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Light A, Kanthabalan A, Pavlou M, Omar R, Adeleke S, Giganti F, Brew-Graves C, Emara A, Haroon A, Latifoltojar A, Sidhu H, Freeman A, Orczyk C, Nikapota A, Dudderidge T, Hindley R, Payne H, Mitra A, Bomanji J, Winkler M, Horan G, Punwani S, Ahmed H, Shah T. Tumor characteristics of multiparametric MRI-detected and -undetected lesions in patients with suspected radiorecurrent prostate cancer: An analysis from the FOcal RECurrent Assessment and Salvage Treatment (FORECAST) trial. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01283-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kharytaniuk N, Lim EA, Chan E, Pavlou M, Werring DJ, Bamiou DE. Olfactory dysfunction is common in classical infratentorial superficial siderosis of the central nervous system. J Neurol 2022; 269:6582-6588. [PMID: 35997818 PMCID: PMC9396566 DOI: 10.1007/s00415-022-11329-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/12/2022]
Abstract
Background Established features of classical infratentorial superficial siderosis (iSS) include hearing loss, impaired balance, myelopathy and, less commonly, cognitive compromise. Olfactory function may be affected but dedicated studies are lacking. This study aimed to assess the prevalence of olfactory dysfunction in iSS and correlate it with auditory and cognitive functions. Methods Ten participants with iSS completed the University of Pennsylvania Smell Identification Test (UPSIT). The scores were compared with population norms; regression analysis was performed to evaluate associations between the scores and hearing thresholds (3-frequency average, 3FA) or the number of cognitive domains impaired. Imaging was reviewed for haemosiderin distribution and to exclude other causes of olfactory and hearing dysfunction. Results Eight of ten participants were male; the mean (standard deviation, SD) age was 52.5 (14.5) years. Olfactory hypofunction was identified in all participants and in six (60%) was moderate or completely absent. The mean UPSIT score of 25.5 (7.8) was significantly worse than population norms (difference in means − 10.0; 95% CI − 15.6 to − 4.4). Linear regression identified an association between UPSIT and hearing thresholds (R = 0.75; p = 0.013). The score decreases by 0.157 units (95% CI − 0.31 to − 0.002; p = 0.048) per unit increase in 3FA, after adjusting for hearing loss risk factors. There was no statistically significant association between UPSIT and cognitive function (R = 0.383; p = 0.397). Conclusion We report a high prevalence of olfactory dysfunction in iSS, the severity of which correlated with hearing loss. Olfaction appears to be a core feature of the iSS clinical syndrome that should be assessed routinely.
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Affiliation(s)
- Natallia Kharytaniuk
- Ear Institute, University College London, London, UK. .,National Institute for Health and Care Research, University College London Hospitals Biomedical Research Centre (Deafness and Hearing Problems Theme), London, UK. .,Department of Neuro-Otology, Royal ENT and Eastman Dental Hospitals, London, UK. .,Centre for Auditory Research, UCL Ear Institute, 332-336 Gray's Inn Road, London, WC1X 8EE, UK.
| | - E A Lim
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - E Chan
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Stroke Research Centre, Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, University College London, London, UK
| | - M Pavlou
- Department of Statistical Science, University College London, London, UK
| | - D J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, University College London, London, UK.,Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - D E Bamiou
- Ear Institute, University College London, London, UK.,National Institute for Health and Care Research, University College London Hospitals Biomedical Research Centre (Deafness and Hearing Problems Theme), London, UK.,Department of Neuro-Otology, Royal ENT and Eastman Dental Hospitals, London, UK
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Shah T, Kanthabalan A, Pavlou M, Adeleke S, Giganti F, Brew-Graves C, Williams N, Haroon A, Sidhu H, Freeman A, Orczyk C, Nikapota A, Dudderidge T, Hindley R, Virdi J, Arya M, Mitra A, Payne H, Bomanji J, Winkler M, Horan G, Moore C, Emberton M, Punwani S, Ahmed H. MRI and targeted biopsies compared to transperineal mapping biopsies for targeted ablation in recurrent prostate cancer after radiotherapy: Primary outcomes of the FORECAST trial. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01566-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Marsden J, Pavlou M, Dennett R, Gibbon A, Knight-Lozano R, Jeu L, Flavell C, Freeman J, Bamiou DE, Harris C, Hawton A, Goodwin E, Jones B, Creanor S. Vestibular rehabilitation in multiple sclerosis: study protocol for a randomised controlled trial and cost-effectiveness analysis comparing customised with booklet based vestibular rehabilitation for vestibulopathy and a 12 month observational cohort study of the symptom reduction and recurrence rate following treatment for benign paroxysmal positional vertigo. BMC Neurol 2020; 20:430. [PMID: 33243182 PMCID: PMC7694922 DOI: 10.1186/s12883-020-01983-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/28/2020] [Indexed: 01/21/2023] Open
Abstract
