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1. Psychological distress and health-related quality of life in patients after hospitalization during the COVID-19 pandemic: A single-center, observational study

Author

Johan Hendrik Vlake, Sanne Wesselius, Michel Egide van Genderen, Jasper van Bommel, Bianca Boxma-de Klerk, and Evert-Jan Wils

Subjects
Medicine, Science
Abstract

Introduction Illnesses requiring hospitalization are known to negatively impact psychological well-being and health-related quality of life (HRQoL) after discharge. The impact of hospitalization during the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) pandemic on psychological well-being and health-related quality of life is expected to be higher due to the exceptional circumstances within and outside the hospital during the pandemic surge. The objective of this study was to quantify psychological distress up to three months after discharge in patients hospitalized during the first coronavirus disease 2019 (COVID-19) pandemic wave. We also aimed to determine HRQoL, to explore predictors for psychological distress and HRQoL, and to examine whether psychological distress was higher in COVID-19 confirmed patients, and in those treated in Intensive Care Units (ICUs). Methods In this single-center, observational cohort study, adult patients hospitalized with symptoms suggestive of COVID-19 between March 16 and April 28, 2020, were enrolled. Patients were stratified in analyses based on SARS-CoV-2 PCR results and the necessity for ICU treatment. The primary outcome was psychological distress, expressed as symptoms of post-traumatic stress disorder (PTSD), anxiety, and depression, up to three months post-discharge. Health-related quality of life (HRQoL) was the secondary outcome. Exploratory outcomes comprised predictors for psychological distress and HRQoL. Results 294 of 622 eligible patients participated in this study (median age 64 years, 36% female). 16% and 13% of these patients reported probable PTSD, 29% and 20% probable anxiety, and 32% and 24% probabledepression at one and three months after hospital discharge, respectively. ICU patients reported less frequently probable depression, but no differences were found in PTSD, anxiety, or overall HRQoL. COVID-19 patients had a worse physical quality of life one month after discharge, and ICU patients reported a better mental quality of life three months after discharge. PTSD severity was predicted by time after discharge and being Caucasian. Severity of anxiety was predicted by time after discharge and being Caucasian. Depression severity was predicted by time after discharge and educational level. Conclusion COVID-19 suspected patients hospitalized during the pandemic frequently suffer from psychological distress and poor health-related quality of life after hospital discharge. Non-COVID-19 and non-ICU patients appear to be at least as affected as COVID-19 and ICU patients, underscoring that (post-)hospital pandemic care should not predominantly focus on COVID-19 infected patients.

Published
2021

2. Normalization of Cardiac Function After Bariatric Surgery Is Related to Autonomic Function and Vitamin D

Author

Sanne M. Snelder, Yaar Aga, Lotte E. de Groot - de Laat, L. Ulas Biter, Manuel Castro Cabezas, Nadine Pouw, Erwin Birnie, Bianca Boxma - de Klerk, René A. Klaassen, Felix Zijlstra, Bas M. van Dalen, and Cardiology

Subjects
Nutrition and Dietetics, SDG 3 - Good Health and Well-being, Endocrinology, Diabetes and Metabolism, Surgery
Abstract

Purpose Subclinical cardiac dysfunction is common in patients with obesity. Bariatric surgery is associated with normalization of subclinical cardiac function in 50% of the patients with obesity. The aim of this study was to identify predictors for a lack of improvement of subclinical cardiac dysfunction 1-year post-bariatric surgery. Methods Patients who were referred for bariatric surgery were enrolled in a longitudinal study. Inclusion criteria were age 35–65 years and BMI ≥ 35 kg/m2. Patients with a suspicion of or known cardiovascular disease were excluded. Conventional and advanced echocardiography, Holter monitoring, and blood tests were performed pre- and 1-year post-bariatric surgery. Subclinical cardiac dysfunction was defined as either a reduced left ventricular ejection fraction, decreased global longitudinal strain (GLS), diastolic dysfunction, arrhythmia, or an increased BNP or hs Troponin I. Results A total of 99 patients were included of whom 59 patients had cardiac dysfunction at baseline. Seventy-two patients completed the 1-year follow-up after bariatric surgery. There was a significant reduction in weight and cardiovascular risk factors. Parameters of cardiac function, such as GLS, improved. However, in 20 patients cardiac dysfunction persisted. Multivariate analysis identified a decreased heart rate variability (which is a measure of autonomic function), and a decreased vitamin D pre-surgery as predictors for subclinical cardiac dysfunction after bariatric surgery. Conclusion Although there was an overall improvement of cardiac function 1-year post-bariatric surgery, autonomic dysfunction and a decreased vitamin D pre-bariatric surgery were predictors for a lack of improvement of subclinical cardiac dysfunction. Graphical abstract

