Does Depression Impact Cognitive Impairment in Patients with Heart Failure?

Prevalence studies have noted the cooccurrence of cognitive decline and depression in persons with heart failure. Cognitive impairment is associated with significant mortality and deteriorated quality of life, likely due to impairments in memory and executive function, which impact a patient’s ability to understand and comply with prescribed treatment plans. This is especially true in complex diseases such as heart failure. Evidence from literature supports the possibility of a pathophysiological relationship between cognitive impairment, depression, and heart failure. Yet, very few studies have sought to investigate this relationship. This paper reviews current literature on the association between depression and cognitive impairment in persons with heart failure and explores possible mechanisms explaining this complex triad

Daylighting, artificial electric lighting, solar heat gain, and space-heating energy performance analyses of electrochromic argon gas-filled smart windows retrofitted to the building

The inevitability to reduce CO2 emissions to avoid preventable climate change is widely being yelped. To minimise the impact of rapidly changing climate, this paper presents novel research findings and contributes to developing electrochromic argon gas-filled glazed smart windows retrofitted to the building with IoT based transparency control. In this, the comparative analyses of the daylighting, electrical lighting, solar heat gain, and space-heating load of the building using the dynamic thermal and electric lighting modelling methods based on real weather temperatures are presented. The daylighting analysis results implicate that the building with electrochromic argon gas-filled smart windows reduced 19% of daylight illuminance during summer months compared with the building retrofitted with double air-filled glazed windows daylight factor remains consistent. As such, the solar heat gains analysis results implicate at least 50 % annual solar heat gain reduction predicted in the building with electrochromic argon gas-filled smart windows in comparison to double air-filled windows. This leads to the conclusion of the space-heating energy analysis that implicates the highest contribution to the space heating demand is the solar heat gain caused by double air-filled glazed windows. The results confirm that the LED artificial electric lighting system requires fewer fittings and thus total power load compared to the fluorescent lighting system, throughout the year, to the building with electrochromic argon gas-filled glazed smart windows. The daylight controls are linked to the electrochromic argon gas-filled glazed smart windows, so they only operate when the glazing is tinted, or the daylight level drops below a set level; this will reduce the energy usage and also lower the space heating of the room

Assessing the Responsiveness of the Persian Version of the Western Ontario Meniscal Evaluation Tool in Patients with Meniscus Injuries

Background and Objective: Responsiveness is one of the important properties of health-related questionnaires in demonstrating the changes in a patient's clinical conditions before and after therapy. The present study was carried out with the aim of assessing the responsiveness of the Western Ontario Meniscal Evaluation Tool (WOMET) and determining its minimal clinically important difference in patients undergoing physical therapy interventions after meniscus injuries. Methods: This cross-sectional methodological study was performed on 100 patients aged 18-70 years with meniscus injuries who underwent physical therapy interventions. Patients completed WOMET and Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaires in the first and tenth sessions. The minimum score obtained from the WOMET questionnaire was zero and the maximum was 1600, and the minimum score obtained from the KOOS questionnaire was zero and the maximum was 168. Internal and external responsiveness were the primary outcomes, and effect size tests, ROC curves, and correlation coefficients were used to examine them. The relationship between the WOMET and KOOS questionnaires were considered as secondary outcomes, which were evaluated by calculating the correlation coefficient. Findings: The results of internal responsiveness showed that the standardized response mean for the entire WOMET questionnaire was 0.11 (insignificant) and Cohen's d score for the entire WOMET questionnaire was -1.586 (large). The difference in the mean internal responsiveness between recovered (20%) and unrecovered (80%) patients reached a significant level (p<0.001). This questionnaire had an acceptable external responsiveness; the area under the curve of the ROC curve was greater and equal to 0.7 and the optimal cut-off point was 20.031 (p<0.001). The Pearson correlation coefficient between WOMET and KOOS questionnaires (except the emotions subscale) was moderate to large (0.5-0.8) with p<0.001. Conclusion: The findings of the study showed that the Persian version of the WOMET questionnaire has a high level of responsiveness and is a suitable tool for evaluating the quality of life among patients suffering from meniscus injury

Hodgkin's lymphoma masquerading as vertebral osteomyelitis in a man with diabetes: a case report