Background Symptoms arising from vestibular system dysfunction are observed in 49–59% of people with Multiple Sclerosis (MS). Symptoms may include vertigo, dizziness and/or imbalance. These impact on functional ability, contribute to falls and significant health and social care costs. In people with MS, vestibular dysfunction can be due to peripheral pathology that may include Benign Paroxysmal Positional Vertigo (BPPV), as well as central or combined pathology. Vestibular symptoms may be treated with vestibular rehabilitation (VR), and with repositioning manoeuvres in the case of BPPV. However, there is a paucity of evidence about the rate and degree of symptom recovery with VR for people with MS and vestibulopathy. In addition, given the multiplicity of symptoms and underpinning vestibular pathologies often seen in people with MS, a customised VR approach may be more clinically appropriate and cost effective than generic booklet-based approaches. Likewise, BPPV should be identified and treated appropriately. Methods/ design People with MS and symptoms of vertigo, dizziness and/or imbalance will be screened for central and/or peripheral vestibulopathy and/or BPPV. Following consent, people with BPPV will be treated with re-positioning manoeuvres over 1–3 sessions and followed up at 6 and 12 months to assess for any re-occurrence of BPPV. People with central and/or peripheral vestibulopathy will be entered into a randomised controlled trial (RCT). Trial participants will be randomly allocated (1:1) to either a 12-week generic booklet-based home programme with telephone support or a 12-week VR programme consisting of customised treatment including 12 face-to-face sessions and a home exercise programme. Customised or booklet-based interventions will start 2 weeks after randomisation and all trial participants will be followed up 14 and 26 weeks from randomisation. The primary clinical outcome is the Dizziness Handicap Inventory at 26 weeks and the primary economic endpoint is quality-adjusted life-years. A range of secondary outcomes associated with vestibular function will be used. Discussion If customised VR is demonstrated to be clinically and cost-effective compared to generic booklet-based VR this will inform practice guidelines and the development of training packages for therapists in the diagnosis and treatment of vestibulopathy in people with MS. Trial registration ISRCTN Number: 27374299 Date of Registration 24/09/2018 Protocol Version 15 25/09/2019 Supplementary Information The online version contains supplementary material available at 10.1186/s12883-020-01983-y.
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Affiliation(s)
- J Marsden
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK.
| | - M Pavlou
- Academic Department of Physiotherapy, King's College London, Room 3.5 Shepherd's House, Guy's Campus, London, SE1 1UL, UK
| | - R Dennett
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK
| | - A Gibbon
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK
| | - R Knight-Lozano
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK
| | - L Jeu
- Academic Department of Physiotherapy, King's College London, Room 3.5 Shepherd's House, Guy's Campus, London, SE1 1UL, UK
| | - C Flavell
- Academic Department of Physiotherapy, King's College London, Room 3.5 Shepherd's House, Guy's Campus, London, SE1 1UL, UK
| | - J Freeman
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK
| | - D E Bamiou
- EAR Institute University College London, 332 Gray's Inn Rd, London, WC1X 8EE, UK
| | - C Harris
- Royal Eye Infirmary, Derriford Hospital, Plymouth, PL6 8DH, UK.,School of Psychology, University of Plymouth, Drakes Circus, Plymouth, PL4 8AA, UK
| | - A Hawton
- Health Economics Group, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - E Goodwin
- Health Economics Group, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - B Jones
- Medical Statistics Group and Peninsula Clinical Trials Unit, Faculty of Health: Medicine, Dentistry and Human Science, Plymouth Science Park, 1 Davy Rd, Derriford, Plymouth, PL6 8BX, UK
| | - S Creanor
- Medical Statistics Group and Peninsula Clinical Trials Unit, Faculty of Health: Medicine, Dentistry and Human Science, Plymouth Science Park, 1 Davy Rd, Derriford, Plymouth, PL6 8BX, UK
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Pavlou M, Shah M, Gikas P, Briggs T, Roberts S, Cheema U. Osteomimetic matrix components alter cell migration and drug response in a 3D tumour-engineered osteosarcoma model. Acta Biomater 2019; 96:247-257. [PMID: 31302294 DOI: 10.1016/j.actbio.2019.07.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/10/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
Abstract
Osteosarcoma management continues to lack the appropriate prognostic tools to assign personalised treatment. This leaves non-responders to standard care vulnerable to recurring disease and pulmonary metastases. Developing 3D in vitro disease models to serve as a test bed for personalised treatment is a promising approach to address this issue. This study describes the generation of 3D osteosarcoma models termed "tumouroids", which are geometrically compartmentalised to reproduce the bone cancer mass and its surrounding. Although the tumour microenvironment impacts osteosarcoma in many ways, this model focussed on interrogating the influence of a biomimetic matrix on tumour cell behaviour. The 3D matrix was supplemented with the bone-marrow proteins laminin, fibronectin and NuOss® bone granules. This led to increased invasion of osteosarcoma cell aggregates from within the bone-like matrix into the surrounding acellular bone marrow-like ECM. The presence of bone granules also yielded an atypical molecular profile of osteosarcoma cells, suggesting malignant metabolic reprogramming. Changes include decreased MMP-9 (p < 0.05) and increased PTEN (p < 0.05), MCP-1 (p < 0.01) and MCT-4 (p < 0.05) gene expression. This complex 3D biomimetic composition also changed cellular responses to doxorubicin, a common chemotherapeutic agent used to treat osteosarcoma, and reproduced key issues of in vivo treatment like drug penetrance and doxorubicin-induced bone toxicity. This work highlights the importance of a biomimetic matrix in 3D osteosarcoma models for both basic and translational research. STATEMENT OF SIGNIFICANCE: This study describes the generation of 3D osteosarcoma models termed "tumouroids", which are geometrically compartmentalised to reproduce the bone cancer mass and its environment. Utilising this novel model, specific parameters of osteosarcoma growth and invasion were investigated. Osteosarcoma cell lines proliferate at a slower rate, exhibit malignant metabolic reprogramming, and respond to drug intervention at lower concentrations of doxorubicin hydrochloride in matrix-complex compared to basic tumouroids. As such, this study provides evidence that the tumour microenvironment impacts osteosarcoma in many ways. The osteosarcoma tumouroid described herein may form the basis of a personalised-medicine strategy, which will allow the testing of drug effectiveness similar to that used for antibiotic selection for pathogenic bacteria.
