DYADIC ADJUSTMENT IN BREAST CANCER: A REVIEW

Dealing with female breast cancer (BC) strongly modulates the patient’s self-concept, hence affecting her interpersonal network, notably with the partner. In this review, we assume that the patient-partner couple reacts as a unique dyadic system when facing the experience of BC, thus influencing the disease’s adjustment and coping processes. From this point of view, BC adjustment and coping studies focused on the patient-partner couple are relevant to better understand the psychosocial dimension of this disease and plan useful dyadic support programs. The paper reviews the studies on a dyadic approach to the adjustment as well as the coping consequences of BC. The dyadic features of adjustment and coping processes over the course of illness are highlighted. The association with some specific relationship patterns as well as with the communication styles is investigated to emphasize the crucial role of conjoint psychological dynamics that define the BC dyad struggle with the illness. Finally, the literature findings on these topics are discussed together with the couple post-traumatic growth phenomena

Fatigue in inflammatory bowel diseases: Relationship with age and disease activity

A higher rate of patients suffering from inflammatory bowel diseases (IBD) are reported to experience the symptom of fatigue compared with general population. Fatigue can impair quality of life of IBD patients by limiting their daily functioning. However, this problem is poorly understood and addressed. Our aim was to investigate the impact of fatigue in IBD patients compared with controls, and to seek for relation between age and disease activity. IBD patients aged between 16 and 75 years observed at our Unit from June 2011 through June 2012 were evaluated for fatigue. Patients were asked to fill the fatigue impact scale (FIS) questionnaire. A cohort of age- and sex-matched patients observed for other-than-IBD diseases were prospectively enrolled to act as controls. Patients diagnosed with malignancies were excluded from evaluation. Each group included 16 patients, of whom half aged over 65 years. Fatigue was more severe in IBD patients than in controls (p = 0.02), irrespective of age and disease activity. IBD patients with moderate to severe disease activity showed worse fatigue compared with controls at any age (p < 0.0001). Young IBD patients with low disease activity showed a trend toward worse FIS score when compared with old IBD counterparts (p = 0.06). IBD significantly impacted on fatigue in our series. Considering IBD patients in remission, younger patients may experience worse fatigue. Further studies are needed to explore the effects of fatigue on quality of life and the potential of appropriate intervention strategies

Cognitive, Brain and Intracranial Artery Involvement in Beta Thalassemia

Background: Brain involvement in beta thalassemia is scarcely known so far, and available data show different degrees of abnormalities in terms of neuroradiologic findings and cognitive impairment, mainly showing asymptomatic white matter lesions in transfusion dependent thalassemia (TDT; Karimi et al, Ann Hematol 2016) or in non transfusion dependent thalassemia (NTDT; Karimi et al, Ann Hematol 2012; Pazgal et al, Thrombosis Research 2016), arterial stenosis in NTDT (Musallam et al, EJH 2011) and a general impairment in cognitive function in TDT (Elalfy et al, Hematology 2017). To our knowledge there are no studies investigating neuroimaging and cognitive function in both groups of patients, comparing results to healthy subjects. Methods: In our observational study thalassemic patients from 4 major Centers in the South of Italy, aged more than 16 year

Brain functional impairment in beta-thalassaemia: the cognitive profile in Italian neurologically asymptomatic adult patients in comparison to the reported literature

Cognitive involvement in beta-thalassaemia is strikingly controversial and poorly studied in adulthood. This multicentre prospective study investigated 74 adult neurologically-asymptomatic beta-thalassaemia patients (mean-age 34·5&nbsp;±&nbsp;10·3&nbsp;years; 53 transfusion-dependent [TDT], 21 non-transfusion dependent [NTDT]) and 45 healthy volunteers (mean-age 33·9&nbsp;±&nbsp;10·7&nbsp;years). Participants underwent testing with Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV), Brief Psychiatric Rating Scale (BPRS) and multiparametric brain 3T-magnetic resonance imaging (MRI) for parenchymal, vascular and iron content evaluation. Patients had lower Full-Scale Intelligence Quotient (FSIQ) than controls (75·5&nbsp;±&nbsp;17·9 vs. 97·4&nbsp;±&nbsp;18·1, P&nbsp;&lt;&nbsp;0·0001) even after correction for education level. Compared to TDT, NTDT showed a trend of higher FSIQ (P&nbsp;=&nbsp;0·08) but a similar cognitive profile at WAIS-subtests. FSIQ correlated with total and indirect bilirubin (P&nbsp;&lt;&nbsp;0·0001 and P&nbsp;=&nbsp;0·002, respectively); no correlation was found with splenectomy, intracranial MRI/magnetic resonance-angiography findings, brain tissue iron content or other disease-related clinical/laboratory/treatment data. FSIQ did not correlate with BPRS scores, although the latter were higher among patients (28·74&nbsp;±&nbsp;3·1 vs. 27·29&nbsp;±&nbsp;4·8, P&nbsp;=&nbsp;0·01) mainly because of increased depression and anxiety levels. Occupation rate was higher among controls (84·4% vs. 64·9%, P&nbsp;=&nbsp;0·004) and correlated with higher FSIQ (P&nbsp;=&nbsp;0·001) and education level (P&nbsp;=&nbsp;0·001). In conclusion, Italian adult beta-thalassaemia patients seem to present a characteristic cognitive profile impairment and an increased rate of psychological disorders with possible profound long-term socio-economic consequences

No evidence of increased cerebrovascular involvement in adult neurologically-asymptomatic β-Thalassaemia. A multicentre multimodal magnetic resonance study

Multi-factorial causes jeopardize brain integrity in β-thalassaemia. Intracranial parenchymal and vascular changes have been reported among young β-thalassaemia patients but conventional magnetic resonance imaging (MRI) findings are contradictory making early MRI and magnetic resonance angiography (MRA)/venography monitoring a matter of debate. This study prospectively investigated 75 neurologically asymptomatic β-thalassaemia patients (mean-age 35·2&nbsp;±&nbsp;10·7&nbsp;years; 52/75 transfusion-dependent; 41/75 splenectomised) using a 3T magnetic resonance scanner; clinical, laboratory and treatment data were also collected. White matter ischaemic-like abnormalities, intracranial artery stenoses, aneurysms and sinus venous thrombosis were compared between patients and 56 healthy controls (mean-age 33·9&nbsp;±&nbsp;10·8&nbsp;years). No patient or control showed silent territorial or lacunar strokes, intracranial artery stenoses or signs of sinus thrombosis. White matter lesions were found both in patients (35/75, 46·7%) and controls (28/56, 50·0%), without differences in terms of number (4·0&nbsp;±&nbsp;10·6 vs. 4·6&nbsp;±&nbsp;9·1, P&nbsp;=&nbsp;0·63), size and Fazekas' Score. Intracranial aneurysms did not differ between patients and controls for incidence rate (7/75, 9·3% vs. 5/56, 8·9%), size and site. Vascular and parenchymal abnormality rate did not differ according to treatments or clinical phenotype. According to this study, asymptomatic β-thalassaemia patients treated according to current guidelines do not seem to carry an increased risk of brain and intracranial vascular changes, thus weakening recommendations for regular brain MRI monitoring