Published
2023

3. Normalization of Cardiac Function After Bariatric Surgery Is Related to Autonomic Function and Vitamin D

Author

Sanne M, Snelder, Yaar, Aga, Lotte E, de Groot-de Laat, L Ulas, Biter, Manuel Castro, Cabezas, Nadine, Pouw, Erwin, Birnie, Bianca, Boxma-de Klerk, René A, Klaassen, Felix, Zijlstra, and Bas M, van Dalen

Abstract

Subclinical cardiac dysfunction is common in patients with obesity. Bariatric surgery is associated with normalization of subclinical cardiac function in 50% of the patients with obesity. The aim of this study was to identify predictors for a lack of improvement of subclinical cardiac dysfunction 1-year post-bariatric surgery.Patients who were referred for bariatric surgery were enrolled in a longitudinal study. Inclusion criteria were age 35-65 years and BMI ≥ 35 kg/mA total of 99 patients were included of whom 59 patients had cardiac dysfunction at baseline. Seventy-two patients completed the 1-year follow-up after bariatric surgery. There was a significant reduction in weight and cardiovascular risk factors. Parameters of cardiac function, such as GLS, improved. However, in 20 patients cardiac dysfunction persisted. Multivariate analysis identified a decreased heart rate variability (which is a measure of autonomic function), and a decreased vitamin D pre-surgery as predictors for subclinical cardiac dysfunction after bariatric surgery.Although there was an overall improvement of cardiac function 1-year post-bariatric surgery, autonomic dysfunction and a decreased vitamin D pre-bariatric surgery were predictors for a lack of improvement of subclinical cardiac dysfunction.

Published
2022

4. Psychological distress and health-related quality of life in patients after hospitalization during the COVID-19 pandemic

Author

J.H. (Johan) Vlake, S (Sanne) Wesselius, M.E. (Michel) van Genderen, J. (Jasper) van Bommel, Bianca Boxma-De Klerk, E.J. (Evert-Jan) Wils, J.H. (Johan) Vlake, S (Sanne) Wesselius, M.E. (Michel) van Genderen, J. (Jasper) van Bommel, Bianca Boxma-De Klerk, and E.J. (Evert-Jan) Wils

Abstract

Introduction Illnesses requiring hospitalization are known to negatively impact psychological well-being and health-related quality of life (HRQoL) after discharge. The impact of hospitalization during the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) pandemic on psychological well-being and health-related quality of life is expected to be higher due to the exceptional circumstances within and outside the hospital during the pandemic surge. The objective of this study was to quantify psychological distress up to three months after discharge in patients hospitalized during the first coronavirus disease

Published
2021
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5. Bacterial lysate add-on therapy to reduce exacerbations in severe asthma

