Assessing a pharmacist-run anaemia educational programme for patients with chronic renal insufficiency.

OBJECTIVE: Assessment of a pharmacist-run anaemia educational programme for patients with chronic renal insufficiency. SETTING: Nephrology Department, Grenoble Hospital, France. METHOD: A 12-week prospective study, using a before-after intervention design. Included in the study were predialysis outpatients with a haemoglobin level < 10 g/dl, de novo EPO prescription; judged qualified by the nephrologist for self-injections; accepting self-injections. The intervention was a single one-hour individual session between the pharmacist and the patient to target (1) medical and therapeutic information; (2) information on the device, a pen used with a cartridge of beta epoietin; (3) training with the pen; and (4) self-injection of the first dose by the patient, in front of the pharmacist. Main outcome measures were knowledge (7-item questionnaire); handling skills (observation) and Quality of Life (1 Likert scale on apprehension towards self-injections and 3 Linear Analog Scales on energy, daily activities, and general well-being); compliance (self-report on self-administered injections) and haemoglobin level. RESULTS: Ten patients were followed for 3 months after intervention. The evolution of the knowledge was positive but not statistically significant after the programme (80% of good answers before; 93% 3 months later). Concerning the patients' skills, difficulties with the pen were important at inclusion, (1) to reset the pen into zero position (2.8 tries/patient +/- 1.8); (2) to insert a new cartridge (1.9 +/- 1.1); and (3) to take air out of the cartridge (2.3 +/- 1.2). After the session, results were satisfactory, since 3 months later, all patients were still on self-injections. QoL improved significantly over the study period respectively on energy, daily activities, and general well-being. The mean level of compliance remained above 90% at 3 months for 8 out of 10 patients. Patients reached the haemoglobin target value of 11 g/dl during the second month of treatment. CONCLUSION: A tailored educational programme conducted by a pharmacist is beneficial for anaemia patients with chronic renal insufficiency. The programme seems to result in a high level of compliance, leading to an optimal haemoglobin level within two months.

[Stomatitis and ageusia induced by candesartan]. / Stomatite et agueusie induites par candésartan.

Cases of dysgeusia or ageusia have been reported in patients treated with angiotensin II receptor antagonist such as losartan (5 cases), valsartan (1 case), eprosartan (1 case). This is the first case-report of ageusia following candesartan. A 46-year-old-male patient, with a medical history of renal chronic reject allograft disease, started candesartan 4 mg once daily to treat high blood pressure. Six months later, a progressive ageusia occurred with a burning mouth syndrome. He also developed aphthous ulcers of the mouth, stomatitis and perleche, which led him to lose 8 kilos within 13 months. Thirteen months after the beginning of the treatment candesartan was stopped. The symptoms and lesions required 2 to 3 weeks to disappear. Subsequently, appetite was found again as well as the sense of taste. The temporal sequence of events suggests a causal relationship between ageusia and candesartan.

Induction versus noninduction in renal transplant recipients with tacrolimus-based immunosuppression.

BACKGROUND: The aim of this study was to compare the efficacy and safety of induction treatment with antithymocyte globulins (ATG) followed by tacrolimus therapy with immediate tacrolimus therapy in renal transplant recipients. METHODS: This 12-month, open, prospective study was conducted in 15 centers in France and 1 center in Belgium; 309 patients were randomized to receive either induction therapy with ATG (n=151) followed by initiation of tacrolimus on day 9 or immediate tacrolimus-based triple therapy (n=158). In both study arms, the initial daily tacrolimus dose was 0.2 mg/kg. Steroid boluses were given in the first 2 days and tapered thereafter from 20 mg/day to 5 mg/day. Azathioprine was administered at 1-2 mg/kg per day. RESULTS: At month 12, biopsy-confirmed acute rejections were reported for 15.2% (induction) and 30.4% (noninduction) of patients (P=0.001). The incidence of steroid-sensitive acute rejections was 7.9% (induction) and 22.2% (noninduction)(P=0.001). Steroid-resistant acute rejections were reported for 8.6% (induction) and 8.9% (noninduction) of patients. A total of nine patients died. Patient survival and graft survival at month 12 was similar in both treatment groups (97.4% vs. 96.8% and 92.1% vs. 91.1%, respectively). Statistically significant differences in the incidence of adverse events were found for cytomegalovirus (CMV) infection (induction, 32.5% vs. noninduction, 19.0%, P=0.009), leukopenia (37.3% vs. 9.5%, P<0.001), fever (25.2% vs. 10.1%, P=0.001), herpes simplex (17.9% vs. 5.7%, P=0.001), and thrombocytopenia (11.3% vs. 3.2%, P=0.007). In the induction group, serum sickness was observed in 10.6% of patients. The incidence of new onset diabetes mellitus was 3.4% (induction) and 4.5% (noninduction). CONCLUSION: Low incidences of acute rejection were found in both treatment arms. Induction treatment with ATG has the advantage of a lower incidence of acute rejection, but it significantly increases adverse events, particularly CMV infection.

Detection of hypoxia by measurement of DNA damage and repair in human lymphocytes (comet assay): a predictive variable for tumor response during chemotherapy in patients with head and neck squamous cell carcinoma.

BACKGROUND: Only few studies have tried to identify parameters at the time of diagnosis or during treatment that can assist the clinician in predicting the response to Cisplatin, 5-Fluorouracil +/- Folinic acid therapy in patients with head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS: The alkaline comet assay was used to measure both cellular hypoxia and DNA single-strand break (ssb) kinetics in individual lymphocytes of HNSCC patients undergoing combined therapy. The intracellular level of FdUMP, dUMP and mTHF were also measured during treatment. RESULTS: Two distinct types of cell populations were detected, from the less damaged population representing the hypoxic cells to the most damaged cells population representing the aerobic cells. We also described a direct relationship between DNA damage and repair and drug metabolism in lymphocytes and treatment efficacy. CONCLUSION: The response of tumors to chemotherapy is thought to be a function of the drug's pharmacological properties (the intracellular level of FdUMP and mTHF). In addition, a relationship between platinum DNA adduct levels in lymphocytes DNA (comet assay) and tumor response has been observed, suggesting that clinical resistance to platinum drugs is attributable to DNA repair functions of the host, and thus the degree of cytotoxicity is similar across all cell types.