Knowledge, Attitude, and Perception About Renal Transplantation of CKD Patients, Caregivers, and General Population.

INTRODUCTION: In this study knowledge about kidney disease and the option of transplantation was assessed in chronic kidney disease (CKD) patients and their care givers. PATIENTS AND METHODS: A knowledge, attitude, and perception (KAP) questionnaire comprising 33 items was developed. It had 4 classes: knowledge of kidney disease (9 items), transplantation (10 items), attitude (6 items), and perception (8 items). There were 3 possible answering options (yes/no/don't know) indicating "agree/disagree/no idea" or "optimal understanding/some understanding/no idea," allocating a score of 4/2/0, respectively. A higher score indicated good KAP. CKD patients, accompanying caregivers, and healthy controls from the general population were included. RESULTS: In 218 subjects, 108 were CKD patients (78 pre-end-stage renal disease and 30 maintenance hemodialysis), 40 were caregivers, and 70 were controls. The majority had a primary level of education (52%) and earned low to middle income (67%). Only 34% claimed to have adequate knowledge; information sources were doctors (61%) and relatives (21%); 63% agreed to involve in transplant program; 58% had no knowledge about types of kidney donors; and 71% believed in no religious restrictions to transplantation. The average KAP score for all in total 25 scoring items (59 ± 23) and separately in knowledge of kidney disease (75 ± 34), transplantation (48 ± 28), attitude (64 ± 28), and perception (51 ± 28) showed a generally low score especially in the field of transplantation. Education level (school vs. higher: 50 ± 23 vs. 70 ± 19, P < .001), income (low-middle vs. higher: 52 ± 23 vs. 72 ± 17, P < .001) and location (rural vs. urban: 53 ± 19 vs.74 ± 19, P < .001) conferred higher KAP scores. CONCLUSION: Knowledge, attitude, and perception towards renal transplantation is positively influenced by a person's educational level and economic status.

A comparison of GFR by modified gates method with measured creatinine clearance rate (CCR) & MDRD formula based estimation in type 2 diabetic subjects with nephropathy.

Accurate estimation of the glomerular filtration rate (GFR) is essential for the evaluation of patient with chronic kidney disease (CKD). The present study was a comparison between modified gates GFR with laboratory measured CCR & MDRD formula based estimated GFR method. Pre-diagnosed 180 diabetic nephropathy patients were selected. All the time of evaluation the blood glucose of the patients were controlled and serum creatinine was stable. Then CCR was done and GFR was estimated by Modified Gates method & MDRD method. All the patients were categorized in 5 stages of CKD. They were matched for age, BMI, blood pressure, duration of diabetes, the blood sugar and HbA1C levels. The Gates GFR in stage-2 (70±13) & stage-3 (48±12) was closer with MDRD in stage-2 (77±8) and stage 3 (43±7). The CCR is closer in stage-1 (110±52) & stage-4 (30±10) with MDRD in stage-1 (112±13) and stage-4 (21±4). Association study showed MDRD GFR had highest correlation with Gates GFR (r=0.86; p<0.05). The estimation of glomerular filtration rate (GFR) in different methods varied significantly between each other at different stages of chronic kidney disease (CKD) in type 2 diabetic nephropathy subjects.

Changes in cardiac parameters of renal allograft recipients: a compilation of clinical, laboratory, and echocardiographic observations.

INTRODUCTION: This study was undertaken to observe changes in cardiac parameters along with clinical and laboratory changes after renal transplantation. PATIENTS AND METHODS: Cardiac parameters were evaluated by M-mode 2-dimensional echocardiography before transplantation and at monthly intervals. All subjects had functioning grafts at the time of the evaluations. RESULTS: Fifty-two allograft recipients underwent pretransplant parameters for comparison to those at posttransplant months 1, 3, 6, and 12. When changes at month 1 and 3 were observed among 22 patients, improvements were evident at month 3. Comparisons of pretransplant versus month 3 showed systolic blood pressure (SBP), 161 +/- 16 to 133 +/- 26 mmHg (P < .002); diastolic BP (DBP), 101 +/- 9 to 86 +/- 11 mmHg, (P < .006); hemoglobin (Hgb), 7.3 +/- 1.6 to 11.2 +/- 3.9 g/dL (P < .006); left atrial diameter (LAD), 41 +/- 5 to 35 +/- 3 mm (P < .001); left ventricular muscle mass index (LVMI), 379 +/- 114 to 248 +/- 58 g/m2 (P < .001); and left ventricular end diastolic volume index (LVEDVI), 96 +/- 28 to 64 +/- 17 mL/m2 (P < .002). When changes at months 3, 6, and 12 were observed among 30 patients, improvements evident at month 3 were maintained. Comparisons of pretransplant and 3 and 12 months observations showed SBP, 157 +/- 17, 131 +/- 14, to 126 +/- 10 mm Hg (P < .001); DBP, 97 +/- 10, 83 +/- 16, to 85 +/- 6 mmHg (P < .001); Hgb, 7 +/- 1, 13 +/- 2, to 13 +/- 2 g/dL (P < .001); LAD, 39 +/- 7, 35 +/- 3, to 34 +/- 4 mm (P < .05); LVMI, 275 +/- 91, 191 +/- 38, to 159 +/- 26 g/m2 (P < .001); and LVEDVI, 87 +/- 29, 56 +/- 34, to 49 +/- 24 mL/m2 (P < .001). CONCLUSION: Significant improvements in cardiac parameters were evident by the third month post-renal transplantation; the changes were maintained over a longer period among patients with functional grafts.

