Comparison of accepted and unaccepted living kidney donors: one-center experience.

BACKGROUND: Kidney transplantation from living donors (LD) has stagnated in many countries. This study aimed to check whether correction of LD selection practice could increase the number of kidney transplantations. METHODS: From January 2003 to December 2012, 241 potential adult LD were evaluated in our hospital. Outcome (mortality and end-stage renal disease-ESRD) of accepted LD (182) was compared with unaccepted (59) donors. RESULTS: Mortality of LD was comparable with that for the standardized Serbian population (SMR = 1.104; 95% CI (0.730-1.606). Among evaluated potential LD, almost every fourth had been unaccepted, but reasons were modifiable in 42.4% of them. In pre-donation period unaccepted donors were significantly older, measured glomerular filtration rate was lower, with higher 15-year and lifelong projected ESRD risks than accepted donors. Despite this, ten years outcome of both groups LD was similar: none of LD developed ESRD, 9.8% of accepted and 11.8% of unaccepted LD died (p = .803). CONCLUSIONS: During an average of 101 months of follow-up mortality of accepted LD did not differ significantly as compared to the age standardized Serbian population and none of them developed ESRD. In examination of potential LD, the use of accurate and precise methods for kidney function estimation and the evaluation of risk for ESRD and mortality as well as treatment of modifiable contraindications for kidney donation are necessary.

Importance of Capgras syndrome in shared psychotic disorder: a case report.

Shared psychotic disorder characterized by Capgras syndrome is an extremely rare condition. To our knowledge, there are only a few published papers on this condition. This paper presents a case of shared Capgras syndrome in two sisters. The inducer was a younger sister with schizophrenia, who passed on her Capgras delusion to her older sister after the death of their father. After committing a violent offense caused by Capgras delusion, a court ordered the sisters' involuntary admission to a psychiatric hospital. After being separated and receiving antipsychotic treatment, the sisters showed substantial improvement. However, shortly after hospital discharge, they stopped taking their medication and disappeared. After 15 years, their mother died and shortly afterwards, the sisters were re-admitted for forensic psychiatric evaluation after another violent crime caused by Capgras delusion. Timely recognition, adequate treatment and maintaining a therapeutic alliance could contribute to a better clinical course and outcome of this disorder, and reduce the risk of violent behavior.

Nonasthmatic Churg-Strauss syndrome superimposed on chronic pyelonephritis: a case report.

Churg-Strauss syndrome (CSS) is a granulomatous small-vessel vasculitis. Asthma is seen in the majority of patients with CSS, but atypical nonasthmatic forms of CSS are also being recognized. We herein describe a 67-year-old woman with a history of chronic pyelonephritis and drug allergy reactions who was admitted to our hospital because of worsening renal function preceded by fever, purpura, sinusitis, and a positive urine culture that confirmed a urinary infection. She was initially treated with pipemidic acid for 7 days, followed by clarithromycin for sinusitis. Laboratory tests on admission showed an absolute eosinophil count of 1750 cells/µL and serum creatinine concentration of 4.72 mg/dL. Urine and blood cultures showed no growth. Kidney biopsy revealed crescent formations with diffuse interstitial fibrosis and foci of eosinophil infiltration. An atypical form of CSS was diagnosed based on tissue eosinophilia, peripheral eosinophilia, and sinusitis. Intravenous methylprednisolone and cyclophosphamide pulse therapy together with hemodialysis treatment improved the patient's clinical condition but did not resolve the kidney damage. The onset of an atypical form of CSS in our patient manifested as symptoms and signs mimicking those of chronic pyelonephritis and drug allergy reactions. The patient's chronic kidney disease finally progressed to dialysis dependence.

Evaluation of the role of stress in patients with breast cancer and depression by paykel's life event and adaptive neuro-fuzzy approach.

INTRODUCTION: The aim of this study was to identify and analyze the stress factors and the level of stress a year preceding the onset of breast cancer and depression in the studied female patients. METHODS: The research in this work was mostly prospectively (clinical and analytical). During the research, Scale of Life Events-Paykel was applied. Stressful life events differed significantly between the groups. In the studied group, the following events were significantly more prevalent: partner infidelity (χ2  = 12.663; p < .001), failure at work (χ2  = 44.429; p < .001), and spontaneous abortions or stillbirths (χ2  = 13.818; p < .001). RESULTS: According to the results of this study, stressful life events differed significantly between the observed groups. These stressful life events had a significant impact on the increase of risk for breast cancer, as well as on depressivity. Afterward, adaptive neuro-fuzzy inference system was used for prediction of the Paykel's Life Event according to Fisher's exact test. CONCLUSION: The obtained results could be of practical usage for improving stress behavior of the patients with breast cancer and depression.

