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Perennial allergic rhinitis (PAR) often causes sleep disturbances and associated daytime somnolence, thus resulting in a poor quality of life. Various clinical interventions in patients suffering from the disorder seek to improve symptoms and quality of life. Additional studies are needed to establish whether the alleviation of PAR symptoms, particularly the reduction of congestion, will improve sleep quality and reduce daytime somnolence. This study seeks to determine whether treatment with montelukast is more effective than placebo in reducing nasal congestion and sleep disturbances, resulting in reduced daytime somnolence and fatigue in patients with PAR. Thirty-one subjects were enrolled in a double-blinded, placebo-controlled study using Balaam's design. Patients were treated with montelukast or placebo. Collected subjective data included a daily diary recording nasal symptoms, sleep issues, and daytime fatigue, the Functional Outcomes of Sleep Questionnaire, the Epworth Sleepiness Scale, Juniper's Rhinoconjunctivitis Quality of Life Questionnaire, the Rhinitis Severity Scale, the Calgary Sleep Apnea Quality of Life Index, and Trail Making tests. Subjects treated with montelukast, compared with placebo, showed a statistically significant improvement in daytime somnolence (p = 0.0089) and daytime fatigue (p = 0.0087), with both factors improving with montelukast and worsening with placebo. In a small cohort of subjects, montelukast, when compared with placebo, improved the symptoms of PAR and reduced the fatigue and daytime somnolence associated with the disorder.
Allergy Asthma Proc
PMID:The role of montelukast on perennial allergic rhinitis and associated sleep disturbances and daytime somnolence. 1843 Mar 10

Allergic rhinitis (AR) has been found to impact the daily activities of allergic patients. This includes the effects on sleep and chronic fatigue. The effect of AR on sexual function has not been well studied. The purpose of this study was to assess the impact of AR on sexual function, sleep, and fatigue. The Rhinosinusitis Disability Index (RSDI) is a quality of life (QOL), validated outcomes tool that assesses how AR affects QOL. Specific questions address the adverse consequence on sexual function, sleep, and fatigue. Four subsets of patient with AR who completed the RSDI were evaluated for the specific questions as well as the physical, emotional, functional, and total scores. The scores were compared with a cohort of normal subjects, patients with a diffuse group of rhinologic disorders, and patients scheduled for septal surgery (non-AR patients). Patients with AR had significantly higher (worse) sexual and sleep RSDI scores than the non-AR patients and normal subjects. Although the AR subjects also had significantly higher fatigue RSDI scores than the normal subjects, there was no significant difference between the AR and non-AR patients' fatigue scores. Non-AR patients had significantly higher sexual, sleep, and fatigue RSDI scores than the normal subjects. AR has a significant negative impact on sexual function and can result in sleep disturbances and fatigue as measured by the RSDI.
Allergy Asthma Proc
PMID:The impact of allergic rhinitis on sexual activity, sleep, and fatigue. 1977 58

The PedsQL Measurement Model was designed as a modular approach to measuring pediatric health-related quality of life, and developed to integrate the relative merits of generic and disease-specific approaches. The PedsQL 4.0 Generic Core Scales have been translated into over 60 languages, with published data on over 25,000 children and adolescents in more than 75 peer-reviewed journals since 2001 for healthy children and numerous pediatric chronic health conditions. The PedsQL Disease and Condition-Specific Modules were designed to measure health-related quality-of-life dimensions specifically tailored for pediatric chronic health conditions, and include the PedsQL Asthma, Arthritis/Rheumatology, Cancer, Diabetes, Cardiac and Cerebral Palsy Modules, as well as the generic PedsQL Multidimensional Fatigue Scale, Pediatric Pain Questionnaire, Family Impact Module and Healthcare Satisfaction Module. The PedsQL has demonstrated reliability, validity, sensitivity and responsiveness for child self report for ages 5-18 years and parent proxy report for ages 2-18 years. The PedsQL has been shown to be related to other key constructs in pediatric healthcare such as access to needed care, healthcare barriers and quality of primary care. Future advances in the PedsQL() Measurement Model include web-based electronic administration (ePedsQL), integration into the electronic medical record, further efficacy and effectiveness outcome trials, including PedsQL ResourceConnect(SM) and PedsQL TIPS(SM), the development of the generic PedsQL Infant Scales for ages birth to 24 months and disease and condition-specific modules for other pediatric chronic health conditions.
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PMID:The PedsQL as a pediatric patient-reported outcome: reliability and validity of the PedsQL Measurement Model in 25,000 children. 1980 13

