Quality of life in patients treated with lipoprotein apheresis.

OBJECTIVES: Elevated levels of low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) [Lp(a)] are known risk factors for atherosclerosis and cardiovascular events. Although lipoprotein apheresis (LA) yields optimal outcomes for patients suffering from progressive cardiovascular disease (CVD; coronary, peripheral, and cerebrovascular arterial disease) in the presence of hyperlipoproteinemia (LDL-C > 100 mg/dL or Lp(a) > 60 mg/dL), LA primarily serves as a "last-resort therapy". Extant findings show that the incidence of new cardiovascular events can be reduced by regular LA. However, it remains unclear whether improvements to the quality of life (QOL) improvement produced by the positive impact on the course of cardiovascular disease outweighs the therapy's time consuming and invasive character. We surveyed 36 patients (32 men and 4 women; age 53 ± 13 years [mean + standard deviation]) undergoing regular LA therapy to assess the effects of apheresis on QOL. METHODS: QOL was evaluated in 29 patients on regular lipoprotein apheresis treatment using the Medical Outcomes Study 36-item Short Form Health Survey (SF-36), the Beck Depression Inventory (BDI), and a newly developed questionnaire for assessing QOL in patients undergoing LA. RESULTS: Patients treated with LA showed lower QOL scores regarding mental aspects and equal scores regarding physical aspects compared to the general population, analogue to the results of patients on hemodialysis (SF-36). Analysis of BDI scores showed apheresis patients did not meet criteria for depression diagnosis, although their depression scores were higher than the general population. Compared to the pre-apheresis period, patients described an improvement of their physical and mental fitness, less angina pectoris and no treatment related pain were reported (apheresis questionnaire). CONCLUSIONS: Apheresis treatment appears to reduce the subjective physical complaints of patients. The partly impaired mental health in patients undergoing apheresis may be attributed to the underlying severe cardiovascular disease. The procedure itself is generally tolerated without major complaints, suggesting the benefits of apheresis exceed any negative effects on patient QOL.

Simultaneous detection of Entamoeba histolytica/dispar, Giardia duodenalis and cryptosporidia by immunochromatographic assay in stool samples from patients living in the Greater Cairo Region, Egypt.

Gastrointestinal infection due to intestinal parasites is an enormous health problem in developing countries and its reliable diagnosis is demanding. Therefore, this study aimed at evaluating a commercially available immunochromatographic assay (ICA) for the detection of cryptosporidia, Giardia duodenalis, and Entamoeba histolytica/dispar for its usefulness in the Greater Cairo Region, Egypt. Stool samples of 104 patients who presented between October 2012 and March 2013 with gastrointestinal symptoms or for the exclusion of parasites at Kasr-Al-Ainy University Medical School were examined by light microscopy of wet mounts and the triple ICA. Microscopy revealed in 20% of the patients [95% confidence interval (CI), 13.5-29.0%] parasites with Hymenolepis nana, E. histolytica/dispar and Blastocystis hominis being the most frequent ones, but was not able to detect G. duodenalis and cryptosporidia, whereas ICA was positive in 21% (95% CI, 14.3-30.0%) and detected E. histolytica/dispar in 12.5% (95% CI, 7.3-20.4%), cryptosporidia in 6.7% (95% CI, 3.1-13.5%) and G. duodenalis in 15.4% (95% CI, 9.6-23.6%) of the patients. Detection of one or more pathogens was associated with access to water retrieved from a well or pump (p = 0.01). Patients between 20 and 29 years of age (p = 0.08) and patients with symptoms of 5 days or longer (p = 0.07) tended to have a higher risk to be infected than patients of other age groups or with shorter-lasting symptoms. In conclusion, the ICA was easy to perform and timesaving. Importantly, it enabled the detection of cryptosporidia, which cannot be found microscopically in unstained smears, demonstrated a higher sensitivity for the detection of G. duodenalis than microscopy, and was more specific for distinguishing E. histolytica/dispar from apathogenic amoeba.