Observation on the Effect of Health Education in Health Management of Chronic Disease Patients

Objective: By the end of 2021, the aging rate of China’s population is 18.9%, and the prevalence rate of chronic diseases in the elderly population is increasing year by year, and chronic diseases have become the main causes of death and health threats of Chinese residents. Therefore, how to manage this huge group well is crucial. This paper analyzes the value of health education in the process of health management for patients with chronic diseases. Methods: 102 patients with chronic diseases treated from January 2021 to December 2021 were divided into control group and experimental group by random number table method. The control group was given routine health management while the experimental group was given health education based on the control group, and the implementation effect was analyzed. Results: After management, the scores of chronic disease knowledge in the experimental group were significantly higher than those in the control group, and the dimensions of ESCA were higher than those in the control group, and P < 0.05;Conclusion: The implementation of health education in the process of chronic disease health management is helpful to improve patients’ self-care ability and better control disease progression.

Infective Endocarditis in Chronic Hemodialysis Patients: Specificities and Therapeutic Management

Infective endocarditis (IE) is a frequent complication in chronic hemodialysis patients (CHD). The repeated placement and manipulation of central venous catheters, underlying valvulopathies, and immunosuppression are the main predisposing factors for these patients to develop IE. We aimed to highlight the clinical and microbiological specificities of IE in CHD patients, detail the therapeutic management in these patients and identify the risk factors for in-hospital mortality. We included 28 CHD patients in whom the diagnosis of IE was established according to modified Duke criteria. The mean age was 47 ± 17 years. Among them, 57% were hypertensive and 39% were diabetic. The average duration of hemodialysis was 3.5 ± 7 years. The vascular access was a tunnelled jugular catheter, arteriovenous fistula, and temporary catheter in 54%, 28%, and 18% of patients, respectively. Half of the patients presented with heart failure at admission. Methicillin-sensitive Staphylococcus is the most commonly implicated pathogen. Transthoracic echocardiography revealed vegetation in all patients. In 60% of cases, the lesion is located on the mitral valve, and in 35% it is on the tricuspid valve. Patients initially received empirical antibiotic therapy, which was adjusted according to bacteriological results. Valve surgery was indicated in 12 patients, with aortic valve replacement being the most performed procedure followed by tricuspid annuloplasty. The in-hospital mortality rate was 32%. Factors associated with mortality were severe mitral insufficiency (p = 0.036), heart failure (p = 0.043), and the presence of Methicillin-resistant Staphylococcus in blood cultures (p = 0.047). IE is a complication with high morbidity and mortality. Its increasing incidence, specificities in chronic CHD patients, and the complexity of its management require a rigorous preventive strategy. A multidisciplinary collaboration between nephrologists, infectious disease specialists, cardiologists, and surgeons is crucial to optimize therapeutic management.

Chronic Subdural Hematoma Associated with an Arachnoid Cyst in Elderly, an Intraoperative Finding after Re-Bleeding: Case Report

Intracranial arachnoid cysts (AC) are believed to be congenital and chronic subdural hematomas tend to occur in elderly patients with a history of mild head injury. The association between these two entities sporadically occur in relatively young patients but rare in elderly patients. We report a 65-year-old man who presented with headache and dizziness of 2 months’ duration with a history of head injury. Brain computed tomography (CT) a CSDH in right side and a hygroma in left side. After first operation with burr holes in both sides, the patient underwent an early recurrence of acute subdural hematoma in the right side. The evacuation of this hematoma by a craniotomy allowed seeing an AC that we resected partially with complete recovery of the patient. The association CSDH/AC is rare and possible in elderly patients and there is no consensus on treatment.

