Speech-Language and Cognitive Findings in Patients with HIV/AIDS

BACKGROUND: Few adult patients with HIV/AIDS are screened regularly for speech-language and cognitive disorders even though they may manifest communication difficulties. No comprehensive studies assessing the broad range of speech-language and cognitive disorders of adults with HIV/AIDS appear in the literature. As such, clinicians may be unfamiliar with the types of communication disorders that may be manifested. This study assessed the prevalence of speech-language and cognitive disorders in adults with HIV/AIDS using a broad inventory of speech, language, and cognitive skills. METHODS: A cross-sectional design was used to investigate communication disorders in a convenience sample of patients living with HIV/AIDS. Adult patients from a general internal medicine clinic in Wichita, Kansas were recruited as they presented for medical appointments. Each participant received a speech-language and cognitive test battery consisting of 10 assessments. RESULTS: The primary outcomes were: (1) presence of any speech-language or cognitive disorder, and (2) degree of communication disorder, as measured by the number of positive results. Eighty-two adults with HIV/AIDS were evaluated for communication disorders. Prevalence was 95%; 78 out of 82 participants manifested abnormal findings on at least one assessment in the test battery. Test results revealed a variety of cognitive and language issues, mostly related to integrating information on the picture description task (45%), timed word generation (44%), and memory-related story retelling (35%). Two participants revealed abnormal results on all ten assessments. CONCLUSION: Speech-language and cognition deficits are common in adult patients with HIV/AIDS. Every patient with HIV/AIDS should be assessed to determine the impact of these communication deficits on their daily living skills

Fatigue and TSH Levels in Hypothyroid Patients

Background. Fatigue is often the complaint that initiates thyroid function investigation. Most available data related to fatigue and hypothyroidism involved patients with subclinical hypothyroidism where fatigue was not the primary outcome. This study investigated the association between TSH levels and fatigue and if there was a target TSH interval that was associated with lower incidence of fatigue in patients with hypothyroidism. Methods. An analytic, retrospective cohort study design assessed the relationship between TSH levels and fatigue. All adult patients at one endocrinology clinic who were diagnosed with hypothyroidism between January 1, 2006 and December 31, 2007 were included. Diagnoses were confirmed by biochemical testing. Data were abstracted from the clinic’s electronic medical record. Fatigue status was self-reported by the subject during examination by the endocrinologist. Fatigue status and TSH levels were obtained twice: at diagnosis and during the first follow-up visit. Results. A total of 135 patients met the inclusion criteria. After treatment, all patients had reductions in TSH levels. Those subjects reporting relief from fatigue tended to be males (p = 0.003), had lower TSH levels at follow-up (p < 0.001), had larger TSH differences from baseline (p =0.007), and had a primary diagnosis of acquired hypothyroidism (p < 0.001). Females were 2.9 times more likely to report persistent fatigue than males. Patients with primary diagnosis of thyroiditis were 3 times more likely to report persistent fatigue than those with acquired hypothyroidism. Conclusions. The observed relief from fatigue after treatment correlated with a higher TSH reduction compared to patients with persistent fatigue. It was unclear if fatigue relief was related to the level of TSH reduction (TSH difference) or to a lower absolute TSH level reached after treatment

Influence of Bone Cement Augmentation on Complications in Cephalomedullary Nail Fixation of Geriatric Intertrochanteric Hip Fractures

Introduction. The purpose of this study was to determine if augmentation of the helical blade with polymethylmethacrylate bone cement decreases the rates of varus cut-out and medial perforation in geriatric intertrochanteric hip fracture fixation. Methods. This was a retrospective comparative cohort study at two urban level I trauma centers. Patients with an extracapsular hip fracture (classified as AO 31A1-3) who were treated with the TFN-Advanced Proximal Femoral Nailing System (TFNA) from January 2018 to December 2021 were eligible for the study. Medical records and postoperative radiographs were reviewed to determine procedure complications and reoperations. Results. Of the 179 patients studied, cement augmentation (CA) was used in 93 patients (52%) and no cement augmentation (NCA) was used in 86 (48%). There were no significant differences between group demographics and fracture reduction grades. Varus cut-out occurred 3 times in the CA group and 5 times in the NCA group (p = 0.484). Medial perforation occurred 3 times, all in the NCA group (p = 0.109). The most frequent complication was symptomatic blade lateralization, with 8 occurrences in the CA group compared with 2 in the NCA group (p = 0.102). There were 10 reoperations in the CA group and 9 in the NCA group (p &gt; 0.999). The most common reason for revision was varus cut-out and most common revision procedure was hip arthroplasty. Conclusions. Intertrochanteric hip fractures treated with the TFNA fixation system with and without cement augmentation have similar complication profiles and failure rates