Author

G.M. (Gatske) Nieuwenhuyzen - de Boer, G.J. (Gert-Jan) Braunstahl, E.K. (Esmee) van der Ploeg, C.M. (Cathelijne) van Zelst, Alie van Bruggen, G.G. (Guido) Epping, M. (Menno) van Nimwegen, Gert T. Verhoeven, Erwin Birnie, Bianca Boxma-De Klerk, J.W. (Marjolein) De Jong - de Bruijn, R. (Ralph) Stadhouders, R.W. (Rudi) Hendriks, Gerdien Tramper-Stranders, G.M. (Gatske) Nieuwenhuyzen - de Boer, G.J. (Gert-Jan) Braunstahl, E.K. (Esmee) van der Ploeg, C.M. (Cathelijne) van Zelst, Alie van Bruggen, G.G. (Guido) Epping, M. (Menno) van Nimwegen, Gert T. Verhoeven, Erwin Birnie, Bianca Boxma-De Klerk, J.W. (Marjolein) De Jong - de Bruijn, R. (Ralph) Stadhouders, R.W. (Rudi) Hendriks, and Gerdien Tramper-Stranders

Abstract

Background: Asthma exacerbations are frequently induced by respiratory tract infections (RTIs). Bacterial lysates have been described to possess immune-modulatory effects and reduce RTIs as well as asthma symptoms in children. However, whether bacterial lysates have similar effects in adult asthma patients is unknown. Aims: To reduce asthma exacerbations by add-on bacterial lysate therapy in adults with severe asthma and to characterize the clinical and immune-modulatory effects of this treatment. Methods: Asthma patients (GINA 4) with ≥2 annual exacerbations in the previous year were included. The intervention regimen consisted of OM-85/placebo for 10 consecutive days per month for 6 months during two winter seasons. Primary end-point was the number of severe asthma exacerbations within 18 months. The study was approved by the national and local ethical review board and registered in the Dutch Trial Registry (NL5752). All participants provided written informed consent. Results: Seventy-five participants were included (38 OM-85; 37 placebo). Exacerbation frequencies were not different between the groups after 18 months (incidence rate ratio 1.07, 95%CI [0.68–1.69], p = 0.77). With the use of OM-85, FEV1% increased by 3.81% (p = 0.04) compared with placebo. Nasopharyngeal swabs taken during RTIs detected a virus less frequently in patients using OM-85 compared to placebo (30.5% vs. 48.0%, p = 0.02). In subjects with type 2 inflammation adherent to the protocol (22 OM-85; 20 placebo), a non-statistically significant decrease in exacerbations in the OM-85 group was observed (IRR = 0.71, 95%CI [0.39–1.26], p = 0.25). Immune-modulatory effects included an increase in several plasma cytokines in the OM-85 group, especially IL-10 and interferons. Peripheral blood T- and B cell subtyping, including regulatory T cells, did not show differences between the groups. Conclusion: Although OM-85 may have immune-modulatory effects, it did not reduce asthma exacerbations in this

Published
2021
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6. Adult but not childhood onset asthma is associated with the metabolic syndrome, independent from body mass index

Author

G.M. (Gatske) Nieuwenhuyzen - de Boer, Gerdien Tramper-Stranders, Laura Houweling, C.M. (Cathelijne) van Zelst, NMC (Nadine) van de Wijngaart - Pouw, Gert T. Verhoeven, Bianca Boxma-De Klerk, Johannes C.C.M. in ’t Veen, E.F.C. (Liesbeth) van Rossum, R.W. (Rudi) Hendriks, G.J. (Gert-Jan) Braunstahl, G.M. (Gatske) Nieuwenhuyzen - de Boer, Gerdien Tramper-Stranders, Laura Houweling, C.M. (Cathelijne) van Zelst, NMC (Nadine) van de Wijngaart - Pouw, Gert T. Verhoeven, Bianca Boxma-De Klerk, Johannes C.C.M. in ’t Veen, E.F.C. (Liesbeth) van Rossum, R.W. (Rudi) Hendriks, and G.J. (Gert-Jan) Braunstahl

