the RTA protocol took longer to RTA.
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Shuwail, A. Y. "Sociodemographic and clinical characteristics of depressive disorder in Saada in Yemen." European Psychiatry 26, S2 (March 2011): 2193. http://dx.doi.org/10.1016/s0924-9338(11)73896-2.
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BackgroundDepression has been recognized as a major public health evidenced by its ranking of fourth position among the global burden of diseases. Many believe it will occupy second position by the year 2020. This is the first study in Saada and Yemen.Aims of the studyTo determine the clinical and sociodemographic characteristic of depressive disorders in Saada country.MethodsPatients who attended the medical OPD in general hospital during six month and consented to participate in this were screened with Hospital Anxiety and Depressive Scale (HAD). Identified depressed patients were studied and results were analysis.Results714 patients attended, 20 refused to participate. 694 patients were screened by HAD Scale. 438(63%) were men. 21% were borderline and only 16% fulfilled the score for depression.72.3 suffer from loss of appetite, 50% from fatigue, 50% from loss of interest, 21% from suicidal ideas, 41% sleep disturbance and 12% of guilt feeling. 28% suffered from dizziness, 23% of gasterointestinal symptoms, and 16% from aches and pains. There was statistically significant difference between major depressive disorder and mixed anxiety and depressive disorder in that women were more. There was a trend towards statistical significance (P = 0.054) between delusions and qat chewing. There was no statistical significance with hallucination and qat chewing. Results were analysed and compared with other local and international studies.ConclusionMild depressive illness is more common in women, there was no impact of qat on depression, loss of appetite was the most common symptom. These finding are consistent with other local studies.
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M’bayo, Tenema, Michal Tomek, Clifford Kamara, and Durodami Lisk. "Psychiatric comorbidity in African patients with epilepsy – Experience from Sierra Leone." International Journal of Epilepsy 04, no. 01 (June 2017): 026–30. http://dx.doi.org/10.1016/j.ijep.2016.12.002.
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Abstract Objective Epilepsy is associated with a significant burden of psychiatric comorbidity, including depression and anxiety disorders. However, paucity of data exists regarding the impact of epilepsy on mental health of patients in the setting of sub-Saharan Africa, where these comorbidities are under-recognized and under-treated. We carried out a cross-sectional descriptive study to investigate the prevalence and determinants of depression and anxiety among people with epilepsy in Sierra Leone. Method A screening tool previously validated in the primary healthcare setting in Zambia was administered to adult patients in our epilepsy clinics in Freetown and Kenema, Sierra Leone. In addition, various socio-demographic and clinical characteristics were recorded for each patient. Results A total of 142 patients were included. The mean screening score was 16.3 out of 40, with 39 (27.5%) patients scoring above the diagnostic cut-off point for anxiety and/or depression. Variables showing a significant association with the presence of psychiatric comorbidity included female gender (p = 0.015), seizure frequency of >2 per month (p = 0.001), and self-reporting of sedation and/or dizziness as side effects of anti-epileptic medications (p = 0.006). Conclusion Symptoms of anxiety and depression are common in epilepsy patients in Sierra Leone. Given the significant negative impacts of such comorbidity on those affected, primary healthcare workers in sub-Saharan countries should be trained to inquire about anxiety and depression symptoms in epilepsy patients, and implementation of screening programs should be considered.
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Geyer, Holly, Robyn M. Scherber, Heidi Kosiorek, Amylou C. Dueck, Jean-Jacques Kiladjian, Zhijian Xiao, Stefanie Slot, et al. "Symptom Burden Profile in Myelofibrosis Patients with Thrombocytopenia: Lessons and Unmet Needs." Blood 126, no. 23 (December 3, 2015): 4080. http://dx.doi.org/10.1182/blood.v126.23.4080.4080.
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Abstract Background Myelofibrosis (MF) is a clonal myeloproliferative neoplasm (MPN) associated with a high degree of symptomatology, progressive cytopenias and potential to transform into acute myelogenous leukemia (AML). Thrombocytopenia amongst MF patients is a proven negative prognostic indicator and predictor of transformation to AML. Ruxolitinib is an effective JAK inhibitor for MF symptoms and splenomegaly, but is not indicated in patients with severe thrombocytopenia. Phase III trials of pacritinib have shown alleviation of the MF symptom burden amongst patients with thrombocytopenia (ASCO 2015 Mesa et. al.). In this study, we assessed the symptom burden of MF patients with significant thrombocytopenia who were naïve to pacritinib. Methods Data was assessed from a prospectively collected international database of MF patients in which demographics, disease features, and MF symptoms utilizing the myeloproliferative neoplasm symptom assessment form (MPN-SAF; Scherber et al, 2011). The MPN-SAF includes the patient's perceptions of common MPN-related symptoms and overall quality of life (QOL) on a 0 (absent) to 10 (worst imaginable) scale. Total symptom score (TSS) was computed based on symptom items using the published scoring algorithm on a 0 (all reported symptoms absent) to 100 (all reported symptoms worst imaginable) scale. MF risk scores were calculated using the DIPSS criteria (Gangat, 2011). Thrombocytopenia was defined as a platelet count <100 x 10(9)/L, anemia was defined as hemoglobin<10 g/dL and leukopenia was defined as a white blood cell count <4.0 x 10(9)/L. Associations between the MPN-SAF individual symptoms were investigated using Pearson correlations. Results Demographic and Disease Features: A total of 418 patients with (n=89) and without (n=329) thrombocytopenia completed the MPN-SAF. Patients with thrombocytopenia were slightly younger (57.4 vs. 61.0, p=0.01) with longer disease durations (11.9 years vs. 8.8 years, p=0.0489) and had a higher prevalence of primary myelofibrosis (PMF; 82% vs. 66%, p=0.01). The presence of thrombocytopenia was associated with other laboratory abnormalities including anemia (60.7% vs. 25.3%, p<0.001) and leukopenia (34.8% vs. 52.3%, p<0.001), along with the need for red blood cell transfusions (34.8% vs. 14.6%, p<0.001). Patient cohorts did not differ by gender, DIPSS risk score, history of prior thrombosis or hemorrhage. In comparing patients with severe thrombocytopenia (<50 x 10(9)/L, n=43) to those with moderate thrombocytopenia (51-100 x 10(9)/L, n=46), severe thrombocytopenia patients were more likely to have anemia (74.4% vs. 47.8%, p=0.01) and require red blood cell transfusions (51.2% vs. 19.6%, p=0.002). Symptoms Scores for individual MPN-SAF items were assessed for each subgroup. Patients with thrombocytopenia had markedly higher total symptom scores than patients without thrombocytopenia (32.8 vs. 24.1, p<0.001). Individual scores were also higher for most items (fatigue, early satiety, inactivity, dizziness, sad mood, sexuality, cough, night sweats, itching, fever, weight loss, overall QOL)[Figure 1]. No significant differences in MPN SAF TSS or individual symptom scores were observed in comparing severe vs. moderate thrombocytopenia patients. Discussion MF patients with thrombocytopenia have distinctive clinical characteristics and face a significantly more severe symptom burden. Importantly, despite thrombocytopenia being a recognized risk factor for disease advancement, no correlations are noted between patient symptomatology and risk category. In addition, patients with severe thrombocytopenia do not differ symptomatically from patients with moderate thrombocytopenia despite having more severe anemia, leukopenia and transfusion requirements. This implies that the degree of symptomatology expressed by thrombocytopenic MF patients occurs independent from the exact platelet value. Conclusion The results of this study suggest that patients with thrombocytopenia will benefit from aggressive symptomatic control, potentially from targeted agents. Figure 1. MF Symptoms in Patients With and Without Thrombocytopenia Figure 1. MF Symptoms in Patients With and Without Thrombocytopenia Disclosures Kiladjian: Novartis: Consultancy; Novartis: Other: Travel grant; Research Funding paid to institution (Hôpital Saint-Louis et Université Paris Diderot); Incyte Corporation: Consultancy. Zweegman:Takeda: Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding. Harrison:Shire: Speakers Bureau; CTI Biopharma: Consultancy, Honoraria, Speakers Bureau; Sanofi: Honoraria, Speakers Bureau; Gilead: Honoraria; Novartis: Honoraria, Research Funding, Speakers Bureau. Cervantes:Novartis: Consultancy, Speakers Bureau; Sanofi-Aventis: Consultancy; CTI-Baxter: Consultancy, Speakers Bureau. Barbui:Novartis: Speakers Bureau. Etienne:ARIAD: Consultancy, Honoraria, Speakers Bureau; Novartis: Consultancy, Honoraria, Other: Congress Travel/Accomodations, Research Funding, Speakers Bureau; BMS: Consultancy, Honoraria, Speakers Bureau. Roy:BMS: Consultancy, Research Funding; Novartis: Consultancy, Research Funding. Vannucchi:Shire: Speakers Bureau; Novartis Pharmaceuticals Corporation: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Baxalta: Membership on an entity's Board of Directors or advisory committees. Mesa:Novartis. Research- incyte, Gilead, cti, Genentech, promedior, NS Pharma: Consultancy.
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Sood, Atal, Himani Prajapati, Suruchi Bhagra, and Rekha Bansal. "Characterization and comparative analysis of ADRs of various ART regimens: experience of our medical college from Western Himalayan region." International Journal of Research in Medical Sciences 5, no. 2 (January 23, 2017): 659. http://dx.doi.org/10.18203/2320-6012.ijrms20170170.
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Background: It is estimated that there are 35.3 million PLHA worldwide and 1.6 million have received ART. ART is freely available in designated ART Centres. HAART (highly active antiretroviral treatment) has significantly reduced AIDS related morbidity and mortality. It involves using three different drugs from two different classes. The main challenge in prescribing HAART is ADRs associated with it affecting patient compliance and treatment outcomes.Methods: A retrospective observational study was carried out in the ADR monitoring Centre of Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India.Results: The data for ADEs was collected from 108 patients over a period of 17 months. A total of 280 ADEs were reported in 65 females and 43 males. TLE was the commonest regimen in 61 (56%) patients followed by ZLN in 37 (34%). Neurological ADRs were reported in 39.8% cases with TLE that was nearly double as reported with ZLN regimen 20.5%. Dermatological ADRs were highest with other regimens (57.4%) followed by ZLN 20.5%. Similarly the frequency of Gastrointestinal ADR was highest with other regimens. Hematological ADRs were maximum with ZLN (22.9%) followed by TLE (3.3%). Most commonly reported ADRs were dizziness (10.7%), rashes (8.2%), anorexia and dyslipidemia (6.8%), asthenia (6.4%), pruritus (6%), joint pains (4.6%), insomnia, alopecia and vomiting (4.3%), numbness or parasthesia (3.9%), hepatotoxicity (3.6%) and deranged RFTs (1.8%).Conclusions: The real burden of ADRs due to ART cannot be estimated until voluntary and mandatory reporting system of ADRs works efficiently. A structured surveillance of the pharmacovigilance system can help to overcome these hurdles to ensure compliance with ART regimens.