The Impact of Psychosocial Influences on Chronic Wound Healing

This comprehensive review explores the intricate dynamics between psychosocial factors and chronic wound healing processes, specifically focusing on prevalent conditions such as pressure ulcers, diabetic foot ulcers, and venous leg ulcers. By examining the roles of psychiatric conditions, including depression, anxiety, and post-traumatic stress disorder (PTSD), this paper illuminates how these factors intricately influence wound healing dynamics, including mechanisms of pain perception and inflammatory responses. Furthermore, we evaluate the effectiveness of integrated biopsychosocial interventions, which encompass a holistic approach to wound care, thereby enhancing healing outcomes for dermatology patients. Future studies should focus on investigating the specific psychosocial determinants that significantly influence wound healing, exploring novel therapeutic strategies, and implementing personalized interventions to meet the unique needs of each patient. Such endeavors hold promise in advancing the fields of psychodermatology and wound management, fostering a deeper understanding and application of psychosocial considerations in dermatological care.

Comment on review article:Chronic hepatitis C virus infection cascade of care in pediatric patients

An enhanced cascade of care should include a younger population,helping to achieve the goal of the World Health Organization with a focus on elimination in the pediatric population.Furthermore,enhanced screening and awareness efforts and continued education of health care providers will improve the outcomes of chronic hepatitis C virus(HCV)infection in the pediatric population.The present work discusses and comments on the topic"cascade of care in HCV chronic pediatric patients".

PCI compared with medical therapy in elderly patients with chronic symptomatic coronary artery disease

Objective The aim of this study was to assess quality of results of elderly patients with coronary disease after medical or revascularisation therapy. Methods In this study, we enrolled 103 patients aged 75 years or older with chronic angina in which 47 patients were assigned coronary angiography and revascularisation and 56 patients with optimised medical therapy. The primary endpoint was quality of life after 6 months, as assessed by questionnaire and the presence of major adverse cardiac events (death, non fatal myocardial infarction, or hospital admission for acute coronary syndrome with or without the need for revascularisation). Results After 6 months follow up, angina severity decreased and measures of quality of life increased in both treatment groups( P <0.05 ); however, these improvements were significantly greater after revascularisation( P <0.01 ). Major adverse cardiac events occurred in 30 ( 53.6% ) of patients in the medical group and 9 ( 19.1% ) in the invasive group ( P <0.01 ).Conclusions Patients aged 75 years or older with angina benefit more from revascularisation than from optimised medical therapy in terms of symptom relief and quality of life. Therefore, these patients should be offered invasive assessment despite their high risk profile followed by revascularisation if feasible.

Additive Benefits of Twice Forest Bathing Trips in Elderly Patients with Chronic Heart Failure

Chronic heart failure （CHF）, a clinical syndrome resulting from the consequences of various cardiovascular diseases （CVDs）, is increasingly becoming a global cause of morbidity and mortality. We had earlier demonstrated that a 4-day forest bathing trip can provide an adjunctive therapeutic influence on patients with CHF. To further investigate the duration of the impact and the optimal frequency of forest bathing trips in patients with CHF, we recruited those subjects who had experienced the first forest bathing trip again after 4 weeks and randomly categorized them into two groups, namely, the urban control group （city） and the forest bathing group （forest）. After a second 4-day forest bathing trip, we observed a steady decline in the brain natriuretic peptide levels, a biomarker of heart failure, and an attenuated inflammatory response as well as oxidative stress. Thus, this exploratory study demonstrated the additive benefits of twice forest bathing trips in elderly patients with CHF, which could further pave the way for analyzing the effects of such interventions in CVDs.

Health Effect of Forest Bathing Trip on Elderly Patients with Chronic Obstructive Pulmonary Disease

Forest bathing trip is a short, leisurely visit to forest. In this study we determined the health effects of forest bathing trip on elderly patients with chronic obstructive pulmonary disease （COPD）. The patients were randomly divided into two groups. One group was sent to forest, and the other was sent to an urban area as control. Flow cytometry, ELISA, and profile of mood states （POMS） evaluation were performed. In the forest group,

