RESUMEN
OBJECTIVES: Our principle objective was to examine the personal and professional impact of service user (SU) suicide on mental health professionals (MHPs). We also wished to explore putative demographic or clinical factors relating to SUs or MPHs that could influence the impact of SU suicide for MHPs and explore factors MHPs report as helpful in reducing distress following SU suicide. METHODS: A mixed-method questionnaire with quantitative and thematic analysis was utilised. RESULTS: Quantitative data indicated SU suicide was associated with personal and professional distress with sadness (79.5%), shock (74.5%) and surprise (68.7%) particularly evident with these phenomena lasting less than a year for more than 90% of MHPs. MHPs also reported guilt, reduced self-confidence and a fear of negative publicity. Thematic analysis indicated that some MHPs had greater expertise when addressing SU suicidal ideation and in supporting colleagues after experiencing a SU suicide. Only 17.7% of MHPs were offered formal support following SU suicide. CONCLUSION: SU suicide impacts MHPs personally and professionally in both a positive and negative fashion. A culture and clear pathway of formal support for MHPs to ascertain the most appropriate individualised support dependent on the distress they experience following SU suicide would be optimal.
Asunto(s)
Salud Mental , Suicidio , Personal de Salud/psicología , Humanos , Autoimagen , Suicidio/psicología , Encuestas y CuestionariosAsunto(s)
Leucemia Linfocítica Crónica de Células B , Leucoencefalopatía Multifocal Progresiva , Púrpura Trombocitopénica Idiopática , Compuestos Bicíclicos Heterocíclicos con Puentes/uso terapéutico , Humanos , Leucemia Linfocítica Crónica de Células B/complicaciones , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Leucoencefalopatía Multifocal Progresiva/inducido químicamente , Leucoencefalopatía Multifocal Progresiva/tratamiento farmacológico , Púrpura Trombocitopénica Idiopática/tratamiento farmacológico , SulfonamidasRESUMEN
Richter's transformation of chronic lymphocytic leukaemia (CLL) to high-grade B-cell Non-Hodgkin lymphoma occurs in < 5% of CLL cases. Transformation of CLL to Hodgkin Lymphoma is a much rarer event and here we describe a patient who developed Richter's transformation into a Hodgkin Lymphoma presenting as rapidly progressive hepatosplenomegaly.
Asunto(s)
Transformación Celular Neoplásica , Enfermedad de Hodgkin/patología , Leucemia Linfocítica Crónica de Células B/patología , Anciano , Hepatomegalia/etiología , Humanos , Masculino , Esplenomegalia/etiologíaAsunto(s)
Péptidos Catiónicos Antimicrobianos/orina , Síndromes Mielodisplásicos/orina , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Ferritinas/sangre , Hepcidinas , Humanos , Sobrecarga de Hierro/sangre , Sobrecarga de Hierro/orina , Masculino , Persona de Mediana Edad , Síndromes Mielodisplásicos/sangre , Riesgo , Adulto JovenRESUMEN
Kenaf is an annual fiber crop adaptable to a wide range of climates and soil types. This study investigated the use of kenaf core fiber as a feedstock for enzyme-enhanced fermentation. Triplicate kenaf core fiber samples were treated with enzymes having cellulase:hemicellulase activity ratios of 0:1, 0.015:1, 0.45:1, and 2.54:1 at a rate of 5010 IU/kg dry matter hemicellulase activity, vacuum-sealed, and incubated at 37 degrees C for 21 d. Samples were analyzed for pH, water soluble carbohydrates, organic acids, and hemicellulose and cellulose concentrations. All treatments produced a pH less than 4.0, which is sufficient for stable storage. Treatments with 2.54:1 and 0.45:1 produced the highest water soluble carbohydrate and lactic acid concentrations. Enzymes with no or low cellulase activity produced results similar to the control. Utilizing enzyme mixtures with high cellulase activity is an effective pretreatment method for ensiled kenaf core fiber.
Asunto(s)
Fermentación , Hibiscus/química , Carbohidratos/análisis , Carbohidratos/química , Celulasa/química , Celulosa/análisis , Glicósido Hidrolasas/química , Concentración de Iones de Hidrógeno , Polisacáridos/análisis , SolubilidadAsunto(s)
Antineoplásicos/efectos adversos , Cromosomas Humanos Par 7/genética , Linfoma Folicular/tratamiento farmacológico , Monosomía , Síndromes Mielodisplásicos/genética , Vidarabina/análogos & derivados , Antineoplásicos/administración & dosificación , Femenino , Humanos , Linfoma Folicular/complicaciones , Persona de Mediana Edad , Síndromes Mielodisplásicos/inducido químicamente , Vidarabina/administración & dosificación , Vidarabina/efectos adversosRESUMEN
Raised percentage hypochromic red cells (%HRC) were detected at diagnosis in 10 of 34 consecutive patients with low-risk myelodysplastic syndrome (MDS) [refractory anemia (RA) (4/26) and RA with ring sideroblasts (6/8)], all of whom had normal or increased serum ferritin and bone marrow iron stores. Elevated %HRC has persisted in all 10 cases and subsequently developed in another RA patient who later had a complete remission of MDS with normalisation of %HRC after a respiratory tract infection. A strong positive correlation was found between %HRC and erythrocyte zinc protoporphyrin levels in 11 MDS patients tested (p=0.01), suggesting that functional iron deficiency contributes to ineffective erythropoiesis in cases of MDS with raised %HRC. Five of seven patients with elevated %HRC had satisfactory haemoglobin responses to a trial of human recombinant erythropoietin without iron supplementation.