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Wicks E, Menezes L, Barnes A, Mohiddin S, Sekhri N, Garrett E, Patel R, Pavlou M, Groves A, Elliott P. 4776Prevalence and clinical significance of abnormalities detected on positron emission tomography in patients with clinically suspected myocarditis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.4776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Siomou E, Pavlou M, Kalaitzidis R. Child onset steroid-dependent nephrotic syndrome with a combination of mini-mal glomerular changes and IgA deposits: long-term follow-up. Hippokratia 2015; 19:381. [PMID: 27703320 PMCID: PMC5033160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- E Siomou
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - M Pavlou
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - R Kalaitzidis
- Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece
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Marks DJB, Hyams C, Koo CY, Pavlou M, Robbins J, Koo CS, Rodger G, Huggett JF, Yap J, Macrae MB, Swanton RH, Zumla AI, Miller RF. Clinical features, microbiology and surgical outcomes of infective endocarditis: a 13-year study from a UK tertiary cardiothoracic referral centre. QJM 2015; 108:219-29. [PMID: 25223570 DOI: 10.1093/qjmed/hcu188] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) causes substantial morbidity and mortality. Patient and pathogen profiles, as well as microbiological and operative strategies, continue to evolve. The impact of these changes requires evaluation to inform optimum management and identify individuals at high risk of early mortality. AIM Identification of clinical and microbiological features, and surgical outcomes, among patients presenting to a UK tertiary cardiothoracic centre for surgical management of IE between 1998 and 2010. DESIGN Retrospective observational cohort study. METHODS Clinical, biochemical, microbiological and echocardiographic data were identified from clinical records. Principal outcomes were all-cause 28-day mortality and duration of post-operative admission. RESULTS Patients (n = 336) were predominantly male (75.0%); median age 52 years (IQR = 41-67). Most cases involved the aortic (56.0%) or mitral (53.9%) valves. Microbiological diagnoses, obtained in 288 (85.7%) patients, included streptococci (45.2%); staphylococci (34.5%); Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella (HACEK) organisms (3.0%); and fungi (1.8%); 11.3% had polymicrobial infection. Valve replacement in 308 (91.7%) patients included mechanical prostheses (69.8%), xenografts (24.0%) and homografts (6.2%). Early mortality was 12.2%, but fell progressively during the study (P = 0.02), as did median duration of post-operative admission (33.5 to 10.5 days; P = 0.0003). Multivariable analysis showed previous cardiothoracic surgery (OR = 3.85, P = 0.03), neutrophil count (OR = 2.27, P = 0.05), albumin (OR = 0.94, P = 0.04) and urea (OR = 2.63, P < 0.001) predicted early mortality. CONCLUSIONS This study demonstrates reduced post-operative early mortality and duration of hospital admission for IE patients over the past 13 years. Biomarkers (previous cardiothoracic surgery, neutrophil count, albumin and urea), predictive of early post-operative mortality, require prospective evaluation to refine algorithms, further improve outcomes and reduce healthcare costs associated with IE.