Nutritional Status in Chronic Hemodialysis Patients

Hitherto, there has been no systematic evaluation of the nutritional status of HD patients in Thailand. 27 patients awaiting renal transplantation, 19 M 8 F, age 47.2 ± 8.6y (mean±SD), underwent HD at Ramathibodi Hospital. Dietary assessment revealed the average daily intake of men and women to be respectively 1571 ±314 and 1379 ± 403 kcal, 47 ± 11 and 42 ± 14 g protein. Anthropometric data showed that mean of BMI,percent ideal body weight (%IBW), percent standard triceps skinfold thickness (%TSF) and percent arm muscle circumference (%std MUAMC) to be 20.5 ± 2.6 kg/m2, 90±12, 75 ±30 and 100±13, respectively. However, 37%, 56% and 70% of these patients had BMI, BW and MUAC less than the minimal cut-off levels. These data reflect the importance of energy depletion in these patients. The average serum albumin was 39 ± 6 g/L while 52% suffered from low albumin levels. TC, LDL-C, HDL-C and TG were 4.34 ± 1.34, 2.9 ±1.06, 0.89 ± 0.33 and 1.10 ± 0.67 mmol/L while 15% had high TC, LDL-C and 58% had low HDL-C levels. Only one patient was suffered from hypertriglyceridemia. Whereas inadequate thiamine, riboflavin, ascorbic acid and α-tocopherol status were present in 4-30%, toxic levels of serum retinol were seen in almost all patients. Low serum zinc and copper levels were also present. This study disclosed a wide spectrum of nutritional problems usually overlooked in CRF patients undergoing chronic hemodialysis. Whereas zinc supplementation may be needed, vitamin A suppIementation in these patients should be discouraged

Transitional care interventions to reduce readmission in patients with chronic obstructive pulmonary disease:A meta-analysis of randomized controlled trials

Objective：To objectively assess the effect of transitional care on readmission for patients with chronic obstructive pulmonary disease.Methods：The PubMed,Science Direct,Web of Science,Cochrane Library,CNKI,and Wanfang databases were searched for relevant randomized controlled trials（RCTs） published from January 1990 through April 2016.The quality of eligible studies was assessed by two investigators.The primary outcome assessed was readmission for COPD and all-cause readmission.The pooled effect sizes were expressed as the relative risk and standard mean difference with 95%confidence intervals.Heterogeneity among studies was assessed using the Cochrane Handbook for Systematic Reviews of Interventions（Version5.1.0） and determined with an I^2 statistic.Results：A total of seven RCTs that included 1879 participants who met the inclusion criteria were analyzed.The results of subgroup analysis showed significant differences in readmission for COPD at the6 month and 18 month time points and all-cause readmission at the 18 month follow-up.Transitional care could reduce readmission for COPD at the 6 month[RR = 0.51,95%CI（0.38,0.68）,P 〈 0.00001]and18 month time points[RR = 0.56,95%CI（0.45,0.69）,P 〈 0.00001,and also reduce all-cause readmission after 18 months[RR = 0.72,95%CI（0.62,0.84）,P 〈 0.0001].The reduction of all-cause readmission between the intervention and control groups in the 2nd year,however,was less than that in the 1st year.Conclusions：Transitional care is beneficial to reducing readmission for patients with COPD.Duration of≥ 6 and ≤ 18 months are more effective,and the effect weakens over intervention time,especially after the end of intervention.Both durations point to the importance of ongoing intervention and reinforcement after the end of intervention.

Reduced bone mineral density and altered bone turnover markers in patients with non-cirrhotic chronic hepatitis B or C infection

AIM: Previous studies suggest that loss of bone mineral density (BMD) frequently occurs in patients with chronic viral liver disease, presenting with histologically proven liver cirrhosis. However, little is known about the occurrence of bone disease in non-cirrhotic patients with chronic hepatitis B or C. Therefore, it was the aim of this study to evaluate this particular population for BMD and bone turnover markers.METHODS: Biochemical markers of bone turnover and BMD were measured in 43 consecutive patients with HCV (n = 30)or HBV (n = 13) infection without histological evidence for liver cirrhosis. Mean age was 49 years (range 26-77 years). BMD was measured by dual X-ray absorptiometry in the femoral neck (FN) and the lumbar spine (LS) region. In addition, bone metabolism markers were measured.RESULTS: BMD was lowered in 25 (58%) of the patients with chronic hepatitis B or C (FN: 0.76 (0.53-0.99); LS:0.96 (0.62-1.23) g/cm2). Eight (32%) osteopenic patients were diagnosed with osteoporosis. Bone-specific alkaline phosphatase (P = 0.005) and intact parathyroid hormone (iPTH) (P = 0.001) were significantly elevated in the more advanced stages of fibrosis. Mean 7-score value was lower in patients with chronic hepatitis C as compared to patients suffering from chronic hepatitis B; however, the difference was not statistically significant (P = 0.09).CONCLUSION: There was a significantly reduced BMD in non-cirrhotic patients with chronic hepatitis B or C infection. Alterations of bone metabolism already occurred in advanced liver fibrosis without cirrhosis. According to our results, these secondary effects of chronic viral hepatitis should be further investigated.

