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Comorbid Factors (comorbid + factor)
Selected AbstractsReconstruction of foot defects with free lateral arm fasciocutaneous flaps: Analysis of fifty patientsMICROSURGERY, Issue 8 2005Betul Gozel Ulusal M.D. In this article, long-term outcomes of foot reconstruction with free lateral arm fasciocutaneous flaps were retrospectively analyzed in 50 patients. The patients, 38 men and 12 women, ranged in age from 7,73 years (mean, 43.5 years). Indications for surgery included trauma (32 patients), diabetes mellitus (7 patients), burns (7 patients), chronic ulcers (3 patients), and tumor (1 patient). The locations of defects were the dorsum (n = 21), ankle (n = 12), medial (n = 6), lateral (n = 6), posterior heel (n = 2), and distal sole (n = 3) Concomitant bone injury occurred in 5 cases, and the weight-bearing surface of the foot was involved in 5 patients. Defects ranged in size from 27,76 cm2 (mean, 36.4 cm2). Successful reconstructions were accomplished in 46 cases (92%). Flap complications included total flap loss and below-knee amputation (1 patient) and partial flap loss (3 patients); 75% (3/4) of these cases had diabetes as a comorbid factor, and 25% (1/4) had a concomitant bone injury. Six patients with dorsum defects required debulking of the flap (11.1%). None of the patients required modified shoes. In the majority of cases, flaps provided stable coverage and a gain in protective deep-pressure sensation. In long-term follow-up (up to 4 years), patients regained their ambulation, free of pain. Even in weight-bearing areas, none of the cases experienced ulceration or skin breakdown. Free lateral arm flaps provided excellent durability, with solid bony union and successful restoration of the contour of the foot in moderate-sized foot defects. © 2005 Wiley-Liss, Inc. Microsurgery 25:581,588, 2005. [source] Recent Research on Impulsivity in Individuals With Drug Use and Mental Health Disorders: Implications for AlcoholismALCOHOLISM, Issue 8 2010Robert D. Rogers Alcohol misuse and dependence, and many of its accompanying psychological problems, are associated with heightened levels of impulsivity that both accelerate the development of clinically significant illness and complicate clinical outcome. This article reviews recent developments in our understanding of impulsivity as they relate to brain circuitry that might underlie these comorbid factors, focusing upon the clinical features of substance use (and dependence), bipolar disorder, and pathological gambling. Individuals who are affected by these disorders exhibit problems in several domains of impulsive behavior including deficient response or "motor" control, and the tolerance of prolonged delays prior to larger rewards at the expense of smaller rewards ("delay-discounting"). These populations, like alcoholic dependents, also exhibit impairments in risky decision-making that may reflect dysfunction of monoamine and catecholamine pathways. However, several areas of uncertainty exist including the specificity of impairments across disorders and the relationship between impulse control problems and altered evaluation of reward outcomes underlying observed impairments in action selection. [source] Abstracts of the 8th Meeting of the Italian Peripheral Nerve Study Group: 73JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2003C Inglese Cryoglobulinemic neuropathy is probably the commonest form of vasculitic neuropathy in Mediterranean countries, as usually related to the widespread hepatitis C virus (HCV) infection. We describe the spectrum of manifestations in a large series of patients with cryoglobulinemic neuropathy, also analyzing the impact of comorbid factors, which are quite frequent in HCV-related mixed cryoglobulinemia. The cohort included 60 patients (10 men, 50 women) with peripheral neuropathy associated with mixed cryoglobulinemia as main or sole cause (type 2 in 36 cases, type 3 in 4, not typized in 20), HCV-related in all patients but 8 (3 men and 5 women). Median age of patients was 65 years (range 41,85), and median age at onset of neuropathy was 59 (range 40,84). Peripheral neuropathy represented an onset manifestation of mixed cryoglobulinemia in about half patients. The most frequent clinical pattern was pure sensory neuropathy in 40 patients, including 4 patients with prominent ataxia; sensory neuropathy was asymmetrical in distribution in 9 patients, and in 14 patients sensory action potentials (SAPs) of the sural nerve were normal, suggesting selective involvement of the small sensory fibers. The remaining patients had sensorimotor neuropathy (15 cases) and mononeuropathy multiplex (5 cases). Positive sensory symptoms and restless legs syndrome were the most common manifestations. Neurophysiological study showed axonal degeneration of varying severity in all patients. In 20 patients, additional causes of neuropathy were present, including type 2 diabetes (5 patients), glucose intolerance (6 patients), non-Hodgkin lymphoma (3 patients), and alcohol (2 patients). With respect with this subset of patients, in "pure" cryoglobulinemic neuropathy there was