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Affiliation(s)
- D J B Marks
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - C Hyams
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - C Y Koo
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - M Pavlou
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - J Robbins
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - C S Koo
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - G Rodger
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - J F Huggett
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - J Yap
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - M B Macrae
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - R H Swanton
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - A I Zumla
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - R F Miller
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
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Pavlou M, Kanegaonkar RG, Swapp D, Bamiou DE, Slater M, Luxon LM. The effect of virtual reality on visual vertigo symptoms in patients with peripheral vestibular dysfunction: a pilot study. J Vestib Res 2013; 22:273-81. [PMID: 23302708 DOI: 10.3233/ves-120462] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Individuals with vestibular dysfunction may experience visual vertigo (VV), in which symptoms are provoked or exacerbated by excessive or disorientating visual stimuli (e.g. supermarkets). VV can significantly improve when customized vestibular rehabilitation exercises are combined with exposure to optokinetic stimuli. Virtual reality (VR), which immerses patients in realistic, visually challenging environments, has also been suggested as an adjunct to VR to improve VV symptoms. This pilot study compared the responses of sixteen patients with unilateral peripheral vestibular disorder randomly allocated to a VR regime incorporating exposure to a static (Group S) or dynamic (Group D) VR environment. Participants practiced vestibular exercises, twice weekly for four weeks, inside a static (Group S) or dynamic (Group D) virtual crowded square environment, presented in an immersive projection theatre (IPT), and received a vestibular exercise program to practice on days not attending clinic. A third Group D1 completed both the static and dynamic VR training. Treatment response was assessed with the Dynamic Gait Index and questionnaires concerning symptom triggers and psychological state. At final assessment, significant between-group differences were noted between Groups D (p=0.001) and D1 (p=0.03) compared to Group S for VV symptoms with the former two showing a significant 59.2% and 25.8% improvement respectively compared to 1.6% for the latter. Depression scores improved only for Group S (p=0.01) while a trend towards significance was noted for Group D regarding anxiety scores (p=0.07). CONCLUSION Exposure to dynamic VR environments should be considered as a useful adjunct to vestibular rehabilitation programs for patients with peripheral vestibular disorders and VV symptoms.
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Affiliation(s)
- M Pavlou
- Centre of Human and Aerospace Physiological Sciences, King's College London, London, UK.
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Coentrao L, Ribeiro C, Santos-Araujo C, Neto R, Pestana M, Kleophas W, Kleophas W, Karaboyas A, LI Y, Bommer J, Pisoni R, Robinson B, Port F, Celik G, Burcak Annagur B, Yilmaz M, Demir T, Kara F, Trigka K, Dousdampanis P, Vaitsis N, Aggelakou-Vaitsi S, Turkmen K, Guney I, Turgut F, Altintepe L, Tonbul HZ, Abdel-Rahman E, Sclauzero P, Galli G, Barbati G, Carraro M, Panzetta GO, Van Diepen M, Schroijen M, Dekkers O, Dekker F, Sikole A, Severova- Andreevska G, Trajceska L, Gelev S, Amitov V, Pavleska- Kuzmanovska S, Karaboyas A, Rayner H, LI Y, Vanholder R, Pisoni R, Robinson B, Port F, Hecking M, Jung B, Leung M, Huynh F, Chung T, Marchuk S, Kiaii M, Er L, Werb R, Chan-Yan C, Beaulieu M, Malindretos P, Makri P, Zagkotsis G, Koutroumbas G, Loukas G, Nikolaou E, Pavlou M, Gourgoulianni E, Paparizou M, Markou M, Syrgani E, Syrganis C, Raimann J, Usvyat LA, Bhalani V, Levin NW, Kotanko P, Huang X, Stenvinkel P, Qureshi AR, Riserus U, Cederholm T, Barany P, Heimburger O, Lindholm B, Carrero JJ, Chang JH, Sung JY, Jung JY, Lee HH, Chung W, Kim S, Han JS, Kim S, Chang JH, Jung JY, Chung W, Na KY, Raimann J, Usvyat LA, Kotanko P, Levin NW, Fragoso A, Pinho A, Malho A, Silva AP, Morgado E, Leao Neves P, Joki N, Tanaka Y, Iwasaki M, Kubo S, Hayashi T, Takahashi Y, Hirahata K, Imamura Y, Hase H, Castledine C, Gilg J, Rogers C, Ben-Shlomo Y, Caskey F, Na KY, Kim S, Chung W, Jung JY, Chang JH, Lee HH, Sandhu JS, Bajwa GS, Kansal S, Sandhu J, Jayanti A, Nikam M, Ebah L, Summers A, Mitra S, Agar J, Perkins A, Simmonds R, Tjipto A, Amet S, Launay-Vacher V, Laville M, Tricotel A, Frances C, Stengel B, Gauvrit JY, Grenier N, Reinhardt G, Clement O, Janus N, Rouillon L, Choukroun G, Deray G, Bernasconi A, Waisman R, Montoya AP, Liste AA, Hermes R, Muguerza G, Heguilen R, Iliescu EL, Martina