Efficacy and Safety of Glecaprevir/Pibrentasvir in Combination Therapy in Chronic Hemodialysis Patients with Genotype 2 Hepatitis C Virus Infection

Background: Glecaprevir (nonstructural protein 3/4A protease inhibitor) and Pibrentasvir (nonstructural protein 5A inhibitor) (G/P), a coformulated once-daily, all oral, ribavirin (RBV)-free, direct-antiviral regimen, was evaluated for safety and efficacy in chronic hemodialysis patients with genotype 2 hepatitis C virus infection. Methods: In this prospective, observational, single-center study at Masuko Memorial Hospital, between November 2017 and December 2018, a total of 8 HD patients with an HCV infection genotype 2 received G/P combination therapy. Age was an average of 67.1 (61 - 75) years and there were four men and two women. It was FIB4 INDX an average of 2.67 (1.5 - 3.34) before the start of therapy. It was quantity of HCV RNA an average of 4.43 (2.1 - 6.5). HCV RNA levels were measured by real-time RCR-based method (COBAS AmpiPrep/COBAS TaqMan HCV Test. 4 cases 12 weeks were 2 cases eight weeks for dosing period. Patients were excluded if they had evidence of hepatocellular carcinoma. This study was approved by the ethics committee of our hospital, while we obtained written consent from the participants after providing a thorough explanation of the contents and methods of this study. Results: 6 patients were available for total dose internal use. As for the HCV RNA of the fourth week, (100%) HCV RNA became negative after administration start of therapy. Rapid virologic response (RVR) achieved all cases. 5 patients achieved 12-week sustained virologic response (SVR12) and were following up the 1 patient. The itching appeared in two cases (33%), but there was symptom improvement in nalfurafine hydrochloride use treatment, and treatment continuation was possible. Conclusion: It is thought that G/P can be given to the HD patients’ safety, but we will accumulate a case in future, and it is thought to be necessary to examine utility and safety.

Neutrophil-to-lymphocyte ratio compared to N-terminal pro-brain natriuretic peptide as a prognostic marker of adverse events in elderly patients with chronic heart failure

BackgroundThe neutrophil-to-lymphocyte (N/L ) 比率与心失败在病人与差的预后被联系了，但是它一直不在有长期的心失败(CHF ) 的老病人与 N 终端支持大脑的 natriuretic 肽(NT-proBNP ) 相比。我们寻求了与 CHF 1355 个老病人使这 comparison.MethodsA 全部被分析。multivariate 逻辑回归模型被用来分析与 atrial 纤维性颤动(AF ) 联系的变量。考克斯回归分析被用来估计在 N/L 比率， NT-proBNP 水平，和随后的主要心血管的事件(MCE ).ResultsIn 之间的 multivariable 关系多重逻辑回归分析， N/L 比率与 CHF 在老病人为 AF 作为一个风险因素被表明[机会比率(或) ：1.079， 95% 信心间隔(CI ) ：1.027-1.134， P = 0.003 ] 。中部的后续时期是 18 个月。在用两个变量的 tertiles 的一个 multivariable 模型， N/L 比率的最高的 tertile 显著地与 MCE 被联系[危险比率(HR ) ：1.407， 95% CI：1.098-1.802， P = 0.007 ] 与最低 tertile 相比。同样，最高的 NT-proBNP tertile 显著地也与 MCE 被联系(HR：1.461， 95% CI：1.104-1.934， P = 0.008 ).ConclusionsIn 有 CHF 的老病人， N/L 比率是为 AF 的重要风险因素之一，它是有到 NT-proBNP 的类似的独立预示的力量的一个便宜、容易地可得到的标记。当 N/L 比率被提高到最高的 tertile 时， MCE 的风险增加 1.407 褶层。

