The role of demographic characteristics and comorbidities in hemodialysis patients' health-related quality of life.

BACKGROUND: The assessment of health-related quality of life (HRQL) is a valid tool, which can measure the degree that a chronic condition and its treatment, can affect patients' quality of life (QOL). METHODS: A cross-sectional study was implemented at three hemodialysis units. One hundred fifteen patients were included in the study and 107 participated (response rate 93 %). The General Health Questionnaire (GHQ-28) and the Missoula-VITAS Quality of Life Index (MVQOLI-25) were utilized for the data collection. RESULTS: Multivariate logistic regression analysis found that increased number of coexisting diseases was associated with increased total score ≥24 on GHQ-28 [odds ratio: 1.35, 95 % confidence intervals (CI): 1.03-1.77, p =0.03]. Multivariate linear regression analysis revealed that increased age was associated with an increased score on somatic symptoms subscale (coefficient beta: 1.01, 95 % CI: 1.00-1.03, p =0.007). Increased number of coexisting diseases was associated with an increased score on anxiety/insomnia subscale (coefficient beta: 1.17, 95 % CI: 1.06-1.29, p =0.003). Moreover, increased educational level was associated with decreased score on social dysfunction subscale (coefficient beta: -0.89, 95 % CI: -1.62 to -0.096, p =0.028) and decreased score on severe depression subscale (coefficient beta: -1.14, 95 % CI: -2.03 to -0.26, p =0.012). Patients with fistula/graft had a higher score on MVQOLI-25 than patients with a central venous catheter (coefficient beta: 2.31, 95 % CI: 0.43-4.19, p =0.017). CONCLUSIONS: Comorbidities, educational level and vascular access were the most important findings regarding to their impact on patients' HRQL. HIPPOKRATIA 2017, 21(4): 163-168.

Natalizumab is effective as second line therapy in the treatment of relapsing remitting multiple sclerosis.

BACKGROUND: Natalizumab has been recommended for the treatment of patients with relapsing remitting multiple sclerosis with insufficient response to interferon-beta (IFN-beta) or glatiramer acetate (GA). METHOD: Prospective, observational study. RESULTS: We found a reduction of the annualized relapse rate from 2.1 under IFN-beta or GA to 0.2 one year after switching to natalizumab. There were 94% fewer gadolinium enhancing lesions with natalizumab. CONCLUSION: Natalizumab reduced short term clinical and MRI activity in second line therapy and efficacy is comparable to first line therapy as demonstrated in the pivotal trials.

First clinical study on ultra-high-field MR imaging in patients with multiple sclerosis: comparison of 1.5T and 7T.

BACKGROUND AND PURPOSE: Higher magnetic field strengths and continuous improvement of high-resolution imaging in multiple sclerosis (MS) are expected to provide unique in-vivo and non-invasive insights in pathogenesis and clinical monitoring. The purpose of this study was to investigate the potential of high-resolution imaging of MS lesions in vivo comparing 7T with conventional 1.5T. MATERIALS AND METHODS: Twelve consecutive patients with clinically definite MS were scanned on a 7T whole-body scanner and on a 1.5T Avanto. The 1.5T and 7T imaging protocol consisted of high-resolution axial proton density (PD) + T2-weighted turbo spin-echo and T2*-weighted gradient-echo (GRE), and sagittal T1-weighted 3D magnetization-prepared rapid acquisition of gradient echo. RESULTS: The sequence parameters at 7T had to be modified because of specific absorption rate (SAR) restrictions while keeping contrast parameters equivalent to 1.5T. White matter lesions were better detected and delineated from adjacent structures at 7T compared with 1.5T. There were 42% of the patients who showed additional lesions at 7T: there were 97 white matter lesions detected on 1.5T versus 126 lesions at 7T, an increase of 23%. The perivascular migration of MS lesions was well visualized on T2*-weighted GRE sequences. In larger lesions (10 mm), a multilayer structure was revealed on T2*-weighted GRE not seen at 1.5T. Because of the higher resolution, it was possible to differentiate between juxtacortical white matter lesions and cortical lesions. There were 44% of the subcortical lesions depicted at 7T that showed cortical involvement. CONCLUSIONS: Ultra-high-field imaging of patients with MS at 7T was well tolerated and provided better visualization of MS lesions in the gray matter and demonstrated structural abnormalities within the MS lesions themselves more effectively.

