IMPORTANCE: One-year outcomes in patients who have had COVID-19 and who received treatment in the intensive care unit (ICU) are unknown. OBJECTIVE: To assess the occurrence of physical, mental, and ...cognitive symptoms among patients with COVID-19 at 1 year after ICU treatment. DESIGN, SETTING, AND PARTICIPANTS: An exploratory prospective multicenter cohort study conducted in ICUs of 11 Dutch hospitals. Patients (N = 452) with COVID-19, aged 16 years and older, and alive after hospital discharge following admission to 1 of the 11 ICUs during the first COVID-19 surge (March 1, 2020, until July 1, 2020) were eligible for inclusion. Patients were followed up for 1 year, and the date of final follow-up was June 16, 2021. EXPOSURES: Patients with COVID-19 who received ICU treatment and survived 1 year after ICU admission. MAIN OUTCOMES AND MEASURES: The main outcomes were self-reported occurrence of physical symptoms (frailty Clinical Frailty Scale score ≥5, fatigue Checklist Individual Strength—fatigue subscale score ≥27, physical problems), mental symptoms (anxiety Hospital Anxiety and Depression {HADS} subscale score ≥8, depression HADS subscale score ≥8, posttraumatic stress disorder mean Impact of Event Scale score ≥1.75), and cognitive symptoms (Cognitive Failure Questionnaire—14 score ≥43) 1 year after ICU treatment and measured with validated questionnaires. RESULTS: Of the 452 eligible patients, 301 (66.8%) patients could be included, and 246 (81.5%) patients (mean SD age, 61.2 9.3 years; 176 men 71.5%; median ICU stay, 18 days IQR, 11 to 32) completed the 1-year follow-up questionnaires. At 1 year after ICU treatment for COVID-19, physical symptoms were reported by 182 of 245 patients (74.3% 95% CI, 68.3% to 79.6%), mental symptoms were reported by 64 of 244 patients (26.2% 95% CI, 20.8% to 32.2%), and cognitive symptoms were reported by 39 of 241 patients (16.2% 95% CI, 11.8% to 21.5%). The most frequently reported new physical problems were weakened condition (95/244 patients 38.9%), joint stiffness (64/243 patients 26.3%) joint pain (62/243 patients 25.5%), muscle weakness (60/242 patients 24.8%) and myalgia (52/244 patients 21.3%). CONCLUSIONS AND RELEVANCE: In this exploratory study of patients in 11 Dutch hospitals who survived 1 year following ICU treatment for COVID-19, physical, mental, or cognitive symptoms were frequently reported.
Background
Data on clinical characteristics of patients with inflammatory bowel disease (IBD)-related colorectal cancer (CRC) are scarce and mainly originate from tertiary referral centres. We ...studied patient and disease characteristics of IBD-related CRC in a nationwide IBD cohort in general hospitals. Main outcome parameters were time to develop CRC, and factors associated with early CRC development.
Methods
All IBD patients diagnosed with CRC between 1 January 1990 and 1 July 2006 were identified using a nationwide automated pathology database (PALGA). Patient charts were assessed to confirm diagnosis and collect clinical data. Early CRC was defined as CRC diagnosed less than 8 years after IBD diagnosis. Statistical analysis was performed using descriptive statistics, independent
t
tests, binary logistic regression and Cox-regression analysis.
Results
Diagnosis of IBD-related CRC was confirmed in 251 patients (171 ulcerative colitis, 77 Crohn’s disease, 3 unclassified colitis), 161 males (64 %). Median time from IBD diagnosis to CRC diagnosis was 12 years (IQR 4–20); 89 patients (35 %) developed early CRC. Type of IBD, gender, concomitant PSC, pseudopolyps, extent of inflammation, and medication use were not related to early CRC (
p
> 0.05). IBD diagnosis at older age (HR for 10 years older age 2.25; 95 % CI 1.92–2.63) was related to early CRC. Twenty-three patients (12 %) had been included in a surveillance programme prior to CRC diagnosis. Patients in the surveillance group had a significantly better tumor stage (
p
= 0.004).