Hereditary angioedema (HAE) types I and II are autosomal dominant conditions characterized by recurrent attacks of edema formation in the subcutaneous tissue of the body or walls of the upper respiratory or gastrointestinal tract. Frequently, prodromal symptoms occur before an HAE attack. If certain prodromal symptoms were determined to be both sensitive and specific in predicting an acute HAE attack, treatment at the time of the prodrome could prevent development of an attack and decrease morbidity and mortality associated with HAE. The goal is to determine the frequency and timing of prodromal symptoms occurring before HAE attacks. After Institutional Review Board approval, a four-page survey was produced, using a focus group of patients with HAE and was assessed by HAE patients and physicians with expertise in HAE for cognitive reliability. Once devised, the questionnaire was sent to 158 HAE patients. The survey focused on questions related to prodromal symptoms that patients developed before their last HAE attack. Forty-six patients returned the survey and 40 (87.0%) reported the presence of prodromal symptoms before their last HAE attack. Forty-four of 46 (95.7%) reported having had prodromal symptoms before HAE attacks in the past. The most commonly reported prodromal symptoms included unusual fatigue, rash, and muscle aches. Prodromes occur frequently before HAE attacks. This high frequency suggests that prodromal symptoms could be a reliable indication to begin treatment to prevent an acute HAE attack, thus decreasing the anxiety associated with having an HAE attack.
Allergy Asthma Proc
PMID:Frequency, timing, and type of prodromal symptoms associated with hereditary angioedema attacks. 1984 5

Asthma disproportionally affects children, minorities, and people who live in urban areas ((1,2)) and is characterized by periodic episodes of wheezing, shortness of breath, tightness in the chest, increased mucus production in the lungs, and fatigue ((3,4)). Approximately 90% of all asthmatic patients experience exercise-induced asthma (EIA) that may develop slowly during exercise, with symptoms returning or intensifying during recovery ((4)).
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PMID:Decreasing activity limits for asthma patients. 2008

The effect of chronic obstructive pulmonary disease (COPD) on patients and their perception of wellbeing goes beyond functional respiratory alterations. Fatigue, mood and sleep alterations constitute a complex of interrelated symptoms affecting perception of health status. Fatigue is a highly important symptom due to its frequency, clinical repercussions and association with other manifestations. Functional alterations during sleep are of various degrees of severity and are most important in sleep apnea-hypopnea syndrome. Mood alterations are important because of their frequency, clinical repercussion and prognostic implications. In the last few years, several measurement instruments have been developed to quantify these manifestations, such as the Living with COPD scale (LCOPD), the COPD and Asthma Fatigue Scale (CAFS) and the COPD and Asthma Sleep Impact Scale (CASIS).The present article reviews the clinical relevance of these manifestations and the measurement instruments available for their evaluation.
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PMID:[Importance of fatigue, sleep quality and mood in patients with chronic obstructive pulmonary disease and the need for measurement instruments]. 2011 55

Allergic rhinitis is a prevalent disease in developed nations, and its prevalence has been increasing throughout the world. Nasal congestion is the most common and bothersome symptoms of rhinitis. Congestion is associated with sleep-disordered breathing and is thought to be a key cause of sleep impairment in individuals with rhinitis. The end result is a decrease in quality of life and productivity and an increase in daytime sleepiness. Treatment with intranasal corticosteroids has been shown to reduce nasal congestion. Data on sleep-related end points from clinical trials of intranasal corticosteroids indicate that this reduction is associated with improved sleep, reduced daytime fatigue, and improved quality of life. Other therapies, such as montelukast, also have a positive influence on congestion and sleep. This review examines nasal congestion and the associated sleep impairment of allergic rhinitis patients. It explores the adverse effects of disturbed sleep on quality of life and how these conditions can be reduced by therapies that decrease congestion.
Curr Allergy Asthma Rep 2010 Mar
PMID:Congestion and sleep impairment in allergic rhinitis. 2042 3