Hypercalcemia due to resistant hyperparathyroidism in renal transplant patients treated with the calcimimetic agent cinacalcet.

INTRODUCTION AND AIMS: Calcimimetic agents increase the sensitivity of calcium-sensing receptors of parathyroid glands and suppress both serum calcium levels and parathyroid hormone (PTH). The use of these drugs in patients with a functioning graft suffering from resistant hyperparathyroidism and hypercalcemia is still under investigation. We report seven patients who were treated with the calcimimetic agent cinacalcet. METHODS: The four male and three female patients of 38 to 72 years of age received a renal transplant from 4 to 35 months before cinacalcet treatment. Serum creatinine was 1.2 to 1.8 mg/dL (estimated glomerular filtration rate between 40 and 75 mL/min). Immunosuppressive treatment consisted of interleukin-2 antibody induction therapy, calcineurin inhibitors (cyclosporine or tacrolimus), prednisolone, and mycophenolate mofetil. Mild to severe hyperparathyroidism resistant to vitamin D analog treatment (intact parathyroid hormone molecule [iPTH] 174 to 519 pg/mL) was accompanied by severe hypercalcemia (Ca >11 mg%). To date the patients have completed 3 to 18 months of therapy. Cinacalcet 30 mg/d was initially administered. RESULTS: This treatment resulted in a rapid decrease in total serum calcium (8.6 to 9.2 mg/dL) while PTH showed a milder, progressive decrease. Having controlled calcium levels, 1alpha OH vitamin D (0.25 microg/d per os) was added to the treatment, which resulted in a further decline of iPTH without producing an increase in serum calcium concentrations (median initial iPTH value 401 pg/mL, median value after treatment 176 pg/mL). Therapy was well tolerated without hypocalcemic events. CONCLUSION: Cinacalcet offered a better holistic treatment approach to such patients.

Delineation of Clavispora lusitaniae clinical isolates by polymerase chain reaction-single strand conformation polymorphism analysis of the ITSI region: a retrospective study comparing five typing methods.

Strain delineation of the emerging opportunistic pathogen Clavispora lusitaniae was studied using 12 strains, including two strains of known opposite mating type, CBS 6936 (h+) and CBS 5094 (h-), and 10 strains isolated between 1998 and 2001 from immunocompromized patients. This retrospective study assessed the occurrence of C. lusitaniae subtypes within and among hospitals, and in outpatients who were regularly screened for fungal infections in the course of radio-chemotherapy. Strain typing was accomplished for the first time using single strand conformation polymorphism (SSCP) analysis of amplicons of the ribosomal DNA internal transcribed spacer (ITS) 1 and 2 regions. The results were compared with those produced by three pulsed-field gel electrophoresis (PFGE) methods and PCR fingerprinting with the minisatellite-specific primer M13. Karyotyping separated 7-9 chromosomes, not 6-8 as previously reported. Pulsotyping of SfiI and NotI digested chromosomes grouped isolates in five and four distinct clusters, respectively. All methods revealed strain heterogeneity, though not as extensive as previously recorded. SSCP analysis of the ITS1 region generated five subtypes, based on a sequencing-confirmed nucleotide polymorphism. The discriminatory power of this method was high. All strains displayed a homogeneous SSCP pattern for the ITS2 region. ITS1 PCR-SSCP appears to allow rapid and reliable delineation of C. lusitaniae strains. Pending examination of a larger sample size and interlaboratory study, this protocol can be recommended for rapid prospective identification of hospital outbreaks.