Conclusions
We emphasize the problem of a high proportion of IBD-associated CRCs developing before the recommended start of surveillance. Therefore, we suggest that older age at IBD onset could be an additional factor to start surveillance in IBD patients.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Human bipedal gait is inherently unstable, and staying upright requires adaptive control of dynamic balance. Little is known about adaptive control of dynamic balance in reaction to long-term, ...continuous perturbations. We examined how dynamic balance control adapts to a continuous perturbation in gait, by letting people walk faster with one leg than the other on a treadmill with two belts (i.e. split-belt walking). In addition, we assessed whether changes in mediolateral dynamic balance control coincide with changes in energy use during split-belt adaptation. In 9 min of split-belt gait, mediolateral margins of stability and mediolateral foot roll-off changed during adaptation to the imposed gait asymmetry, especially on the fast side, and returned to baseline during washout. Interestingly, no changes in mediolateral foot placement (i.e. step width) were found during split-belt adaptation. Furthermore, the initial margin of stability and subsequent mediolateral foot roll-off were strongly coupled to maintain mediolateral dynamic balance throughout the gait cycle. Consistent with previous results, net metabolic power was reduced during split-belt adaptation, but changes in mediolateral dynamic balance control were not correlated with the reduction of net metabolic power during split-belt adaptation. Overall, this study has shown that a complementary mechanism of relative foot positioning and mediolateral foot roll-off adapts to continuously imposed gait asymmetry to maintain dynamic balance in human bipedal gait.
Aliment Pharmacol Ther 2011; 34: 113–124
Summary
Background There is no international agreement on scoring systems used to measure disease activity in ulcerative colitis, nor is there a validated ...definition for disease remission.
Aim To review the principles and components for defining remission in ulcerative colitis and propose a definition that will help improve patient outcomes.
Methods A review of current standards of remission from the perspective of clinical trials, guidelines, clinical practice and patients was conducted by the authors. Selected literature focused on the components of a definition of remission, the utility of a definition and treatment strategies, based on current definitions.
Results Different definitions of remission affect the assessment of outcome and make it difficult to compare trials. In the clinic, endoscopy is rarely used to confirm remission, because mucosal healing has only recently begun to be related to the duration of subsequent remission in a way that will affect clinical practice. Histopathology may be the ultimate arbiter of mucosal healing. There is no agreement on the definition of remission in current guidelines. Patient‐defined remission may predict endoscopic remission, but has yet to be shown to predict duration of remission.
Conclusions A standard based on clinical symptoms and endoscopy is proposed. Histopathology is a third dimension of remission that may have prognostic value. The definition of remission should help predict long‐term outcome. The expectations of patients and their physicians need to be raised, as the goal of treatment of active ulcerative colitis should be to induce remission.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
LINKED CONTENT
This article is linked to Arkenbosch et al papers. To view these articles, visit https://doi.org/10.1111/apt.17347 and https://doi.org/10.1111/apt.17377
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Human bipedal gait requires active control of mediolateral dynamic balance to stay upright. The margin of stability is considered a measure of dynamic balance, and larger margins are by many authors ...assumed to reflect better balance control. The inverted pendulum model of gait indicates that changes in the mediolateral margin of stability are related to changes in bilateral single support times. We propose updated equations for the mediolateral margin of stability in temporally symmetric and asymmetric gait, which now include the single support times of both legs. Based on these equations, we study the relation between bilateral single support times and the mediolateral margin of stability in symmetric, asymmetric, and adaptive human gait. In all conditions, the mediolateral margin of stability during walking followed predictably from bilateral single support times, whereas foot placement co-varied less with the mediolateral margin of stability. Overall, these results demonstrate that the bilateral temporal regulation of gait profoundly affects the mediolateral margin of stability. By exploiting the passive dynamics of bipedal gait, bilateral temporal control may be an efficient mechanism to safeguard dynamic stability during walking, and keep an inherently unstable moving human body upright.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Purpose
Long-term mental outcomes in family members of coronavirus disease 2019 (COVID-19) intensive care unit (ICU) survivors are unknown. Therefore, we assessed the prevalence of mental health ...symptoms, including associated risk factors, and quality of life (QoL) in family members of COVID-19 ICU survivors 3 and 12 months post-ICU.
Methods
A prospective multicentre cohort study in ICUs of ten Dutch hospitals, including adult family members of COVID-19 ICU survivors admitted between March 1, and July 1, 2020. Symptom prevalence rates of anxiety, depression (Hospital Anxiety and Depression Scale) and Post-Traumatic Stress Disorder (Impact of Event Scale-6), and QoL (Short Form-12) before ICU admission (baseline), and after 3 and 12 months were measured. Additionally, associations between family and patient characteristics and mental health symptoms were calculated.