Asunto(s)
Anemia Hipocrómica/epidemiología , Anemia Ferropénica/epidemiología , Síndromes Mielodisplásicos/sangre , Anemia Ferropénica/sangre , Recuento de Células Sanguíneas , Proteína C-Reactiva/análisis , Ferritinas/sangre , Humanos , Hierro/sangre , L-Lactato Deshidrogenasa/sangre , Prevalencia , Transferrina/metabolismoRESUMEN
A patient with cold-type autoimmune haemolytic anaemia for 8 years developed progressive B cell chronic lymphocytic leukaemia (CLL). Despite the risk of fludarabine induced exacerbation of haemolysis, he was given aggressive anti-CLL therapy with six courses of FCR (fludarabine 25 mg/m2 D1-3, cyclophosphamide 250 mg/m2 D2-4 and rituximab 375 mg/m2 D1) every 4 weeks. This resulted in a marked acute increase in haemolysis shortly after completing each course of fludarabine. However, haemolysis had settled to its baseline level by the time of subsequent courses of FCR. FCR resulted in complete clinical remission of CLL but residual haemolysis persisted. The patient was then given four weekly infusions of single agent rituximab, resulting in ongoing remission of haemolysis. In this patient, rituximab appears to have controlled fludarabine induced exacerbation of autoimmune haemolysis. In addition, subsequent single agent rituximab therapy resulted in prolonged remission of cold-type autoimmune haemolytic anaemia. It remains to be seen if the addition of rituximab will allow other patients with a positive direct Coomb's test and/or autoimmune haemolysis to receive fludarabine containing chemotherapy without undue risk of life-threatening haemolytic anaemia.
Asunto(s)
Anemia Hemolítica Autoinmune/complicaciones , Anticuerpos Monoclonales/administración & dosificación , Antineoplásicos/efectos adversos , Hemólisis/efectos de los fármacos , Factores Inmunológicos/administración & dosificación , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Vidarabina/análogos & derivados , Adulto , Anemia Hemolítica Autoinmune/tratamiento farmacológico , Anticuerpos Monoclonales de Origen Murino , Antineoplásicos/administración & dosificación , Humanos , Leucemia Linfocítica Crónica de Células B/etiología , Masculino , Rituximab , Vidarabina/administración & dosificación , Vidarabina/efectos adversosRESUMEN
We describe a 58-year-old male diagnosed with chronic myeloid leukaemia (CML) who failed to have a cytogenetic response to interferon-alpha and hydroxyurea. On subsequent therapy with imatinib mesylate he failed to have any cytogenetic response but also developed a complex clonal evolution with an additional Philadelphia (Ph) chromosome and trisomy 8 respectively in two Ph-positive subclones. The addition of cytosine arabinoside to imatinib resulted in reversion to single Ph-chromosome positivity with the disappearance of the previous additional clonal abnormalities. The case demonstrates the efficacy of combined treatment with imatinib and cytarabine in the management of CML resistant to single agent imatinib.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Transformación Celular Neoplásica/inducido químicamente , Leucemia Mielógena Crónica BCR-ABL Positiva/tratamiento farmacológico , Leucemia Mielógena Crónica BCR-ABL Positiva/patología , Piperazinas/efectos adversos , Pirimidinas/efectos adversos , Benzamidas , Transformación Celular Neoplásica/genética , Células Clonales/patología , Citarabina/uso terapéutico , Resistencia a Antineoplásicos , Humanos , Hidroxiurea/uso terapéutico , Mesilato de Imatinib , Interferón-alfa/uso terapéutico , Leucemia Mielógena Crónica BCR-ABL Positiva/genética , Masculino , Persona de Mediana Edad , Cromosoma Filadelfia , Piperazinas/uso terapéutico , Pirimidinas/uso terapéutico , Inducción de Remisión/métodos , Insuficiencia del Tratamiento , TrisomíaRESUMEN
BACKGROUND: High-dose treatment with autologous stem cell transplantation (ASCT) has become the standard of care for patients with myeloma below the age of 65 years. AIMS: We report an audit of 60 patients (median age: 52.5 years) who underwent ASCT in the National Bone Marrow Transplant centre in St James's Hospital in Dublin between 1997 and 2003 inclusive. METHODS: Clinical and laboratory data were retrieved from patient medical records and hospital information management systems. RESULTS: Thirty-six patients had IgG, 11 IgA, 1 IgD, 9 light chain and 3 non-secretory MM. Fifty-seven (95%) patients received anthracycline-corticosteroid combination chemotherapy prior to autografting. There was no transplant-related mortality (TRM). Complete (CR) and Partial Responses (PR) were seen in 16 (29.6%) and 29 (53.7%) of those evaluable (n = 54 (90%)). The actuarial Progression-Free (PFS) and Overall Survival (OS) rates at five years are 13% and 55% respectively. CONCLUSION: Centre outcome is comparable to published international series and supports the use of ASCT in the treatment of this malignancy.