Abstract

Introduction: Adult-onset asthma (AOA) is usually more severe compared to childhood onset asthma (CoA). Given the increasing evidence that AoA is associated with obesity, we investigated the relationship of other related metabolic comorbid conditions with AoA compared to CoA. Study design and methods: This cross-sectional study compared the metabolic syndrome and lipid derived inflammatory markers in patients with AoA, CoA and age- and sex-matched control subjects without asthma. Participants were asthma patients visiting the outpatient clinic of two teaching hospitals in Rotterdam, The Netherlands. All participants underwent lung function tests, blood tests and physical activity tracking. AoA was defined as asthma age of onset after the age of 18 years. Metabolic syndrome was defined according to the international joint interim statement criteria. Results: Eighty-one participants were included (27 AoA, 25 CoA, 29 controls). AoA was associated with the metabolic syndrome (Odds Ratio = 3.64 95% CI (1.16–11.42) p = 0.03, Nagelkerke R2 = 0.26), adjusted for age, sex, body mass index and smoking habits. AoA patients had higher median serum IL-6 and leptin-adiponectin (LA) ratio compared to controls (IL-6 (pg/mL): 3.10 [1.11–4.30] vs. 1.13 [0.72–1.58], p = 0.002 and LA ratio (pg/mL): 6.21 [2.45–14.11] vs. 2.24 [0.67–4.71], p = 0.0390). This was not observed in CoA and controls. Conclusion: AoA was associated with the metabolic syndrome and its related pro-inflammatory endocrine and cytokine status. This may suggest adipose tissue derived inflammatory markers play a role in the pathophysiology of AoA.

Published
2021
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7. Efficacy of Hydroxychloroquine in Hand Osteoarthritis: A Randomized, Double-Blind, Placebo-Controlled Trial

Author

Bianca Boxma-de Klerk, Weiching Lee, Peter B J de Sonnaville, Andreas H. Gerards, Angelique E. A. M. Weel, Bart Grillet, M. Hazes, Marc R. Kok, Margreet Kloppenburg, Liesbeth Ruijgrok, N.M. Basoski, M. Huisman, and Rheumatology

Subjects
Adult, Male, medicine.medical_specialty, Placebo-controlled study, Placebo, law.invention, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Rheumatology, Randomized controlled trial, law, Internal medicine, Multicenter trial, Osteoarthritis, medicine, Humans, 030212 general & internal medicine, Young adult, Adverse effect, 030203 arthritis & rheumatology, business.industry, Hydroxychloroquine, Middle Aged, Hand, Surgery, Treatment Outcome, Antirheumatic Agents, Female, business, Hand osteoarthritis, medicine.drug
Abstract

Objective. To determine the symptom-modifying effect of hydroxychloroquine (HCQ) in hand osteoarthritis (OA).Methods. In this randomized, double-blind, multicenter trial, patients with symptomatic hand OA received either HCQ 400 mg once a day or placebo during 24 weeks. The primary outcome was change of pain measured on a 100-mm visual analog scale (VAS) at 24 weeks. Secondary outcomes included decrease of pain at weeks 6 and 12 and change in Australian Canadian Hand Osteoarthritis Index (AUSCAN) and Arthritis Impact Measurement Scale 2 short form (AIMS2-SF) total scores.Results. A total of 196 patients was included (placebo n = 98, HCQ n = 98). Mean +/- SD age was 58.0 +/- 7.6 years, and 86% were female. Baseline mean +/- SD pain VAS was 44.9 +/- 22.9 mm in the placebo group and 43.2 +/- 22.3 mm in the HCQ group. At 24 weeks, change in pain VAS was not significantly different between both groups (imputed mean VAS 42.7 in the HCQ group versus 45.3 in the placebo group after 24 weeks), as was the case in pain VAS at weeks 6 and 12. Changes in AUSCAN total score and AIMS2-SF total score in both groups were similar between the groups. In total, 24 patients in the placebo group and 21 patients in the HCQ group reported >= 1 adverse event. In the HCQ group, 3 patients reported a severe allergic reaction. Fifteen patients withdrew from the study (5 placebo, 10 HCQ group) due to adverse events.Conclusion. Treatment with HCQ at 24 weeks is not effective in reducing the symptoms of hand OA compared to placebo.

Published
2018

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