V, Rizzo MA, Magenta P, Lubatti L, Rombola G, Gallieni M, Loirat C, Loirat C, Mellerio H, Labeguerie M, Andriss B, Savoye E, Lassale M, Jacquelinet C, Alberti C, Aggarwal Y, Baharani J, Tabrizian S, Ossareh S, Zebarjadi M, Azevedo P, Travassos F, Frade I, Almeida M, Queiros J, Silva F, Cabrita A, Rodrigues R, Couchoud C, Kitty J, Benedicte S, Fergus C, Cecile C, Couchoud C, Sahar B, Emmanuel V, Christian J, Rene E, Barahimi H, Mahdavi-Mazdeh M, Nafar M, Petruzzi M, De Benedittis M, Sciancalepore M, Gargano L, Natale P, Vecchio MC, Saglimbene V, Pellegrini F, Gentile G, Stroumza P, Frantzen L, Leal M, Torok M, Bednarek A, Dulawa J, Celia E, Gelfman R, Hegbrant J, Wollheim C, Palmer S, Johnson DW, Ford PJ, Craig JC, Strippoli GF, Ruospo M, El Hayek B, Hayek B, Baamonde E, Bosch E, Ramirez JI, Perez G, Ramirez A, Toledo A, Lago MM, Garcia-Canton C, Checa MD, Canaud B, Canaud B, Lantz B, Pisoni R, Granger-Vallee A, Lertdumrongluk P, Molinari N, Ethier J, Jadoul M, Gillespie B, Port F, Bond C, Wang S, Alfieri T, Braunhofer P, Newsome B, Wang M, Bieber B, Guidinger M, Bieber B, Wang M, Zuo L, Pisoni R, Yu X, Yang X, Qian J, Chen N, Albert J, Yan Y, Ramirez S, Bernasconi A, Waisman R, Beresan M, Lapidus A, Canteli M, Heguilen R, Tong A, Palmer S, Manns B, Craig J, Ruospo M, Gargano L, Strippoli G, Mortazavi M, Vahdatpour B, Shahidi S, Ghasempour A, Taheri D, Dolatkhah S, Emami Naieni A, Ghassami M, Khan M, Abdulnabi K, Pai P, Ruospo M, Petruzzi M, De Benedittis M, Sciancalepore M, Gargano L, Vecchio M, Saglimbene V, Natale P, Pellegrini F, Gentile G, Stroumza P, Frantzen L, Leal M, Torok M, Bednarek A, Dulawa J, Celia E, Gelfman R, Hegbrant J, Wollheim C, Palmer S, Johnson DW, Ford PJ, Craig JC, Strippoli GF, Muqueet MA, Muqueet MA, Hasan MJ, Kashem MA, Dutta PK, Liu FX, Noe L, Quock T, Neil N, Inglese G, Qian J, Bieber B, Guidinger M, Bieber B, Chen N, Yan Y, Pisoni R, Wang M, Zuo L, Yu X, Yang X, Wang M, Albert J, Ramirez S, Ossareh S, Motamed Najjar M, Bahmani B, Shafiabadi A, Helve J, Haapio M, Groop PH, Gronhagen-Riska C, Finne P, Helve J, Haapio M, Sund R, Groop PH, Gronhagen-Riska C, Finne P, Cai M, Baweja S, Clements A, Kent A, Reilly R, Taylor N, Holt S, Mcmahon L, Usvyat LA, Carter M, Van der Sande FM, Kooman J, Raimann J, Levin NW, Kotanko P, Usvyat LA, Malhotra R, Ouellet G, Penne EL, Raimann J, Thijssen S, Levin NW, Kotanko P, Etter M, Tashman A, Guinsburg A, Grassmann A, Barth C, Marelli C, Marcelli D, Van der Sande FM, Von Gersdorff G, Bayh I, Kooman J, Scatizzi L, Lam M, Schaller M, Thijssen S, Toffelmire T, Wang Y, Sheppard P, Usvyat LA, Levin NW, Kotanko P, Neri L, Andreucci VA, Rocca-Rey LA, Bertoli SV, Brancaccio D, Tjipto A, Simmonds R, Agar J, Huang X, Stenvinkel P, Qureshi AR, Riserus U, Cederholm T, Barany P, Heimburger O, Lindholm B, Carrero JJ, Vecchio M, Palmer S, De Berardis G, Craig J, Lucisano G, Johnson D, Pellegrini F, Nicolucci A, Sciancalepore M, Saglimbene V, Gargano L, Bonifati C, Ruospo M, Navaneethan SD, Montinaro V, Stroumza P, Zsom M, Torok M, Celia E, Gelfman R, Bednarek-Skublewska A, Dulawa J, Graziano G, Gentile G, Ferrari JN, Santoro A, Zucchelli A, Triolo G, Maffei S, Hegbrant J, Wollheim C, De Cosmo S, Manfreda VM, Strippoli GF, Janus N, Janus N, Launay-Vacher V, Juillard L, Rousset A, Butel F, Girardot-Seguin S, Deray G, Hannedouche T, Isnard M, Berland Y, Vanhille P, Ortiz JP, Janin G, Nicoud P, Touam M, Bruce E, Rouillon L, Laville M, Janus N, Juillard L, Rousset A, Butel F, Girardot-Seguin S, Deray G, Hannedouche T, Isnard M, Berland Y, Vanhille P, Ortiz JP, Janin G, Nicoud P, Touam M, Bruce E, Rouillon L, Laville M, Janus N, Launay-Vacher V, Juillard L, Rousset A, Butel F, Girardot-Seguin S, Deray G, Hannedouche T, Isnard M, Berland Y, Vanhille P, Ortiz JP, Janin G, Nicoud P, Touam M, Bruce E, Rouillon L, Laville M, Grace B, Clayton P, Cass A, Mcdonald S, Baharani J, Furumatsu Y, Kitamura T, Fujii N, Ogata S, Nakamoto H, Iseki K, Tsubakihara Y, Chien CC, Wang JJ, Hwang JC, Wang HY, Kan WC, Kuster N, Kuster N, Patrier L, Bargnoux AS, Morena M, Dupuy AM, Badiou S, Canaud B, Cristol JP, Desmet JM, Fernandes V, Collart F, Spinogatti N, Pochet JM, Dratwa M, Goffin E, Nortier J, Zilisteanu DS, Voiculescu M, Rusu E, Achim C, Bobeica R, Balanica S, Atasie T, Florence S, Anne-Marie S, Michel L, Cyrille C, Emmanuel V, Strakosha A, Strakosha A, Pasko N, Kodra S, Thereska N, Lowney A, Lowney E, Grant R, Murphy M, Casserly L, O' Brien T, Plant WD, Radic J, Radic J, Ljutic D, Kovacic V, Radic M, Dodig-Curkovic K, Sain M, Jelicic I, Fujii N, Hamano T, Nakano C, Yonemoto S, Okuno A, Katayama M, Isaka Y, Nordio M, Limido A, Postorino M, Nichelatti M, Khil M, Dudar I, Khil V, Shifris I, Momtaz M, Soliman AR, El Lawindi MI, Dzekova-Vidimliski P, Pavleska-Kuzmanovska S, Trajceska L, Nikolov I, Selim G, Gelev S, Amitov V, Sikole A, Shoji T, Kakiya R, Hayashi T, Tatsumi-Shimomura N, Tsujimoto Y, Tabata T, Shima H, Mori K, Fukumoto S, Tahara H, Koyama H, Emoto M, Ishimura E, Nishizawa Y, Inaba M. Epidemiology and outcome research in CKD 5D. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Adlakha A, Pavlou M, Walker DA, Copas AJ, Dufty N, Batson S, Edwards SG, Singer M, Miller RF. Survival of HIV-infected patients admitted to the intensive care unit in the era of highly active antiretroviral therapy. Int J STD AIDS 2012; 22:498-504. [PMID: 21890545 DOI: 10.1258/ijsa.2011.010496] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We retrospectively studied outcomes for HIV-infected patients admitted to the intensive care unit (ICU) between January 1999 and June 2009. Patient demographics, receipt of highly active antiretroviral therapy (HAART), reason for ICU admission and survival to ICU and hospital discharge were recorded. Comparison was made against outcomes for general medical patients contemporaneously admitted to the same ICU. One hundred and ninety-two HIV-infected patients had 222 ICU admissions; 116 patients required mechanical ventilation (MV) and 43 required renal replacement therapy. ICU admission was due to an HIV-associated diagnosis in 113 patients; 37 had Pneumocystis pneumonia. Survival to ICU discharge and hospital discharge for HIV-infected patients was 78% and 70%, respectively, and was 75% and 68% among 2065 general medical patients with 2274 ICU admissions; P = 0.452 and P = 0.458, respectively. HIV infection was newly diagnosed in 42 patients; their ICU and hospital survival was 69% and 57%, respectively. From multivariable analysis, factors associated with ICU survival were patient's age (odds ratio [OR] = 0.74 [95% confidence interval (CI) = 0.53-1.02] per 10-year increase), albumin (OR = 1.05 [1.00-1.09] per 1 g/dL increase), Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 0.55 [0.35-0.87] per 10 unit increase), receipt of HAART (OR = 2.44 [1.01-4.94]) and need for MV (OR = 0.14 [0.06-0.36]). In the era of HAART, HIV-infected patients should be offered ICU admission if it is likely to be of benefit.
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Affiliation(s)
- A Adlakha
- Critical Care Unit, University College London Hospitals, London, UK
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Adlakha AG, Pavlou M, Walker D, Copas AJ, Batson S, Edwards SG, Singer M, Miller RF. S82 Survival of HIV-infected patients admitted to the intensive care unit. Thorax 2010. [DOI: 10.1136/thx.2010.150938.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dasoula A, Kalantaridou S, Sotiriadis A, Pavlou M, Georgiou I, Paraskevaidis E, Makrigiannakis A, Syrrou M. Skewed X-Chromosome Inactivation in Greek Women with Idiopathic Recurrent Miscarriage. Fetal Diagn Ther 2008; 23:198-203. [DOI: 10.1159/000116741] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Accepted: 12/05/2006] [Indexed: 12/16/2022]
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Tzoufi M, Mantas C, Pappa S, Kateri M, Hyphantis T, Pavlou M, Mavreas V, Siamopoulou-Mavridou A. The impact of childhood chronic neurological diseases on Greek families. Child Care Health Dev 2005; 31:109-15. [PMID: 15658971 DOI: 10.1111/j.1365-2214.2005.00492.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although the impact of childhood chronic neurological diseases (CND) on patients' psychological well-being has been increasingly addressed, little attention has been given to the influence of these conditions on family members and family functioning. The purpose of the present study was to investigate the family characteristics of Greek children suffering from CND. METHODS A total of 52 parents of children with CND were studied by using the Family Environmental Scale (FES), the Family Burden Scale, the General Health Questionnaire (GHQ-28) and a questionnaire on the knowledge of their children's illness, their coping strategies and their satisfaction with our services. During the same period, 30 parents of hospitalized children for common paediatric illnesses completed the FES. In both groups social and demographic features were registered. Appropriate statistical processes were applied to compare the above-mentioned family groups and to study the differences between the families of children with epilepsy (n=37) and the families of children with other CND (n=15). RESULTS Parents of children with CND discuss their problems less freely, talk less openly around home, score highly on FES subscale of Conflict and, pay more attention to ethical and religious issues and values. Furthermore, the families of children with other CND were more burdened regarding the financial state and the health status of other family members in comparison with families of children with epilepsy. In addition, families of children with epilepsy were more involved in social and recreational activities, appeared to be more knowledgeable on the availability of help in critical conditions and were more satisfied with rendered medical services, in comparison with families of children with other CND. CONCLUSION These preliminary findings provide important information concerning the special characteristics of Greek families of children suffering from CND, which may prove especially helpful in organizing specific support services.