<p>Abstract</p> <p>Introduction</p> <p>Infection and malignancy often have common characteristics which render the differential diagnosis for a prolonged fever difficult. Imaging and tissue biopsy are crucial in making a correct diagnosis, though differentiating between chronic osteomyelitis and malignancy is not always straightforward as they possess many overlapping features.</p> <p>Case Presentation</p> <p>A 52-year-old Caucasian man was treated with antibiotics for his diabetic foot infection after a superficial culture showed <it>Staphylococcus aureus</it>. He had persistent fevers for several weeks and later developed acute onset of back pain which was treated with several courses of antibiotics. Radiographic and pathological findings were atypical, and a diagnosis of Hodgkin's lymphoma was made 12 weeks later.</p> <p>Conclusion</p> <p>Clinicians should maintain a suspicion for Hodgkin's lymphoma or other occult malignancy when features of presumed osteomyelitis are atypical. Chronic vertebral osteomyelitis in particular often lacks features common to acute infectious disease processes, and the chronic lymphocytic infiltrates seen on histopathology have very similar features to Hodgkin's lymphoma, highlighting a similar inflammatory microenvironment sustained by both processes.</p

Monogenic Primary Immunodeficiency Disorder Associated with Common Variable Immunodeficiency and Autoimmunity

Background: Common variable immunodeficiency (CVID) is the most frequent primary immunodeficiency disorder mainly characterized by recurrent bacterial infections besides other immunological defects including loss of or dysfunction of B cells and decreased immunoglobulin levels. In this study, our aim is to evaluate clinical, immunological, and molecular data of patients with a primary clinical diagnosis of CVID and autoimmune phenotype with a confirmed genetic diagnosis. Methods: Among 297 patients with CVID, who were registered in the Iranian Primary Immunodeficiency Registry at Children's Medical Center Hospital in Iran, 83 patients have been genetically examined and 27 patients with autoimmunity and confirmed genetic mutations were selected for analysis. Whole-exome sequencing and confirmatory Sanger sequencing methods were used for the study population. A questionnaire was retrospectively filled for all patients to evaluate demographic, laboratory, clinical, and genetic data. Results: In the 27 studied patients, 11 different genetic defects were identified, and the most common mutated gene was LRBA, reported in 17 (63.0) patients. Two patients (7.7) showed autoimmune complications as the first presentation of immunodeficiency. Eleven patients (40.7) developed one type of autoimmunity, and 16 patients (59.3) progressed to poly-autoimmunity. Most of the patients with mono-autoimmunity (n = 9, 90.0) primarily developed infectious complications, while in patients with poly-autoimmunity, the most common first presentation was enteropathy (n = 6, 37.6). In 13 patients (61.9), the diagnosis of autoimmune disorders preceded the diagnosis of primary immunodeficiency. The most frequent autoimmune manifestations were hematologic (40.7), gastrointestinal (48.1), rheumatologic (25.9), and dermatologic (22.2) disorders. Patients with poly-autoimmunity had lower regulatory T cells than patients with mono-autoimmunity. Conclusion: In our cohort, the diagnosis of autoimmune disorders preceded the diagnosis of primary immunodeficiency in most patients. This association highlights the fact that patients referring with autoimmune manifestations should be evaluated for humoral immunity. © 2020 Georg Thieme Verlag. All rights reserved

Responsiveness of two Persian-versions of shoulder outcome measures following physiotherapy intervention in patients with shoulder disorders