Pulmonary Hypertension in Chronic Hemodialysis Patients at Aristide Le Dantec University Hospital

Introduction: Pulmonary hypertension (PH) is defined as high blood pressure in the lungs. It is recently described as a vascular disease entity in chronic kidney disease, particularly for chronic hemodialysis patients. The aims of this study were to determine the prevalence of PH, to describe clinico-biological and morphological characteristics and to identify risk factors associated with PH in hemodialysis patients. Patients and methods: This is a cross-sectional, descriptive, and analytical study during a period of 8 months from January 1, 2019, to August 31, 2019, in the hemodialysis center of nephrology department of Aristide Le Dantec Hospital. All chronic hemodialysis patients for more than 3 months and with PH confirmed by cardiac doppler ultrasound were included. Results: During the study period, 25/94 patients on chronic hemodialysis, presented with pulmonary hypertension (26.6%). The mean age was 49.3 ± 12.9 years. The sex ratio (M/F) was 0.92. Exertional dyspnea was found in 18 patients (72%). Cardiac auscultation revealed an arrhythmia in 3 patients (12%), augmented second heart sound in 12 patients (48%). On transthoracic doppler ultrasound, pulmonary systolic arterial pressure was on average 51.4 ± 13.2 mmHg. PH was moderate in 13 patients (52%), mild in 9 patients (36%) and severe in 3 patients (12%). The left ventricular ejection fraction was altered in 9 patients (36%). Three patients (12%) had valve calcifications. They were mainly located at aortic valve (8%) and mitral valve (4%). The major risk factors associated to PH in our patients are pathological fractures (p = 0.023), aortic calcifications (p = 0.023), ischemic heart disease (p = 0.023). The duration of hemodialysis represents another favoring factor (p = 0.042). Also implicated are arrhythmias (p = 0.004), high cardiac index (p = 0.043), ventricular dilatation (p = 0.034) and left atrial dilation (p = 0.015), as well as dilation of the inferior vena cava (p = 0.048).

Outcomes after percutaneous coronary interventions in patients with chronic kidney disease

Introduction Chronic kidney disease (CKD) is a significant contributor to cardiovascular morbidity and mortality.Patients with CKD are known to have a greater prevalence of cardiovascular disease than the general population,1 and patients with concurrent CKD and coronary artery disease (CAD) have greater mortality than patients without CKD.2-4 The rate of cardiovascular mortality is approximately 50%,five to 10 times higher than the general population.

The Inferior Vena Cava Diameter as a Marker of Dry Weight in Chronic Hemodialyzed Patients(续)

The IVC diameters in HD patients Since BW and stature as well as gender and age were not considered to be determinant factors of the IVC diameters, these factors were not accounted for in evaluating the IVC diameters in HD patients. The IVC diameters of stable anuric HD patients are shown in Table 2. In agreement with our previous observation [7-9] ,the reduction of BW from (51.7±12.6) to (49.3±12.6)kg by ultrafiltration during HD resulted in a significant (P<0.0001)reduction of the IVCe and IVCi from (14.9 ± 3.2) to (6.8±1.9)mm and (5.2±4.2) to (0.1±0.3) mm,respectively. Thus,CI values before and at the end of HD were calculated as (0.68±0.24) and (0.98±0. 05), respectively (P<0.0001). ……

