Fatigue in rheumatoid arthritis patients: association with sleep quality, mood status, and disease activity / Fatiga en pacientes con artritis reumatoide: asociación con la calidad del sueño, el estado de ánimo y la actividad de la enfermedad

OBJECTIVES: Rheumatoid arthritis (RA) is a chronic inflammatory disease, characterized by polyarthritis and systemic manifestations. RA-fatigue is a significant problem and adds on disease burden. Sleep disturbance, depression, and disease activity are suggested contributing factors to RA-fatigue; however, their combined role did not examine before among Egyptian RA patients. The objective of the study was to investigate the presence of fatigue, sleep and mood disturbances in RA patients. Also, to evaluate the possible association of poor sleep, depression, and disease activity with RA-fatigue. METHODS: This cross-sectional study included 115 RA patients diagnosed according to the 2010 ACR-EULAR criteria and 46 age and sex matched controls. Fatigue using the Multidimensional Assessment of Fatigue-Global Fatigue Index, sleep using the Pittsburgh Sleep Quality Index and mood status using Beck Depression Inventory were assessed for all participants. RA disease activity was evaluated using disease activity score-28 joints. RESULTS: RA patients had higher mean fatigue, sleep disturbance, and depression scores (27.2±8.9, 6.4±3.6, and 12.8±7.3; respectively) than controls (22.7±7, 4.8±3, 7.8±5.9; respectively) (P<.05). Poor sleep, depression and higher disease activity were significantly correlated with fatigue (r=0.4, r=0.65, r=0.55; respectively) (P<.001). The three variables may explain up to 49.1% of the variation in fatigue on multiple regression analysis. CONCLUSION: Fatigue, poor sleep, and depression are more common in Egyptian patients with RA. A remarkably higher fatigue was associated with poor sleep, depression, and high disease activity, thus monitoring these silent comorbidities in clinical practice is required

OBJETIVOS: La artritis reumatoide (AR) es una enfermedad inflamatoria crónica, caracterizada por poliartritis y manifestaciones sistémicas. La fatiga asociada a AR es un problema importante y aumenta la carga de la enfermedad. La alteración del sueño, la depresión y la actividad de la enfermedad son factores sugeridos que contribuyen a la fatiga asociada a AR; sin embargo, su papel no se ha examinado previamente en pacientes egipcios con AR. El objetivo del estudio fue investigar la presencia de fatiga y alteraciones del sueño y humor en pacientes con AR. Además, evaluar la posible asociación del sueño deficiente, depresión y la actividad de la enfermedad con la fatiga asociada a AR. MÉTODOS: Este estudio transversal incluyó 115 pacientes con AR, diagnosticados según los criterios de la ACR-EULAR 2010 y 46 pacientes de control emparejados por edad y sexo. Se evaluó en todos los participantes la fatiga mediante el índice de evaluación multidimensional de la fatiga y la fatiga global, el sueño utilizando el índice de calidad del sueño de Pittsburgh y el estado de ánimo mediante el Inventario de Depresión de Beck. La actividad de la enfermedad de la AR se evaluó utilizando la medida de la actividad de enfermedad-28 articulaciones. RESULTADOS: Los pacientes con AR presentaron en promedio una mayor fatiga, alteración del sueño y puntuaciones de depresión (27,2±8,9; 6,4±3,6 y 12,8±7,3, respectivamente) que los pacientes de control (22,7±7; 4,8±3 y 7,8±5,9, respectivamente) (p < 0,05). El sueño deficiente, la depresión y una mayor actividad de la enfermedad se correlacionaron significativamente con la fatiga (r=0,4; r=0,65; r=0,55, respectivamente) (p < 0,001). Las 3 variables pueden explicar hasta el 49,1% de la variación en fatiga en el análisis de regresión múltiple. CONCLUSIÓN: La fatiga, el sueño deficiente y la depresión son más comunes en pacientes egipcios con AR. Una notablemente alta fatiga se asoció con un sueño deficiente, depresión y alta actividad de la enfermedad, por lo que se requiere el control de estas comorbilidades silenciosas en la práctica clínica

Fatigue in Rheumatoid Arthritis Patients: Association With Sleep Quality, Mood Status, and Disease Activity.