Sitagliptin is a dipeptidyl peptidase-4 (DPP IV, CD26) inhibitor indicated for treatment of Type II diabetes as a second line therapy after metformin. We report fifteen sitagliptin intolerant patients who developed anterior and posterior rhinorrhea, cough, dyspnea, and fatigue. Symptoms typically developed within 1 to 8 weeks of starting, and resolved within 1 week of stopping the drug. Peak expiratory flow rates increased 34% in 8 patients who stopped sitagliptin. Similar changes were found in 4 out of 5 persons who had confirmatory readministration. Chart review identified 17 patients who tolerated sitagliptin and had no symptomatic changes. The sitagliptin intolerant group had higher rates of clinically diagnosed allergic rhinitis (15/15 vs. 6/18; p = 0.00005), Fisher's Exact test) and angiotensin converting enzyme inhibitor - induced cough (6/13 vs. 1/18; p = 0.012). Nasal and inhaled glucocorticoids may control the underlying allergic inflammation and abrogate this new sitagliptin - induced pharmacological syndrome. Potential mucosal and central nervous system mechanisms include disruption of neuropeptides and/or cytokines that rely on DPP IV for activation or inactivation, and T cell dysfunction.
Allergy Asthma Clin Immunol 2010 May 12
PMID:Rhinorrhea, cough and fatigue in patients taking sitagliptin. 2046 26

We present a 74-year-old woman with a recent diagnosis of myelodysplastic syndrome who presented with left upper quadrant abdominal pain and fatigue with significant splenomegaly, anemia, and thrombocytopenia. She underwent splenectomy and bone marrow biopsy. Pathology of both spleen and bone marrow revealed an unusual diagnosis. A review of the differential diagnosis, laboratory tests, nature of the underlying disease, and treatment are provided.
Allergy Asthma Proc
PMID:Seventy-four-year-old woman with myelodysplastic syndrome and splenomegaly. 2061 27

The safety of loratadine (second-generation antihistamine) and montelukast (leukotriene receptor antagonist) as monotherapies is well documented. Safety of the fixed-dose, single-tablet therapy loratadine/montelukast (L/M; SCH 445761, containing loratadine [10 mg]/montelukast [10 mg]), for treatment of the symptoms of allergic rhinitis in >3800 subjects is described. Safety data from 19 randomized clinical studies in which subjects were administered L/M are presented. Adverse events (AEs) were defined as any unfavorable and unintended sign, symptom, or laboratory data, including onset of new illness and exacerbation of preexisting conditions. Only AEs with an onset during the treatment period (i.e., treatment emergent) are summarized. Safety was also assessed via clinical laboratory evaluations and monitoring of vital signs and electrocardiogram (ECG). Overall, the incidence of AEs reported with L/M in the 19 studies was low and comparable with placebo, loratadine monotherapy, and montelukast monotherapy. The most frequently reported AE across all studies was headache. Most AEs were not severe and the duration of such events was short lived. Three AEs (headache [4.5%], fatigue [1.2%], and pharyngolaryngeal pain [1.2%]), regardless of relation to treatment, were reported by >1% of subjects in the L/M treatment group of multiple-dose, placebo-controlled studies. There were no clinically significant changes in clinical laboratory analyses or in vital signs, physical findings, or ECG found to be clinically relevant. Administration of the fixed-dose, single-tablet formulation of L/M was well tolerated. In these clinical studies, the safety of L/M was comparable with placebo, loratadine, and montelukast.
Allergy Asthma Proc
PMID:Safety of fixed-dose loratadine/montelukast in subjects with allergic rhinitis. 2170 61


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