Cryoglobulinemia in elderly patients with HCV-related chronic hepatitis

Hepatitis C virus(HCV) infection affects about 3% of the world's population and often leads to chronic liver disease.In some industrialized countries,HCV prevalence increases with age,but the optimal management of older patients has not been accurately defined.HCV infection can also lead to lymphoproliferative disorders,the most common being mixed cryoglobulinemia(MC),and also for this condition that frequently affects elderly patients,the optimal therapeutic strategy is still debated.We report the case of a 77-year-old Caucasian woman with HCV-related chronic hepatitis and cutaneous manifestations consisting of urticaria and pruritus related to MC resistant to antihistamines.The patient underwent a treatment with interferon and ribavirin.Such a treatment led to early biochemical and virological response associated with the resolution of cryoglobulinemia and cutaneous symptoms.After the end of treatment,HCV replication relapsed,but cryoglobulinemia and cutaneous symptoms did not recur.In the absence of definite treatment guidelines in this particular context,our experience suggests that the presence of symptoms related to HCV-infection that deeply affect patient quality of life warrants antiviral therapy even beyond the age limits that currently exclude patients from treatment.

Awareness of Chronic Kidney Disease among Patients Attending Tertiary Care Hospital in Bangladesh

Background: Patients with chronic kidney disease (CKD) are at increased risk of morbidity & mortality. Educational interventions aimed at empowering patients are successful in chronic disease management including CKD. Objective: To explore the awareness regarding CKD among patients attending in a tertiary care hospital in Bangladesh. Methodology: This was a descriptive observational study, which includes 100 adult patients attending the department of Medicine in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2013 to June 2013. Data were collected on a pre-tested questionnaire by face-to-face interview to investigate awareness toward: 1) basic knowledge of personal health;2) perceptions of factors increasing the risk of CKD;3) knowledge of therapies to slow CKD progression;4) perceptions of CKD increasing the risk of other medical conditions and 5) demographic information. Main outcome variables were demographic parameters, socio-economic status and awareness about chronic kidney disease. Data were analyzed and compared by statistical tests. Results: Almost one third (32.0%) respondents were in 3rd decade and male to female ratio was 1:1.5. Majority (43.0%) patients came from lower-middle income family. In all age groups, the majority (60%) respondents had low knowledge of CKD. Among the study population, 44.0% believe that smoking increases risk of CKD;42.0% believe that restricting salt intake reduces the progression of CKD;34.0% mention that CKD increases the risk for hypertension and 82.0% mention that renal transplantation is the treatment of choice in CKD. Among the participants, 32.8% had knowledge of increasing risk factor of CKD, 30.8% had knowledge of the method of slow progression of CKD, 30.3% had knowledge of conditions for increase risk of CKD and 41.7% respondent had knowledge of treatment of CKD. Conclusion: Most of the study participants had inadequate knowledge of CKD. Lack of CKD screening and educational programs have contributed to the inadequate patient knowledge about the condition.

Influence Factors of Mobility-Related Activities of Daily Living in Chronic Dialysis Patients Needing Long-Term Care: Analysis of Long-Term Care Eligibility Assessment Survey Data

Background: In the near future in Japan, chronic dialysis patients will likely face a situation where the aging and the lengthening of hemodialysis treatment periods will adversely affect the mobility-related activities of daily living (MR-ADL). The aim of this study was to investigate chronological change in MR-ADL among chronic dialysis patients in need of long-term care and the effect of admission to long-term care facilities on their MR-ADL. Methods: Data were analyzed from a long-term care eligibility assessment survey conducted in late March 2009 of 1000 individuals residing in Niigata City, Japan who were approved to receive long-term care. Then data from those individuals who had undergone the assessment survey ≥4 times over a period of ≥4 years were statistically evaluated. To reveal change in MR-ADL, this study performed a three-way analysis of variance with mean survey scores from assessment categories 2 - 5 containing questions related to MR-ADL as the independent variable and the number of eligibility assessment surveys (within-subjects factor), facility admission, and dialysis therapy (between-subjects factors) as dependent variables. Results: We observed the effect of facility admission in individuals aged >70 years for categories 2 - 5, and observed the effect of the number of assessment surveys taken only in women ≥80 years for categories 2 and 5. Regarding the effect of dialysis therapy, female dialysis patients aged ≥80 years and in need of long-term care scored significantly higher on survey items for transferring, grooming, toileting, eating, and instrumental activities of daily living, all of which are indicators of a moderate decline in ADL. Conclusions: Because dialysis is often initiated in women aged around 80 years, ADL in this group of individuals can be improved by the initiation and proper provision of dialysis.