Quantities of comorbidities affects physical, but not mental health related quality of life in type 1 diabetes with confirmed polyneuropathy

BACKGROUND A large number of adults with long-term type 1 diabetes are affected by symmetrical peripheral neuropathy.These complications increase socioeconomic expenses and diminish the individual quality of life.The 36-Item Short Form Health Survey(SF-36)is a generic patient reported questionnaire,measuring mental and physical health related quality of life.We hypothesized that diabetic neuropathy would decrease physical and mental quality of life measured with SF-36,and that clinical appearance may be associated with the decline.AIM To investigate if diabetic neuropathy would decrease physical and mental quality of life measured with SF-36,and if clinical appearance may be associated with the decline.METHODS Forty-eight adults[age 50±9 years,10 females,disease duration 32(14-51)years]with verified diabetic symmetrical peripheral neuropathy and 21 healthy participants(age 51±6 years,6 females)underwent standardised nerve conduction testing and completed the SF-36 questionnaire.Furthermore,disease duration,number of comorbidities,both diabetes related and nondiabetes related,vibration perception threshold,number of hypoglycaemic events,HbA1c and administration way of insulin was notified.RESULTS In comparison to healthy subjects,patients’mental composite score was not significantly diminished(51.9±8.9 vs 53.1±5.5,P=0.558),while the physical composite score was(46.3±11.7 vs 54.6±3.3,P=0.002).As expected,the overall physical health related symptoms in patients were associated to total number of comorbidities(P<0.0001),comorbidities relation to diabetes(P=0.0002)and HbA1c(P=0.005)as well as comorbidities not related to diabetes(P=0.0006).CONCLUSION The finding of this study emphasises the importance of focusing on quality of life in adults with diabetes and especially in those with multiple comorbidities as well as the possibility of HbA1c as a biomarker for severe complication.

Functional and clinical outcome with modified lateral approach total hip arthroplasty in stiff hips with ankylosing spondylitis

BACKGROUND Ankylosing spondylitis at total hip arthroplasty(THA)has significant hip stiffness with flexion deformity,restricted mobility,and function.Range of movement(ROM)improvement with good functional outcome is seen following THA in these hips.The modified Hardinge approach without abductor compromise is helpful in these stiff hips with associated flexion deformity.AIM To assess improvement in ROM and functional outcomes with a modified lateral approach THA in ankylosing spondylitis with stiff hips.METHODS A total of 69 hips that underwent THA with a modified Hardinge approach in 40 patients were evaluated at a mean follow-up of 38.33 mo.All individuals ambulated with weight-bearing as tolerated and ROM exercises from the 1st postoperative day.Modified Harris hip score and ROM were assessed during follow-up.Quality of life assessments using the 36-item and 12-item short form health surveys were done along with clinical and functional outcomes at followup.SPSS 22.0 was used for statistical analysis.The correlation of ROM and functional score change was performed using Pearson’s correlation coefficient.RESULTS Sixty-nine hips with a significant decrease in ROM preoperatively with 32 clinically fused hips showed significant improvement in flexion range.The mean flexion in 69 hips improved from 29.35±31.38 degrees to 102.17±10.48 degrees.The mean difference of 72.82 with a P value<0.0001 was significant.In total,45 out of 69 hips had flexion deformity,with 13 hips having a deformity above 30 degrees.The flexion during the follow-up was below 90 degrees in 3 hips.Eleven hips had flexion of 90 degrees at follow-up,while the remaining 55 hips had flexion above 100 degrees.Modified Harris hip score improved from 17.03±6.02 to 90.66±7.23(P value<0.0001).The 36-item short form health survey at the follow-up indicated health status in 40 patients as excellent in 11,very good in 20,good in 5,fair in 3,and poor in 1.The mean mental health score was 84.10±11.58.Pain relief was good in all 69 hips.Altogether,28/40 patients(70%)had no pain,9 patients(22%)had occasional pain,and 3 patients(8%)had mild to moderate pain with unusual activity.Heterotopic ossification was seen in 21 hips with Brooker class 1 in 14 hips.CONCLUSION Modified Hardinge approach THA in ankylosing spondylitis with stiff hips with flexion deformity significantly improved ROM,Harris hip score,and quality of life indicated by the 36-item and 12-item short form health surveys.

Acupuncture and moxibustion for the elderly patients with depression:A randomized controlled trial

Objective:To identify the effects of acupuncture and moxibustion therapy by soothing liver and regulating mind on the quality of life among the elders with depression.Methods:This was a single-blind,randomized,controlled trial of 75 elders with depression conducted in Guangdong Province,China,in January to December 2010.Eligible patients were randomly divided into three treatment groups.22 patients received acupuncture and moxibustion treatment of soothing liver and regulating mind[group A,in acupuncture procedure:Hegu(合谷L14),Taichong(太冲LR3),Baihui(百会GV20)and Yinting(印堂GV29)were selected,in moxibustion procedure,bilateral Geshu(膈俞BL17)and Danshu(胆俞BL19)were selected,the moxibustion cones was placed on the acupoints,five cones were given to each point.In intradermal needling procedure,Xinshu(心俞BL15),and Ganshu(肝俞BL18)were selected].28 patients received acupoint shallow puncturing treatment(group B,patients received the same acupoints as in the group A,with a 2-3 mm needling depth and no needle sensation was required.A shorter duration of moxibustion and only 1-2 mm of needle body was inserted into the points when intradermal needling).25 patients received non-acupoint shallow puncturing treatment(group C,patients received non-acupoint shallow puncturing at points 10 mm lateral to LI4 and LR3,10 mm left side of GV20 and GV29 in acupuncture procedure;10 mm lateral to BL17 and BL19 in moxibustion procedure;10 mm lateral to BL15 and BL18 in intradermal needling procedure,with the same manipulation method as that in the group B).In all three groups,the treatment was given twice a week for 12 weeks.The Short Form(36)Health Survey(SF36)and TCM Symptom Scale Score as clinical efficacy and quality of life were used to quantitatively assess patients'outcomes before and after treatment.Results:The TCM Symptom Scale scores showed significant differences between the group A and C,and between group B and C(both P<0.05),while there was no significant difference between group A and B(P>0.05).An item-by-item analysis of the SF36 showed the elders in group A obtained the highest scores at each time point after treatment(all P<0.05).Among the results,mental health and report health transition items showed no significant differences between the group A and group B at time point of after treatment(all P>0.05).Vitality and social functioning items at a month after treatment time point,social functioning and report:health transition items at 3 months after treatment time point,role emotional item at after treatment time point showed no significant differences between the group B and group C(all P>0.05).Conclusions:The therapeutic effect of acupuncture and moxibustion by soothing liver and regulating mind can obviously improve the quality of life of depression elders.