Office-based respiratory assessment in patients with generalized myasthenia gravis.

Patients with myasthenia gravis (MG) can present with respiratory dysfunction, ranging from exercise intolerance to overt respiratory failure, increased fatigue, or sleep-disordered breathing. To investigate the value of multiple respiratory tests in MG, we performed clinical and respiratory assessments in patients with mild to moderate generalized disease. One-hundred and thirty-six patients completed the myasthenia gravis quality-of-life score(MG-QOL-15), myasthenia gravis impairment index(MGII), Epworth sleepiness scale(ESS), University of California-San Diego Shortness of Breath Questionnaire(UCSD-SOB), Modified Medical Research Council Dyspnea Scales(MRC-DS), supine and upright forced vital capacity(FVC), maximal inspiratory pressures(MIPs) and sniff nasal inspiratory pressures(SNIP). Seventy-three (54 %) had respiratory and/or bulbar symptoms and 45 (33 %) had baseline abnormal FVC, with no significant postural changes (p = 0.89); 55 (40.4 %) had abnormal MIPs and 50 (37 %) had abnormal SNIPs. Overall, there were low scores on respiratory and disability scales. Females had increased odds of presenting with abnormal FVC (OR 2.89, p = 0.01) and MIPs (OR 2.48, p = 0.022). There were significant correlations between MIPs, FVC and SNIPs; between MGII/MG-QOL15 and UCSD-SOB/MRC-DS and between ESS and respiratory scales in the whole group. Our data suggests that office-based respiratory measurements are a useful screening method for stable MG patients, even when presenting with minimal respiratory symptoms and no significant disability.

Qualitative, Patient-Centered Assessment of Muscle Cramp Impact and Severity.

BACKGROUND: There is an urgent need for new therapeutic options to treat muscle cramps; however, no patient-reported measures exist that capture the entire cramp experience. We conducted a qualitative study to assess the experience of patients suffering muscle cramps, aiming to understand what factors determine the impact cramps have in patients' lives to guide the development of a patient-centered outcome measure of cramp severity and impact. METHODS: We enrolled patients with cramps due to several etiologies, including motor neuron disease, pregnancy-induced cramps, cirrhosis and hemodialysis, and idiopathic and exercise-induced cramps. Patients participated in semistructured interviews about their experiences with muscle cramps and their responses were recorded and transcribed. Data were analyzed with content analysis using data saturation to determine the sample size. We subsequently developed a conceptual framework of cramp severity and overall cramp impact. RESULTS: Ten patients were interviewed when data saturation was reached. The cramp experience was similar across disease and physiological states known to cause muscle cramps. The main themes that compose the overall cramp impact are cramp characteristics, sleep interference, daytime activities interference, and the effect on mental health. CONCLUSIONS: This framework will be used to develop a patient-reported outcome of cramp severity and impact.

Évaluer qualitativement l'impact et la gravité des crampes musculaires tout en étant axé sur les patients qui en souffrent. Contexte : Il existe un besoin urgent de mettre en œuvre de nouvelles options thérapeutiquespour le soulagementdes crampes musculaires. Cela dit, aucun patient qui en souffre ne semble avoir fait état d'optionstenant compte de la totalité de leurexpérience. À cet égard, nous avons effectué une étude qualitative afin justement de mieux cerner l'expérience de ces patients et de comprendreles facteurs qui déterminentl'impact que les crampes peuvent avoir dans leur vie. Nous voulons du coup orienter l'élaboration d'indicateursaxés sur les patients eux-mêmes, indicateurs visant à mesurer l'impact et la gravité de leurs crampes musculaires. Méthodes : Nous avons recruté des patients atteints de crampes musculaires en raison de plusieurs étiologies, par exemple des pathologies du motoneurone, des crampes liées à une grossesse, des cas de cirrhosenécessitant une hémodialyse, des crampes idiopathiquesou déclenchées par l'exercice, etc. Les patients recrutés ont participé à des entrevues semi-structurées portant sur leur expérience en lien avec des crampes musculaires, leurs réponses étant enregistrées et par la suite transcrites. En plus déterminer la taille de notre échantillon à l'aide de la saturation de données, nous avons ensuite analysé ces dernières au moyen de la méthode d'analyse de contenu. Enfin, nous avons élaboré un cadre conceptuel de la gravité des crampes musculaires et de leur impact général. Résultats : Une fois nos données saturées, dix patients ont été interviewés. Les expériences liées à leurs crampes se sont révélées comparables peu importe les maladies et les états physiologiques. Parmi les principaux aspects caractérisant l'impact général des crampes, mentionnons les suivants : les caractéristiques des crampes, les perturbations du sommeil qu'elles entraînent, leur interférence dans des activités de jour et leurs effets sur la santé mentale. Conclusions : Ce cadre de référence sera utilisé pour élaborer un outil mesurant la gravité et l'impact des crampes musculaires, et ce, en fonction de l'apport des patients eux-mêmes.

Frequency of depression and somatic symptoms in patients on interferon alpha/ribavirin for chronic hepatitis C.

BACKGROUND: Large numbers of patients suffering from Chronic Hepatitis C (HCV) are seeking treatment with interferon alpha (IFN) because of significant advances in overall improvement in the course of HCV and its complications. Objectives were to estimate the frequency of depression and somatic symptoms in patients on interferon alpha/ribavirin treatment for chronic hepatitis C. METHODS: It was an observational study conducted in the out-patient Department of Gastroenterology Shaikh Zayed Hospital, Lahore during a period of three months, i.e., from September to November 2008. One hundred consecutive patients undergoing interferon alpha/ ribavirin treatment for chronic HCV were included in the study. All patients, irrespective of age, sex or duration of treatment were administered with a check list of common physical complaints and DSM-IV symptoms for Major Depressive Episode. RESULTS: Out of a total of 100 subjects 37 were male and 63 were female. In all, 39 (39%) patients fulfilled the diagnostic criteria of DSM-IV for Major Depressive Episode. Major Depression was more common in female 28 (44.4%) as compared to male 11 (28.7%) patients. Somatic symptoms were common in all the patients but they were reported more frequently by patients with Major Depression compared to those without Major Depression. Myalgias, headache, joint pain, nausea/vomiting, abdominal pain and palpitation were the most common physical symptoms. CONCLUSION: Major Depression and somatic complaints are a common consequence of interferon alpha/ribavirin treatment for chronic hepatitis C. All patients receiving this treatment should be periodically assessed for the detection of these side effects to promptly address relevant treatment options.