OBJECTIVES: Rheumatoid arthritis (RA) is a chronic inflammatory disease, characterized by polyarthritis and systemic manifestations. RA-fatigue is a significant problem and adds on disease burden. Sleep disturbance, depression, and disease activity are suggested contributing factors to RA-fatigue; however, their combined role did not examine before among Egyptian RA patients. The objective of the study was to investigate the presence of fatigue, sleep and mood disturbances in RA patients. Also, to evaluate the possible association of poor sleep, depression, and disease activity with RA-fatigue. METHODS: This cross-sectional study included 115 RA patients diagnosed according to the 2010 ACR-EULAR criteria and 46 age and sex matched controls. Fatigue using the Multidimensional Assessment of Fatigue-Global Fatigue Index, sleep using the Pittsburgh Sleep Quality Index and mood status using Beck Depression Inventory were assessed for all participants. RA disease activity was evaluated using disease activity score-28 joints. RESULTS: RA patients had higher mean fatigue, sleep disturbance, and depression scores (27.2±8.9, 6.4±3.6, and 12.8±7.3; respectively) than controls (22.7±7, 4.8±3, 7.8±5.9; respectively) (P<.05). Poor sleep, depression and higher disease activity were significantly correlated with fatigue (r=0.4, r=0.65, r=0.55; respectively) (P<.001). The three variables may explain up to 49.1% of the variation in fatigue on multiple regression analysis. CONCLUSION: Fatigue, poor sleep, and depression are more common in Egyptian patients with RA. A remarkably higher fatigue was associated with poor sleep, depression, and high disease activity, thus monitoring these silent comorbidities in clinical practice is required.

Anodal transcranial direct current stimulation over the dorsolateral prefrontal cortex improves anorexia nervosa: A pilot study.

BACKGROUND: Existing treatments for adults with anorexia nervosa (AN) have limited proven efficacy. New treatments that have been suggested involve targeted, brain-directed interventions such as transcranial direct current stimulation (tDCS). We describe findings from seven individuals with treatment-resistant AN who received 10 sessions of anodal tDCS, over the left dorsolateral prefrontal cortex (DLPFC). MATERIAL AND METHOD: In this open-label, single-arm study, seven patients received anodal tDCS (2mA) for 25 minutes over the left dorsolateral prefrontal cortex daily for ten days. Assessments pre-tDCS, post-tDCS and one month later included the Eating Attitude Test (EAT), Eating Disorder Inventory (EDI) and Beck Depression Inventory (BDI). RESULTS: Three patients improved in all three rating scales immediately after the treatment sessions and one month later. Two patients showed improvement at the end of treatment but returned to the baseline after one month. One subject improved only on the BDI scale but not eating scales. The scores in the three rating scales were unaffected by treatment in the remaining patient. There was a significant effect of time (pre, post and 1 month later) on the three rating scores; BDI (P = 0.016), EDI (P = 0.018) and EAT (P = 0.016) and a significant correlation between the percent improvement of BDI and EAT (p = 0.01), and between BDI and EDI (P = 0.006). CONCLUSIONS: These findings suggest that tDCS has potential as an adjuvant treatment for AN and deserves further study.

Epidemiological study and risk factors of stroke in Assiut Governorate, Egypt: community-based study.

BACKGROUND: Because there have been no epidemiological studies of stroke in Egypt, a community-based survey was conducted in the Assiut Governorate to estimate the prevalence and risk factors of stroke in our community. METHODS: A three-phase door-to-door study was performed in which 6,498 participants were chosen by random sampling from 7 districts in Assiut (first phase). Out of this sample, 578 dropped out leaving 3,066 males (51.8%) and 2,854 females (48.2%). There were 3,660 (61.8%) urban residents and 2,260 (38.2%) from the rural community. In the second phase participants were screened using the questionnaire for stroke, while the third phase involved medical evaluation of all suspected cases, with diagnosis of stroke confirmed by evaluation of CT scans. The Mini Mental State Examination and Hamilton Depression Scale were evaluated for each patient. RESULTS: 65 participants were identified as positive on the survey questionnaire, but only 57 patients were found to have stroke, giving a crude prevalence rate of 963/100,000 inhabitants with an age-adjusted local prevalence rate of 699.2/100,000 and an age-adjusted prevalence relative to the standard world population of 980.9/100,000. The prevalence among males was higher than females (1174/100,000 vs. 736/100,000) with a ratio 1.7:1. There was a significantly higher prevalence of ischemic (895/100,000) than hemorrhagic (68/100,000) stroke. Stroke prevalence was the same in rural and urban areas and in males and females. There was, however, a significantly higher prevalence in illiterate (2413/100,000) than literate participants (357/100,000). Forty-two patients (73.7%) had one or more risk factors for stroke, hypertension being the commonest (66%) and diabetes mellitus second (38.6%). Nine cases had poststroke dementia (15.8%) and 14 cases (24.6%) had mild depression. CONCLUSIONS: The overall prevalence rate of stroke is high, especially in older adults, men and illiterate individuals. A higher prevalence of ischemic than hemorrhagic stroke was recorded, with hypertension and diabetes mellitus being the commonest risk factors in our community.