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Affiliation(s)
- M Tzoufi
- Child Health Department, University of Ioannina, Ioannina, Greece.
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Damianou C, Pavlou M, Velev O, Kyriakou K, Trimikliniotis M. High intensity focused ultrasound ablation of kidney guided by MRI. Ultrasound Med Biol 2004; 30:397-404. [PMID: 15063522 DOI: 10.1016/j.ultrasmedbio.2003.10.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2003] [Revised: 09/29/2003] [Accepted: 10/14/2003] [Indexed: 05/24/2023]
Abstract
The effectiveness of magnetic resonance imaging (MRI) to monitor therapeutic protocols of high-intensity focused ultrasound (HIFU), in freshly excised pig kidney cortex is investigated. For high quality imaging, the pulse sequence fast spin echo (FSE) T1- and T2-weighted, and proton density were evaluated. For fast imaging, the pulse sequence T1-weighted fast spoiled gradient (FSPGR) was used. The main goal was to evaluate the MRI detection of large lesions (bigger than 1 cm x 1 cm x 1 cm) that is achieved by moving the transducer in a predetermined pattern. The contrast between lesion and kidney tissue is excellent with either T1-weighted or T2-weighted FSE. With T1-weighted FSE, the best contrast is observed for recovery time (TR) between 200 ms and 400 ms. With T2-weighted FSE best contrast can be achieved for echo time (TE) between 16 and 32 ms. T2-weighted FSE was proven as the best pulse sequence to detect cavitational activity. This advantage is attributed to the significant difference in signal intensity between air spaces and necrotic tissue. Air spaces appear brighter than thermal lesions. Therefore, for therapeutic protocols created using cavitational mode, T2-weighted FSE may be the optimum pulse sequence to use. The proton density pulse sequence does not provide any advantage over the T1- and T2-weighted pulse sequences. Using T1-weighted FSPGR, acquisition time as low as 5 s could be achieved. Good contrast and signal-to-noise ratio (SNR) are achieved with TR = 100 ms and flip angle between 75 to 90 degrees. The above techniques were very successful in detecting large lesion volumes.
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Abstract
Congenital mesoblastic nephroma (CMN) can present with atypical clinical and imaging findings. A premature male neonate was born to an 18-year-old woman after 33 weeks' gestation, which was complicated by polyhydramnios and placenta abruptio. A right abdominal mass was diagnosed antenatally. From the 1st day of life, the newborn had hypercalcemia with initially normal parathormone levels and polyuria for the first hours of life and normal urine output afterwards. Ultrasonographic study and magnetic resonance imaging of the abdomen showed at the upper pole of the right kidney a heterogeneous, solid, poorly defined mass, partially surrounded by a subcapsular fluid collection mimicking malignant rhabdoid tumor of the kidney. Surgical resection revealed a CMN of mixed, classic, and in areas, cellular type. One year after the resection, the patient is asymptomatic and normocalcemic. In conclusion, CMN may present with atypical clinical and imaging findings, necessitating an extensive work-up in order to exclude highly malignant renal tumors of the neonatal period.
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Affiliation(s)
- N Daskas
- Neonatology Clinic, University Hospital of Ioannina, Moskopoleos 18, Ioannina 45333, Greece.
