Pulmonary rehabilitation improves only some domains of health-related quality of life measured by the Short Form-36 questionnaire.

BACKGROUND: Pulmonary rehabilitation (PR) has inconsistent effects on health-related quality of life (HRQL) in patients with chronic lung diseases. We evaluated the effect of PR on HRQL outcomes using the 36-item short form of the medical outcomes (SF-36). METHODS: We retrospectively reviewed the files of all patients who completed PR in 2010, 2011, and first half of 2012. We collected information on demographics, symptoms, pulmonary function tests, 6-minute walk tests (6-MWT), and responses on the SF-36 survey, including the physical component score (PCS) and mental component score (MCS). RESULTS: The study included 19 women and 22 men. The mean age was 69.8 ± 8.5 years. The diagnoses included chronic obstructive pulmonary disease (COPD; n = 31), asthma (n = 3), interstitial lung disease (n = 5), and obstructive sleep apnea (OSA; n = 2). The mean forced expiratory volume-one second (FEV1) was 1.16 ± 0.52 L (against 60.5 ± 15.9% of predicted value). There was a significant improvement in 6-MWT (P < 0.0001). The PCS improved post-PR from 33.8 to 34.5 (P = 0.02); the MCS did not change. CONCLUSION: These patients had low SF-36 scores compared to the general population; changes in scores after PR were low. These patients may need frequent HRQL assessment during rehabilitation, and PR programs should consider program modification in patients with small changes in mental health.

Pulmonary Rehabilitation Increases Gait Speed in Patients With Chronic Lung Diseases.

INTRODUCTION: Gait speed provides an integrated index of physical performance; changes in gait speed could reflect deterioration in the underlying medical disorder or a response to medical/surgical interventions. Slower gait speeds reflect the overall level of impairment, especially in patients with chronic lung disease. METHODS: We retrospectively reviewed the medical files of 119 patients who completed the pulmonary rehabilitation program at the University Medical Center in Lubbock, Texas, and collected demographic, pulmonary function, and 6-minute walk test information. Gait speed was calculated using the 6-minute walk test information. RESULTS: The patients in this study had a mean age of 68.8 ± 10.1 years. Most patients (95) had chronic obstructive pulmonary disease/asthma. The mean forced expiratory volume in the first second of expiration (FEV1) was 1.3 ± 0.7 L (47.2% ± 19.7% predicted). The baseline gait speed was 41 ± 15 m/min before rehabilitation and 47 ± 15 m/min after rehabilitation. Baseline gait speed, body mass index, and FEV1 predicted postrehabilitation gait speed (P < .05 for each variable). Ten patients had a gait speed >60 m/min before rehabilitation; this number increased to 29 postrehabilitation. Using multivariable analysis, it was found that only the baseline gait speed predicted a speed of more than 60 m/min postrehabilitation. Seventy-four patients had an increase in 6-minute walk distance of greater than 30 m. CONCLUSIONS: Patients with chronic lung diseases have slow gait speeds. Most patients improve their speed with rehabilitation but do not increase their speed above 60 m/min and remain frail by this criterion. However, the majority of patients increase their walk distance by 30 m, a distance that represents a minimal clinically important distance.

Stand alone surgical ablation for atrial fibrillation.

BACKGROUND: Trials to maintain sinus rhythm in patients with atrial fibrillation (AF) and refractory symptoms have been complicated by lack of success or intolerance of medications. Experience with minimally invasive AF surgery is relatively new, and early results have been promising. However, the study populations and techniques were heterogeneous, and the follow-up periods were short in many series. METHODS: We present a single center experience through a retrospective review of medical records of patients who had minimally invasive AF surgery. RESULTS: The surgical techniques addressed several possible mechanisms of AF and causes of recurrence, including pulmonary vein isolation, underlying substrates modification, ligament of Marshall interruption, ganglion plexus ablation, and left atrial appendage exclusion. Thirty-three cases were identified. The mean duration of follow-up was 23.2 months, and 58.6% were maintained in a sinus rhythm and were off antiarrhythmic drugs at the end of the follow-up period. Cases with persistent AF had a lower success rate. CONCLUSION: Results with minimally invasive surgery are suboptimal at two years of follow-up, particularly for patients with persistent AF.

Screening for osteoporosis in men aged 70 years and older in a primary care setting in the United States.

Osteoporosis in men is an underrecognized and undertreated condition. Despite the National Osteoporosis Foundation recommending osteoporosis screening in men aged 70 years and older since 2008, screening rates in the United States remain undefined. In our study, we analyzed dual-energy X-ray absorptiometry (DXA) screening rates in a primary care setting. Overall, screening rates were low (11.3%). Although there was an increase with age in both the 10-year osteoporotic and 10-year hip fracture probabilities, no association was found between increased age and bone mineral density testing using DXA. Only 23.2% of patients were prescribed bone protective treatments. The performance of DXA screening strongly predicted prescription of bone protective treatment. Increased age raised the likelihood of bone protective treatment prescriptions; however, smokers were less likely to be prescribed these medications. As the population in the United States ages, an increased awareness of this major public health problem is warranted.