A community based epidemiological study of epilepsy in Assiut Governorate/Egypt.

BACKGROUND: The aim of the study was to estimate the prevalence of different types of epilepsy and their possible risk factors in the region of the Assiut Governorate/Egypt. MATERIAL AND METHODS: A community based study with random sampling of 7 districts, involving 6498 inhabitants. Out of this sample, 578 dropped out leaving 3066 males (51.8%) and 2854 females (48.2%). There were 3660 (61.8%) urban residents and 2260 (38.2%) from the rural community. Patients were evaluated using a screening questionnaire for epilepsy, and then referred to the hospital to be re-evaluated by a qualified neurologist and with electroencephalography (EEG) and computed tomography of the brain (CT). RESULTS: Seventy-five cases were diagnosed with epilepsy giving an overall the crude lifetime prevalence rate (CPR) for epilepsy of 12.67/1000 (95% CI: 9.8-15.54). The active prevalence rate was 9.3/1000 and the incidence rate was 1.5/1000 (95% confidence interval: 0.53-2.51). Fifty-six cases (75%) had idiopathic epilepsy (CPR 9.5/1000). Symptomatic epilepsy was recorded in 19 (25%) cases (CPR 3.2/1000). Generalized seizures were more common (CPR 6.75/1000) than partial seizures (CPR 2.5/1000). The prevalence rate of partial seizures evolving to secondary generalization was 0.84/1000 while simple partial and complex partial seizures had CPR 1.4/1000 and 0.34/1000, respectively. The CPR of mixed seizures was 0.17/1000. Epilepsy was slightly but not significantly more common among males than females (CPR of 14.4 and 10.9 per 1000 population, respectively). The CPR was higher in rural than urban populations (17.7/1000, with 95% CI 12.2-23.18 and 9.56/1000, with 95% CI: 6.39-12.7, respectively) and in the illiterate group than the literate population (12.02/1000 and 9.94/1000, respectively). The highest prevalence rate was recorded in the early and late childhood period (69.78/100,000 and 43.78/100,000, respectively). Prenatal insults and infection represented major causes of symptomatic epilepsy. CONCLUSIONS: We found a high prevalence rate of epilepsy (comparable with that in other Arabic and European countries) in our community particularly among children and teenagers. Overall the prevalence was higher in the rural than in the urban population. A family history of epilepsy, prenatal insults, and infection represented major risk factors of symptomatic epilepsy.

Door-to-door survey of major neurological disorders in Al Kharga District, New Valley, Egypt: methodological aspects.

Epidemiology of neurological disorders is still lacking in Egypt. The door-to-door method is the most suitable one to screen neurological disorders in our country. Over a 4-year period (June 1, 2005 to May 31, 2009), screening and examination had been carried out to ascertain the incidence and prevalence rate of epilepsy, stroke, cerebral palsy and Bell's palsy, as well as the prevalence of dementia, extrapyramidal syndromes, muscle and neuromuscular disorders, cerebellar ataxia and primary nocturnal enuresis among the urban and rural population of Al Kharga District, New Valley, Egypt. A total of 62,583 people were screened by 3 neurologists in a door-to-door manner, including every door, using a standardized Arabic questionnaire to detect any patient with a neurological disorder. This was a project study of neurological disorders including 3 stages: first stage (June 1, 2005 to May 31, 2006) for data collection, designing a standardized questionnaire and screening; second stage (June 1, 2006 to May 31, 2008) for case ascertainment, classification of neurological disorders and investigations, and third stage (June 1, 2007 to May 31, 2009) for data entry and statistical analysis. The results of this study revealed that the total prevalence rate of neurological disorders in Al Kharga District, New Valley was 2.4/100 with no significant difference among both sexes. The highest prevalence rate was recorded among elderly people (60+ years; 9.25%) and among children (≤18 years; 2.9%).