Purpose: To identify the ability of the Persian-version of the Shoulder Pain and Disability Index (SPADI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) to detect changes in shoulder function following physiotherapy intervention (i.e. responsiveness) and to determine the change score that indicates a meaningful change in functional ability of the patient (i.e. Minimally Clinically Important Difference (MCID)). Method: A convenient sample of 200 Persian-speaking patients with shoulder disorders completed the SPADI and the DASH at baseline and then again 4 weeks after physiotherapy intervention. Furthermore, patients were asked to rate their global rating of shoulder function at follow-up. The responsiveness was evaluated using two methods: the receiver operating characteristics (ROC) method and the correlation analysis. Two useful statistics extracted from the ROC method are the area under curve (AUC) and the optimal cutoff point called as MCID. Results: Both the SPADI and the DASH showed the AUC of greater than 0.70 (AUC ranges = 0.77-0.82). The best cutoff points (or change scores) for the SPADI-total, SPADI-pain, SPADI-disability and the DASH were 14.88, 26.36, 23.86, and 25.41, respectively. Additionally, moderate to good correlations (Gamma = -0.51 to -0.58) were found between the changes in SPADI/DASH and changes in global rating scale. Conclusions: The Persian SPADI and DASH have adequate responsiveness to clinical changes in patients with shoulder disorders. Moreover, the MCIDs obtained in this study will help the clinicians and researchers to determine if a Persian-speaking patient with shoulder disorder has experienced a true change following a physiotherapy intervention.Implications for RehabilitationResponsiveness was evaluated using two methods; the receiver operating characteristics (ROC) method and the correlation analysis.The Persian SPADI and DASH can be used as two responsive instruments in both clinical practice and research settings.The MCIDs of 14.88 and 25.41 points obtained for the SPADI-total and DASH indicated that the change scores of at least 14.88 points on the SPADI-total and 25.41 points on the DASH is necessary to certain that a true change has occurred following a physiotherapy intervention. © 2015 © 2015 Informa UK Ltd

Assessing the Responsiveness of the Persian Version of the Western Ontario Meniscal Evaluation Tool in Patients with Meniscus Injuries

Background and Objective: Responsiveness is one of the important properties of health-related questionnaires in demonstrating the changes in a patient's clinical conditions before and after therapy. The present study was carried out with the aim of assessing the responsiveness of the Western Ontario Meniscal Evaluation Tool (WOMET) and determining its minimal clinically important difference in patients undergoing physical therapy interventions after meniscus injuries. Methods: This cross-sectional methodological study was performed on 100 patients aged 18-70 years with meniscus injuries who underwent physical therapy interventions. Patients completed WOMET and Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaires in the first and tenth sessions. The minimum score obtained from the WOMET questionnaire was zero and the maximum was 1600, and the minimum score obtained from the KOOS questionnaire was zero and the maximum was 168. Internal and external responsiveness were the primary outcomes, and effect size tests, ROC curves, and correlation coefficients were used to examine them. The relationship between the WOMET and KOOS questionnaires were considered as secondary outcomes, which were evaluated by calculating the correlation coefficient. Findings: The results of internal responsiveness showed that the standardized response mean for the entire WOMET questionnaire was 0.11 (insignificant) and Cohen's d score for the entire WOMET questionnaire was -1.586 (large). The difference in the mean internal responsiveness between recovered (20%) and unrecovered (80%) patients reached a significant level (p<0.001). This questionnaire had an acceptable external responsiveness; the area under the curve of the ROC curve was greater and equal to 0.7 and the optimal cut-off point was 20.031 (p<0.001). The Pearson correlation coefficient between WOMET and KOOS questionnaires (except the emotions subscale) was moderate to large (0.5-0.8) with p<0.001. Conclusion: The findings of the study showed that the Persian version of the WOMET questionnaire has a high level of responsiveness and is a suitable tool for evaluating the quality of life among patients suffering from meniscus injury

The pervasive triad of food security, gender inequity and women's health: exploratory research from sub-Saharan Africa

Objectives: This study was designed to explore the interactions between food securing activities, health and gender equity from the perspective of rural east African women. The specific objectives were to document the critical interaction among these three issues—food security, gender inequity, women's health within the context of sub-Saharan Africa; to describe the nature of this triad from the perspective of women farmers in Africa; and to propose a framework for linking available interventions to the vicious nature of this triad. Setting: In-depth interviews and focus group discussions were conducted with rural women farmers in Kwale District, Kenya and Bagamoyo District, Tanzania. Methods: A total of 12 in-depth interviews and 4 focus group discussions have been included in this analysis. Transcribed text from interviews and focus group discussions were coded and thematic conceptual matrices were developed to compare dimensions of common themes across interviews and settings. A thematic analysis was then performed and a framework developed to understand the nature of the triad and explore the potential for interventions within the interactions. Findings: The vicious cycle of increasing work, lack of time, and lack of independent decision making for women who are responsible for food production and health of their families, has health and social consequences. Food securing activities have negative health consequences for women, which are further augmented by issues of gender inequity. Conclusion: The African development community must respond by thinking of creative solutions and appropriate interventions for the empowerment of women farmers in the region to ensure their health. African Health Sciences Vol. 5 (4) 2005: pp. 328-33