Cardiac functional and morphologic changes of renal allograft recipients in the early posttransplant period.

UNLABELLED: After renal transplantation there is a substantial alteration in cardiac morphology and functions. This prospective study was undertaken to observe changes in different cardiac parameters in early months after transplantation. PATIENTS AND METHODS: Twenty-two allograft recipients (primary disease glomerulonephritis) were evaluated in the immediate pretransplant period (0 month) and 1 and 3 months after transplantation by clinical and echocardiographic (M mode, 2D) evaluations. RESULTS: Pretransplant echocardiogram showed left ventricular hypertrophy (LVH) in 100% subjects, LV dilation in 52%, and systolic dysfunction in 18%. By the third month, significant differences in systolic blood pressure (SBP-161 +/- 16 to 133 +/- 26 mm Hg, P < .002); diastolic BP (DBP-101 +/- 9 to 86 +/- 11 mm Hg, P < .006), and hemoglobin level (Hgb-7.3 +/- 1.6 to 11.2 +/- 3.9 g/dL, P < .006) were evident. Echocardiography showed decreased left atrial diameter (LADd-41 +/- 5 to 35 +/- 3 mm, P < .001); left ventricular internal diameter (LVIDd-54 +/- 6 to 47 +/- 6 mm, P < .02); left ventricular muscle mass index (LVMI-379 +/- 114 to 248 +/- 58 g/m(2), P < .001); and left ventricular end diastolic volume index (LVEDVI-96 +/- 28 to 64 +/- 17 ml/m2, P < .002). Bivariate correlations showed positive associations of mean blood pressure (MBP) and serum creatinine with LVMI, LVEDVI, and negative association of hemoglobin with MBP, serum creatinine, LVMI, and LVEDVI. CONCLUSION: From these observations, we concluded that cardiac morphological parameters start improving in the early posttransplant period. Improvements in renal function, anemia status, and lower blood pressure showed strong associations with these changes.

Association of HLA class I antigen matching and early graft outcome in living donor kidney transplantation.

INTRODUCTION: HLA antigen matching often plays an important role in organ transplantation. As for HLA class I antigen matching, there are differences of opinion regarding its influence on the outcome of renal transplantations. The aim of this study was to evaluate the association of HLA class I antigen matching with early graft outcomes in living donor kidney transplantation. PATIENTS AND METHODS: We evaluated graft outcomes in the first month of transplantation. Major events were slow graft function (serum creatinine > 250 micromol/L at the end of first week), delayed graft function (patients requiring dialysis in first week), and acute rejection episode. Graft outcomes were compared for normal renal function (NRF, serum creatinine < or = 175 micromol/L) impaired renal function (IRF, serum creatinine > 175 micromol/L) or impaired graft function due to an acute rejection episode (IGF). RESULTS: The 115 subjects had a mean age of 29 +/- 8 years and their donors 38 +/- 11 years (P < .01). Immunosuppression included prednisolone, azathioprine, and cyclosporine. Parents, siblings, and others were kidney donors in 46%, 33%, and 21%, respectively. Comparisons between NRF/IRF (serum creatinine 133 +/- 24 vs 201 +/- 36 micromol/L, P < .01) and NGF/IGF (serum creatinine 146 +/- 44 vs 161 +/- 39 micromol/L, P < .05) showed no difference in number or pattern of HLA matching. CONCLUSION: HLA class I antigen matching may not produce an added influence on early graft outcome among living donor kidney transplantations.

Fifteen-year follow-up of conversion disorder.

The terms 'conversion', 'hysteria' and 'conversion hysteria' were used interchangeably to describe a condition characterised by a single somatised symptom, often pseudo-neurological in nature. DSM-III (American Psychiatric Association, 1980) expanded the concept of conversion to generalised symptoms involving loss or alteration of physical functioning suggestive of a physical disorder, along with a clinical indication that the conversion was an expression of psychological conflict or need. The type of symptom or deficit should be specified as: with motor symptom or deficit, with sensory symptom or deficit, with seizure or convulsions, or with mixed presentation (Kaplan & Sadock, 2004).