more often a pattern of sensory neuropathy (31/40 vs. 6/20; p = 0.001), with more frequent asymmetrical distribution (9 vs 0; p = 0.05) and small fiber involvement (11 vs 3). Severity of neuropathy, as judged on the basis of the Rankin scale and of neurophysiological changes, was similar in the two subgroups. Our study confirms that sensory neuropathy, often asymmetrical, is the most common clinical pattern in cryoglobulinemic neuropathy, and is consistently present in pure cryoglobulinemic neuropathy rather than in patients with other associated causes of neuropathy; in these latter, paradoxically, clinical and neurophysiological impairment seems not greater than in pure cryoglobulinemic neuropathy. [source] Higher rate and earlier peritonitis in Aboriginal patients compared to non-Aboriginal patients with end-stage renal failure maintained on peritoneal dialysis in Australia: Analysis of ANZDATANEPHROLOGY, Issue 2 2005WAI H LIM SUMMARY Background: Aboriginal patients maintained on peritoneal dialysis (PD) have a higher rate of technique failure than any other racial group in Australia. Peritonitis accounts for the bulk of these technique, failures,, but, it, is, uncertain, whether, the, increased, risk, of, peritonitis, in, Aboriginal, patients was independent of associated comorbid conditions, such as diabetes mellitus. Methods: Using data collected by the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), peritonitis rates and time to first peritonitis were compared between Aboriginal (n = 238) and non-Aboriginal patients (n = 2924) commencing PD in Australia between 1 April 1999 and 31 March 2003. Results: Aboriginal PD patients were younger, and had a higher incidence of diabetes than their non-Aboriginal counterparts. Mean peritonitis rates were significantly higher among Aboriginal (1.15 episodes/year; 95% confidence interval (CI): 1.03,1.28) than non-Aboriginal patients (0.60 episodes/year; 95% CI: 0.57,0.62, P < 0.05). Using multivariate negative binomial regression, independent predictors of higher peritonitis rates include Aboriginal racial origin (adjusted odds ratio 1.78; 95% CI: 1.45,2.19), obesity, age and absence of a recorded dialysate : plasma creatinine ratio (D/P creatinine) measurement. Aboriginal racial origin was also associated with a shorter median time to first peritonitis (9.9 vs 19.3 months, P < 0.05), which remained statistically significant in a multivariate Cox proportional hazards model (adjusted hazard ratio 1.76; 95% CI: 1.47,2.11, P < 0.05). Conclusion: Aboriginal and obese PD patients have a higher rate of peritonitis and a shorter time to first peritonitis, independent of demographic and comorbid factors. Further investigation of the causes of increased peritonitis risk in Aboriginal patients is needed. [source] ORIGINAL RESEARCH,WOMEN's SEXUAL DYSFUNCTIONS: The Sexual Interest and Desire Inventory,Female (SIDI-F): Item Response Analyses of Data from Women Diagnosed with Hypoactive Sexual Desire DisorderTHE JOURNAL OF SEXUAL MEDICINE, Issue 6 2005Terrence Sills PhD ABSTRACT Introduction Hypoactive sexual desire disorder (HSDD) is the most common sexual complaint in women. Currently there are no validated instruments for specifically assessing HSDD severity, or change in HSDD severity in response to treatment, in premenopausal women. The Sexual Interest and Desire Inventory,Female (SIDI-F) is a clinician-administered instrument that was developed to measure severity and change in response to treatment of HSDD. Seventeen items were included in a preliminary version of the SIDI-F, including 10 items related to desire, and seven items related to possible comorbid factors (e.g., other kinds of sexual dysfunction, general relationship satisfaction, mood, and fatigue). Aim The aim of the study was to use the outcome of item response analyses of blinded data from two randomized, placebo-controlled trials, to assist in the revision of the scale. Methods A nonparametric item response (IRT) model was used to assess the relation between item functioning and HSDD severity on this preliminary version of the SIDI-F. Results Results show that the majority of SIDI-F items demonstrated good sensitivity to differences in overall HSDD severity. That is, there was an orderly relation between differences in option selection for an item and differences in overall HSDD severity. The IRT analyses further indicated that revisions were warranted for a number of these items. Five items were not sensitive to differences in HSDD severity and were removed from the scale. Conclusion The SIDI-F is a brief, clinician-administered rating scale designed to assess severity of HSDD symptoms in women. IRT analyses show that majority of the items of the SIDI-F function well in discriminating individual differences in HSDD severity. A revised 13-item version of the SIDI-F is currently undergoing further validation. Sills T, Wunderlich G, Pyke R, Segraves RT, Leiblum S, Clayton A, Cotton D, and Evans K. The Sexual Interest and Desire Inventory,Female (SIDI-F): item response analyses of data from women diagnosed with hypoactive sexual desire disorder. J Sex Med 2005;2:801,818. [source] |