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Pavlou M, Tsatsoulis A, Efstathiadou Z, Bitsis S, Papadopoulou ZL. A study of the growth-promoting and metabolic effects of growth hormone (GH) in a patient with the "growth without GH" syndrome. Growth Horm IGF Res 2001; 11:225-230. [PMID: 11735238 DOI: 10.1054/ghir.2001.0204] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The paradox of normal or even excessive growth despite a proven lack of GH is a well-known but still unexplained phenomenon that has been described in some patients following resection of a craniopharyngioma or other suprasellar tumours. However, the consequences of GH deficiency on other metabolic aspects of GH action in this syndrome have not been adequately investigated. The aim of this study was to examine whether a dissociation might exist between the growth-promoting and metabolic effects of GH. We studied a 7.1 year old boy who, after removal of a suprasellar craniopharyngioma, developed panhypopituitarism with mild hyperprolactinaemia. Despite the presence of severe GH deficiency associated with persistently low IGF-I and IGFBP-3 levels, the patient grew spontaneously at an accelerated rate for a prepubertal boy, achieving a height velocity of 9.0 cm during the first and 8.5 cm during the second post-operative year. However, other metabolic parameters of GH activity were adversely affected by the lack of GH. The maximum tubular reabsorption rate for phosphate over glomerular filtration rate ratio (2.8) was persistently low and normalized during a 4 day course of hGH administration (4.2) together with the normalization of IGF-I (from 34 microg/l to 294 microg/l), suggesting that GH-dependent renal phosphate handling is impaired in this syndrome. In addition, bone age was delayed by 1.7 years consistently with delayed skeletal maturation, whereas skinfold thickness and the waist to hip ratio were increased in comparison with normative data, suggesting increased adipose tissue mass with central fat distribution, a phenotype characteristic of GH deficiency. In conclusion, our case study suggests that, in the "growth without GH" syndrome, the excessive growth is independent of GH and dissociated from other GH-dependent metabolic effects, which are decreased.
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Affiliation(s)
- M Pavlou
- Department of Paediatrics, University of Ioannina, 45110 Ioannina, Greece
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Zeldow PB, Pavlou M. Physical and psychosocial functioning in multiple sclerosis: descriptions, correlations, and a tentative typology. Br J Med Psychol 1988; 61 ( Pt 2):185-95. [PMID: 3401427 DOI: 10.1111/j.2044-8341.1988.tb02778.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Multiple sclerosis (MS) is a disease of great variety and ambiguity. It outcome is both multidimensional and uncertain. As part of an ongoing effort to describe and differentiate the various courses that MS can follow, 81 out-patients diagnosed with MS completed the California Psychological Inventory (CPI) and the Sickness Impact Profile (SIP) administered as a structured interview. Descriptive statistics for the SIP and the CPI are provided and examined as a function of age and sex. Correlations between health status and personality scales are reported. Increasing physical dysfunction is associated with lowered performance on a broad array of psychosocial dimensions but only among women. A cluster analysis of CPI factor scores is described and a very tentative typology of persons with MS is offered for further investigation.
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Affiliation(s)
- P B Zeldow
- Northwestern University Medical School, Chicago, IL 60611
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Abstract
Eighty-one outpatients with diagnosed multiple sclerosis were studied in an effort to examine the relative contributions of physical health status, life stress, duration of illness, age, sex, marital status, and social class on various aspects of personal and interpersonal functioning. Stepwise multiple regression analyses were performed to identify the most significant discriminators of the seven psychosocial measures. Physical health status exerted the broadest influence, affecting personal efficiency and well-being, capacity for independent thought and action, self-confidence, self-reliance, and number of meaningful social contacts. Life stress was associated with lowered personal efficiency and sense of well-being. Duration of illness and the demographic variables had few or no effects on psychosocial adjustment. Discussion contrasts the present findings with others in the rehabilitation literature and specifies certain limitations of the study's design.
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Counte MA, Bieliauskas LA, Pavlou M. Stress and personal attitudes in chronic illness. Arch Phys Med Rehabil 1983; 64:272-5. [PMID: 6860098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The possible relation of two stressor types (life events and illness experience) to three sets of attitudes (personal life satisfaction, self-assessed coping, and satisfaction with treatment personnel/facilities) was examined within a sample of 97 outpatients having multiple sclerosis. In addition, potential moderators of hypothesized relationships were examined (trait anxiety, age, social class, and knowledge of the disease). When attitudes were regressed on stressors and moderators, both sets of stressors exerted significant influence, though their impacts were mitigated by the moderators. This study's findings support the position that the association of attitudes with stressor exposure in chronic disease populations is contingent on demographic and psychological moderating factors.
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Abstract
Chronic medical illness may produce emotional stress of a variety which encourages the development of patterns of somatization. Discussed here are patterns of somatization in multiple sclerosis. The long-term uncertainty and changing nature and severity of symptoms raises the likelihood that people will become absorbed in their bodies, will demonstrate heightened responses to minor physical change, and may come to experience psychic conflict through the language of physical symptomatology. Case examples are discussed as well as recommendations for treatment.
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Pavlou M, Hartings M, Davis FA. Discussion groups for medical patients. A vehicle for improved coping. Psychother Psychosom 1978; 30:105-115. [PMID: 693771 DOI: 10.1159/000287289] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Describing 14 professionally run discussion groups for multiple sclerosis patients, this paper delineates appropriate functions and goals of the medical discussion group. Such groups address coping activities related to affiliation with a social reference group, information seeking and, in a more limited way, consolidation of intrapsychic resources. The discussion describes the dynamic issues which arise in the groups and explores ways in which group dynamics interact with the medical format.
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