De novo once-monthly darbepoetin alpha treatment for the anemia of chronic kidney disease using a computerized algorithmic approach.

BACKGROUND: Anemia of chronic kidney disease (CKD) has been traditionally treated by erythropoiesis-stimulating agents (ESAs) and/or iron following manual determination of dose. We hypothesized that once-monthly (QM) algorithmically dosed darbepoetin α (DA) and iron administration would successfully treat anemia of CKD in ESA-naïve CKD subjects. METHODS: QM DA and iron doses were determined via a computerized program targeting a hemoglobin (Hb) of 10.5 - 12.5 g/dl in anemic, ESA-naïve, CKD Stages 3 - 5 subjects. Six consecutive QM doses were administered. Hb, ferritin, and transferrin saturation were recorded. Data are presented as means ± standard deviation. RESULTS: Anemia was identified in 133 subjects, with a mean follow-up of 188 days. DA doses and Hb were significantly greater at Months 3 and 6 compared to baseline (p < 0.05); DA doses were 109 ± 68 µg and 118 ± 91, respectively, at Months 3 and 6. Hemoglobin levels were correspondingly 11.3 ± 1.1 g/dl and 11.3 ± 1.0. 78% of patients achieved the target Hb by 6 months of therapy. The elevation of Hb was greater in non-proteinuric than proteinuric subjects at 6 months of treatment (11.6 ± 0.8 g/dl vs. 11.0 ± 1.1; p < 0.05), despite lower DA dose (96 ± 76 µg vs. 139 ± 98; p < 0.05). CONCLUSION: Successful treatment of the anemia of CKD by QM DA based upon a computerized dosing program was achieved by 6 months in 78% of ESA-naïve, CKD subjects.

Linezolid for treatment of vancomycin-resistant enterococcal peritonitis.

A 42-year-old woman on continuous ambulatory peritoneal dialysis (CAPD) developed peritonitis secondary to vancomycin-resistant Enterococcus faecium and Candida albicans while hospitalized for pneumonia. She was treated successfully with intravenous linezolid, fluconazole given by nasogastric tube, and removal of the peritoneal catheter. A concentration of linezolid above the minimum inhibitory concentration for most gram-positive pathogens, including vancomycin-resistant E faecium, was achieved in the dialysate fluid after an oral loading dose of 1200 mg. Additional data are needed to establish the role of linezolid in treating CAPD-associated peritonitis.

Response of Weeksella virosa peritonitis to imipenem/cilastin.

CAPD peritonitis is most commonly due to gram positive infection. Gram negative bacillary infection is less frequent but is often seen in hospitalized patients or in those on antibiotics. Weeksella virosa (formerly known as Flavobacterium II F) has been isolated from the vaginal secretions and urine of normal women. As gram negative colonization typically proceeds from the perineal region, Weeksella virosa peritonitis might be expected in women at risk for gram negative peritonitis. A 33-year-old woman on CAPD developed multiply resistant Weeksella virosa peritonitis after prior hospitalization for pericarditis and antibiotic treatment for pneumonia. Cultures became negative and cell counts returned to normal during treatment with intravenous imipenem/cilastin. Curative treatment was completed with intraperitoneal imipenem/cilastin and oral ampicillin. Treatment was well tolerated despite theoretical concerns about the risk of seizures in patients with severe renal insufficiency not on hemodialysis.

Chance, structure, stress: the birth and development of the human mind-brain.

Recent physiological studies of the human mind-brain lend support to the theory of object relations, and in particular to the manner in which the object of the early period enters the infant's dawning psyche to elicit a perdurable pattern of both positive and negative response to stimuli. The psychoanalytic concept of reactivation, and the psychoanalytic view of language as (in part) a substitute for the absent object, are linked with specific cerebral mechanisms to disclose the bodily realities that underlie emotive disturbance.