Results
A total of 166 out of 197 (84.3%) included family members completed the 12-month follow-up of whom 46.1% and 38.3% had mental health symptoms 3 and 12 months post-ICU, respectively; both higher compared to baseline (22.4%) (
p
< 0.001). The mental component summary score of the SF-12 was lower at 12-month follow-up compared with baseline mean difference mental component score: − 5.5 (95% confidence interval (CI) − 7.4 to − 3.6). Furthermore, 27.9% experienced work-related problems. Symptoms of anxiety (odds ratio (OR) 9.23; 95% CI 2.296–37.24;
p
= 0.002) and depression (OR 5.96; 95% CI 1.29–27.42;
p
= 0.02) prior to ICU admission were identified as risk factors for mental health symptoms after 12 months.
Conclusion
A considerable proportion of family members of COVID-19 survivors reported mental health symptoms 3 and 12 months after ICU admission, disrupting QoL and creating work-related problems.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Summary
Background
Women with inflammatory bowel disease (IBD) are at increased risk of high‐grade cervical intraepithelial neoplasia and cervical cancer (CIN2+).
Aim
To assess the association ...between cumulative exposure to immunomodulators (IM) and biologic agents (BIO) for IBD and CIN2+
Methods
Adult women diagnosed with IBD before December 31st 2016 in the Dutch IBD biobank with available cervical records in the nationwide cytopathology database were identified. CIN2+ incidence rates in IM‐ (i.e., thiopurines, methotrexate, tacrolimus and cyclosporine) and BIO‐ (anti‐tumour necrosis factor, vedolizumab and ustekinumab) exposed patients were compared to unexposed patients and risk factors were assessed. Cumulative exposure to immunosuppressive drugs was evaluated in extended time‐dependent Cox‐regression models.
Results
The study cohort comprised 1981 women with IBD: 99 (5%) developed CIN2+ during median follow‐up of 17.2 years IQR 14.6. In total, 1305 (66%) women were exposed to immunosuppressive drugs (IM 58%, BIO 40%, IM and BIO 33%). CIN2+ risk increased per year of exposure to IM (HR 1.16, 95% CI 1.08–1.25). No association was observed between cumulative exposure to BIO or both BIO and IM and CIN2+. In multivariate analysis, smoking (HR 2.73, 95%CI 1.77–4.37) and 5‐yearly screening frequency (HR 1.74, 95% CI 1.33–2.27) were also risk factors for CIN2+ detection.
Conclusion
Cumulative exposure to IM is associated with increased risk of CIN2+ in women with IBD. In addition to active counselling of women with IBD to participate in cervical screening programs, further assessment of the benefit of intensified screening of women with IBD on long‐term IM exposure is warranted.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Aliment Pharmacol Ther 2011; 33: 1053–1058
Summary
Background Typically, inflammatory bowel disease (IBD) patients are in their reproductive years, raising questions about safely using antitumour ...necrosis factor antibodies like infliximab (IFX) during pregnancy. IgG antibodies naturally cross the placenta, especially during the last trimester. To prevent foetal intra‐uterine exposure, stopping IFX treatment at gestational week 30 is recommended. However, whether this limits intra‐uterine and early postnatal IFX exposure is unestablished.
Aim To determine the intra‐uterine exposure to IFX following maternal treatment with IFX.
Methods Four pregnant IBD patients intentionally continued IFX during pregnancy. IFX levels were assessed in newborns’ cord blood and the mothers’ peripheral blood at delivery. The children’s development during the first 3–6 months, infections, vaccine reactions and antibody responses to vaccinations against Haemophilus influenzae type b and Pneumococcus were assessed.
Results The patients stopped IFX therapy at gestational week 21, 26, 26 and 30, respectively. In three infants, therapeutic IFX levels were present in cord blood at levels of 5.5–13.7 μg/mL and were two‐ to three‐fold higher than in the peripheral blood of their mothers. During the 3‐ to 6‐month follow‐up, the children developed normally without signs of infections or allergic reactions, and had normal antibody titres after routine childhood vaccinations.
Conclusion The use of IFX until gestational week 30 leads to foetal intra‐uterine exposure to IFX at levels that exceed those in the mothers’ peripheral blood. Although no short‐term complications were detected, the high IFX levels observed in newborns raise concerns about unknown effects of IFX on the developing immune system.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
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