The effects of lithium, valproic acid, and carbamazepine during pregnancy and lactation.

The chronic, complex, and episodic course of bipolar mood disorder presents a particularly formidable challenge to the clinician making a treatment plan for the onset or recurrence of the illness during pregnancy and lactation. Women treated with anti-manic drugs who become pregnant are commonly considered to be at high risk for fetal complications during the pregnancy or during lactation. The risks of antimanic drug use during pregnancy include teratogenic effects, direct neonatal toxicity, and the potential for longer-term neurobehavioral sequela. The use of medications during pregnancy and lactation requires critical attention to the timing of exposure, dosage, duration of use, and fetal susceptibility. The postnatal period is a time of increased onset and relapse of mental illness. No antimanic drug can be proven completely safe. Prescribing antimanic medications with a long safety record, avoiding exposure in the first trimester; avoiding multidrug regimens, and prescribing the lowest dose for the shortest duration will minimize the fetal risk. This review considers treatment with lithium, valproic acid, and carbamazepine. It assesses the risk to the fetus, the perinatal risks for the infant, the risks associated with treatment during the puerperium and breast-feeding, and the risks to the later development of the child.

Effects of antimanic mood-stabilizing drugs on fetuses, neonates, and nursing infants.

Pregnancy presents a special problem to the clinician treating bipolar disorders in women. Since the first episode of mania typically occurs before the age of 30, many women in their prime childbearing years may be exposed to potentially teratogenic mood-stabilizing agents. This exposure may also continue for the nursing infant during lactation. Pregnancy itself can exacerbate bipolar symptoms and also alter the pharmacokinetics of mood-stabilizing drugs. Risks to mother and fetus can be reduced with a number of simple strategies, including monotherapy with the lowest effective dose of a drug for the shortest period necessary, periconceptional use of multivitamins with folate, prescription of drugs with established safety records, and avoidance of exposure to antimanic agents during the first trimester of pregnancy. In this article, we review existing evidence on the risks to fetuses and nursing infants of mothers taking specific mood-stabilizing agents, and we present appropriate management guidelines designed to minimize these risks.

Assignment of Alteromonas elyakovii KMM 162T and five strains isolated from spot-wounded fronds of Laminaria japonica to Pseudoalteromonas elyakovii comb. nov. and the extended description of the species.

A marine bacterium, Alteromonas elyakovii KMM 162T, which was described recently, and five strains isolated from spot-wounded fronds of Laminaria japonica have been subjected to phylogenetic analysis, and geno- and phenotypic characterization. The phenotypic features of Pseudoalteromonas elyakovii strains were closely related to that of Pseudoalteromonas espejiana IAM 12640T, but utilization of three carbon compounds (D-mannose, L-tyrosine and trehalose) distinguished both species. The G+C content of Pseudoalteromonas elyakovii was between 38.5 and 38.9 mol%. Pseudoalteromonas elyakovii KMM 162T and the five Laminaria isolates constitute a single species different from any other Alteromonas and Pseudoalteromonas species as revealed by DNA-DNA hybridization data, especially Pseudoalteromonas distincta KMM 638T (52.4%), Pseudoalteromonas citrea KMM 216 (49.5%), Pseudoalteromonas carrageenovora NCIMB 302T (46.9%) and Pseudoalteromonas espejiana IAM 12640T (29.9%). All the data indicated that Alteromonas elyakovii KMM 162T should be reclassified as Pseudoalteromonas elyakovii and five strains isolated from Laminaria japonica have to be included in the species. Pseudoalteromonas elyakovii comb. nov. (type strain, KMM 162T = ATCC 700519T) is proposed and a set of phenotypic features which differentiate the Pseudoalteromonas species is described.

Osteoporosis: epidemiology, diagnosis, and treatment.

Osteoporosis is an important health problem in the United States affecting approximately 24 million Americans, 15 to 20 million of whom are women over 45 years of age. Bone fractures are the major cause of morbidity and mortality associated with osteoporosis. The most common fractures are those of the forearm, hip, and vertebral body, as well as the humerus, tibia, pelvis, and ribs. Osteoporosis-related injuries result in complications leading to prolonged hospitalization, decreased independence, increased incidence of depression, and a reduced quality of life. The disease takes an enormous personal and economic toll, with estimated costs in excess of $13.8 billion annually for direct medical treatment. The incidence of osteoporosis-related fractures is increasing and constitutes a major public health problem in the United States. With a few preventive measures such as identification of risk factors, careful examination, and a few simple diagnostic tests, prevention of osteoporosis during the teen and early adult years is far superior to any treatment for older individuals. Osteoporosis can be identified and an appropriate treatment strategy can be determined.