Poor compliance makes treatment of latent tuberculosis infection unsatisfactory.

OBJECTIVES: The recommended treatment for latent tuberculosis infection is isoniazid for 9 months, but this regimen has a low completion rate. The authors wanted to compare treatment with isoniazid and treatment with isoniazid and rifampin in the typical public health setting in a large diverse state and recover as much information as possible from a state database. METHODS: Patients who received latent tuberculosis infection treatment were identified in the Texas Department of State Health Services database for the years 1995-2002. Treatment completion, adverse reactions, and disease development were recorded. Results were analyzed using logistic regression to predict disease development. RESULTS: In sum, 50 578 patients received isoniazid, and 280 received isoniazid/rifampin. Sixty-one percent of the isoniazid group and 54% of the isoniazid/rifampin group completed treatment. Eighteen percent of the isoniazid/rifampin group possibly had adverse reactions and discontinued treatment; 3% of the isoniazid group discontinued therapy because of side effects. More than 70% of patients with adverse reactions in the isoniazid/rifampin group took the treatment for more than 4 months. Overall, 168 patients in the isoniazid group with a normal chest X-ray and a positive skin test developed tuberculosis during follow-up to 2008; no patients in the isoniazid/rifampin group who had a normal X-ray and completed chemoprophylaxis developed tuberculosis during follow-up. CONCLUSIONS: The isoniazid/rifampin regimen appears to be as effective as the isoniazid regimen. However, completion rates on combination therapy were slightly lower. This regimen needs more formal clinical study since it has the potential to decrease administrative costs and improve completion rates. In addition, state departments of health need to develop networks using community-based resources to reach patients and increase completion rates.

Genetic susceptibility to Graves' ophthalmopathy: The role of polymorphisms in anti-inflammatory cytokine genes.

BACKGROUND: Various polymorphisms occur in cytokine genes involved in inflammatory processes in Graves' ophthalmopathy (GO). Anti-inflammatory cytokines such as transforming growth factor- ß (TGF-ß), interleukin-10 (IL-10) and interleukin-4 (IL-4) are among those believed to be involved in the disease process. In this study, we investigated the association between 8 polymorphisms within the mentioned cytokines and GO. METHODS: The following polymorphisms were studied in 50 patients with GO, 57 Graves' patients without GO and 140 healthy individuals using polymerase chain reaction with sequence-specific primers: TGF-ß (+869C/T, +915G/C), IL-10 (-1082A/G, -819C/T, -592C/A) and IL-4 (-1098T/G, -590T/C, -33C/T). A corrected p value less than 0.05 was considered statistically significant. RESULTS: The TGF-ß +915C allele (Odds Ratio [OR] = 2.20) and CC genotype (OR = 7.50) as well as +869C allele (OR = 2.21) showed significant correlations with GO. Regarding IL-4 polymorphisms, the -1098G allele (OR = 2.09) and GG genotype (OR = 7.49), and the -33T allele (OR = 2.05) and TT genotype (OR = 4.00) were significantly associated with GO. The IL-10 -819TT genotype (OR = 5.00) was significantly correlated with GO. CONCLUSION: This is the first study to show that polymorphisms in anti-inflammatory cytokine genes are associated with susceptibility to GO.

Association of CTLA-4 gene polymorphism with Graves' disease and ophthalmopathy in Iranian patients.

BACKGROUND: The cytotoxic T lymphocyte associated antigen-4 (CTLA-4) gene, is one of the candidate genes for susceptibility to Graves' disease. This study aimed to investigate the association of Graves' disease and Graves' ophthalmopathy with polymorphisms at position +49 in exon 1 and positions -318 and -1147 in the promoter region of CTLA-4 gene in Iranian patients. METHODS: A total of 205 unrelated Iranian patients with Graves' disease who were referred to the outpatient endocrine clinic of a large university general hospital and 103 sex-matched healthy controls were included in this study. Venous blood was obtained, genomic DNA was extracted by a salting out method, and the polymorphisms at positions +49, -318 and -1147 of the CTLA-4 gene were determined using the PCR-restriction fragment length polymorphism method (PCR-RFLP). Genotype and allele frequencies were determined. RESULTS: The frequency of the G allele at position +49 was significantly higher in patients with Graves' disease than in the control group (27.1% vs. 15.1%, OR=2.096, 95%CI=1.350-3.253 and p<0.01). Significant trends were not seen for the other two polymorphisms studied. In patients with ophthalmopathy, the frequency of the G allele at position +49 was higher than in those without ophthalmopathy (33.8% vs. 20.0%, OR=2.043, 95%CI=1.304-3.202 and p<0.01). CONCLUSION: The results of this study suggest that the G allele at position +49 in exon1 of the CTLA-4 gene is associated with Graves' disease and Graves' ophthalmopathy in Iranian patients.