Evaluation of quality of life for patients with schizophrenic and schizoaffective disorders related to the use of antipsychotic therapy.

The purpose of the study was to understand the impact of using antipsychotics in the treatment of schizophrenic and schizoaffective disorders related to the quality of life and overall social functioning of schizophrenic patients. In addition to this, the study monitored and compared the efficacy of classical, commonly used antipsychotics to that of atypical antipsychotic drugs with respect to the velocity and degree of reduction in symptoms of the primary disease. The 160 respondents who participated in this research were divided into two groups of 80. The respondents in the first group (A) were treated with atypical antipsychotics, whereas the respondents in the second group were treated with classical antipsychotics. The respondents were observed over a one-year monitoring period. Therapeutic effect of the used medicamentous therapy was monitored by means of a PANSS and CGI scales, while the velocity and degree of reduction in social functioning was monitored using the Quality of Life scale (QLS) - Heinrich-Hanlon-Carpenter-scale. The results show a remarkably improved social rehabilitation and a better quality of life, as well as higher reduction in symptoms among the respondents treated with atypical antipsychotics compared to the ones treated with classical antipsychotics.

[Current issues in psychiatry].

INTRODUCTION: Psychiatry is the branch of medicine concerned with the defining and diagnosing mental disorders, finding ways of treatment, developing methods for determining causes, and conceiving measures for prevention of mental disorders. Psychiatry has greatly advanced over the last two decades. In our country, however, due to prejudice and ignorance, mental disorders are still often considered incurable and alarming by the general public as well as by physicians, and psychiatric patients are stigmatized and marginalized by the society. THE ROLE OF PSYCHIATRY IN MODERN MEDICINE AND SOCIETY: Psychiatry has an important role in the contemporary medicine and society in general, considering the increasing number of people suffering from mental disorders, disability they cause, and their frequent simultaneous occurrence with various physical illnesses, especially chronic ones. Comorbidity of physical and mental disorders makes the treatment more difficult and time-consuming, whereas an unrecognized and untreated mental disorder has a negative impact on the prognosis and outcome of the physical illness. PSYCHIATRY AS AN INTEGRATIVE DISCIPLINE: Because of the great advances in psychopharmacology and etiopathological research, as well as development of new classifications, contemporary psychiatry integrates biological, psychological and social aspects into an integrative biopsychosocial approach to etiopathogenesis, manifestations, course, treatment, and outcome of mental disorders. In fact, this means that the etiological factors of a psychiatric disorder include mutually interacting biological (genetic, neuroanatomical, biochemical, etc), psychological (personality/temperament), and social (background, stressful life events) factors. Therefore, the treatment itself involves application of biological, psychological and social methods. THE POSITION OF'PSYCHIATRY IN OUR COUNTRY: The significant increase in the number of people suffering fiom mental disorders (depression, anxiety disorders, substance abuse disorders) underlines the importance of psychiatry in our country. It is also clear that psychiatric services need to be reformed. In order for this reorganization to be effective it is necessary to review the current conditions, include both mental health specialists and general physicians, provide financial resources, and carry it out gradually, with an adequate support from the health care administration.

[Family dysfunction in adolescents with suicidal behavior and in adolescents with conduct disorders].

INTRODUCTION: The period of life known as adolescence generally refers to transition from childhood to adulthood. Adolescents' progress toward autonomy involves remaining connected with, as well as separated from parents. Young people and their parents usually have mixed feelings about adolescent autonomy and attachment. An estimated 50% of children born in the 80-s have spent part of their developmental years in single-parent households. Divorce is almost always a stressful event in children's lives. Youthful suicide rate has increased dramatically and is the third leading cause of death among 15-19 year olds. Conduct disorder is one of the mostfrequently diagnosed conditions in adolescents. Suicidal adolescents and adolescents with conduct disorder are much more likely than their peers to have grown up in disrupted, disorganized homes with lack of attachment between parents and their children. MATERIAL AND METHODS: This prospective study was carried out during 2002, 2003, and 2004. The research included 60 adolescents treated at the Center for Child and Adolescent Psychiatry in Novi Sad, 30 with diagnosed conduct disorder and 30 with suicidal behavior. RESULTS: Along with other kinds of distress, suicidal adolescents have experienced an escalation of family problems a few months prior to attempted suicide. DISCUSSION: Divorce and life in singe-parent households is almost always a stressful period in children's lives. Conduct disorder and suicidal behavior represent a desperate cryfor help. Conclusion Most adolescents in both groups live in single-parent households. These young people have frequently passed into adolescence with little reason to feel that they could rely on their parentsfor support, or on their home as a place of sanctuary.