Effects of antidepressants during pregnancy and lactation.

Depression is one of the most common psychiatric disorders. A variety of different chemical structures have been found to have antidepressant activity. The number is constantly growing; however, as yet, no one group has been found to have a clear therapeutic advantage over the others. The major indication for antidepressant drugs is depression, but a number of side effects have been established by clinical experience and controlled trials. It is clear that, to some extent, any drug or chemical substance administered to the mother is able to cross the placenta unless it is destroyed or altered during metabolism. Placental transport of maternal substrates to the fetus and of substances from the fetus to the mother is established at about the fifth week of fetal life. Traditionally, teratogenic effects of antidepressants or other drugs have been noted as anatomic malformation. It is clear that these are dose- and time-related and that the fetus is at great risk during the first 3 months of gestation. However, it is possible for antidepressants to exert their effects on the fetus at other times during pregnancy as well as to infants during lactation. Administration of antidepressants to pregnant women presents a unique problem for the physician. Not only must maternal pharmacologic mechanisms be taken into consideration when prescribing an antidepressant drug, but the fetus must also be regarded as a potential recipient of the drug. Certain results are evident with regard to drugs administered during lactation. It is essential that physicians need to be aware of the results of animal studies in this area and of the potential risk of maternal drug ingestion to the suckling infant.

Can we get AIDS from mosquito bites?

Human immunodeficiency virus, or HIV, is a human retrovirus that infects lymphocytes and other cells bearing the CD4 surface marker. The virus is transmitted primarily by sexual and parental routes. There are two ways blood feeding arthropods can spread disease, mechanically, by simple transfer of virus between hosts by contaminated mouth parts, or, biologically, which would require virus replication in arthropod tissues (especially salivary glands). There are some important factors which have proven that AIDS is not transmitted by mosquito bite. These factors are: (1) AIDS virus can not replicate inside the mosquito, bed bug, flea, or other blood sucking insect and the lack of replication of HIV in arthropod cells due to lack of T4 antigen on cell surface, and (2) it is unlikely that HIV is transmitted by insects, given the low infectivity of HIV and the short survival of the virus in the mosquito. HIV appears to be much less easily transmitted probably due to lower titers of virus in body fluids. So, on the basis of experimental evidence and probability estimates, it has been concluded that the likelihood of mechanical or biological transmission of HIV by insects is virtually nonexistent.

Birth defects: prevention of neural tube defects by periconceptional use of folic acid and screening.

Folate deficiency is one of today's most common vitamin deficiencies in women. Women who consume a low level of folate during pregnancy are at risk for poor pregnancy outcomes including birth defects. Birth defects are the leading cause of fetal and infant deaths throughout the world. Neural tube defects comprise a major portion of the birth tube defects. Neural tube defects are common and serious malformations that originate early in pregnancy. Each year in the US, about 4000 babies are born with these two most common neural tube defects, spina bifida and anencephaly. Spina bifida is the leading cause of childhood paralysis. Several studies showed that about 70% of the neural tube defects could be prevented if all women capable of becoming pregnant consumed 0.4 mg of folic acid daily before and during early pregnancy. This paper reports results from various human and animal studies.

Salmonella speticemia resistant to 3rd generation cephalosporins in a child with sickle crisis.

Full text is available as a scanned copy of the original print version.

Pseudoalteromonas bacteriolytica sp. nov., a marine bacterium that is the causative agent of red spot disease of Laminaria japonica.

An aerobic, polarly flagellated marine bacterium that produces a prodigiosin-like pigment was isolated from the red-spotted culture beds of Laminaria japonica. Five isolates had unique bacteriolytic activity for both Gram-positive and -negative bacteria, which had never been observed among Alteromonas or related species. The isolates were identified as the causative agent of red spot disease of L. japonica seeds. The phenotypic features of the isolates were similar to these of Pseudoalteromonas rubra ATCC 29570T, but they could be differentiated using 10 traits (growth at 37 degrees C, requirement for organic growth factors, bacteriolytic activity, utilization of sucrose, N-acetylglucosamine, fumarate, succinate, D-galactose, L-proline and acetate). The G+C content of DNAs from the isolates was 44-46 mol%. The isolates constitute a new species, distinct from the other Alteromonas and Pseudoalteromonas species, as shown by DNA-DNA hybridization experiments and phylogenetic clustering of 16S rRNA gene sequences, for which the name Pseudoalteromonas bacteriolytica sp. nov. (type strain = IAM 14595T) is proposed. A set of phenotypic features which differentiate this new species from closely related Pseudoalteromonas and Alteromonas species is provided.