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1.
Am J Transplant ; 14(9): 1992-2000, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25307034

RESUMO

A consensus meeting was held in Vienna on September 8-9, 2013, to discuss diagnostic and therapeutic challenges surrounding development of diabetes mellitus after transplantation. The International Expert Panel comprised 24 transplant nephrologists, surgeons, diabetologists and clinical scientists, which met with the aim to review previous guidelines in light of emerging clinical data and research. Recommendations from the consensus discussions are provided in this article. Although the meeting was kidney-centric, reflecting the expertise present, these recommendations are likely to be relevant to other solid organ transplant recipients. Our recommendations include: terminology revision from new-onset diabetes after transplantation to posttransplantation diabetes mellitus (PTDM), exclusion of transient posttransplant hyperglycemia from PTDM diagnosis, expansion of screening strategies (incorporating postprandial glucose and HbA1c) and opinion-based guidance regarding pharmacological therapy in light of recent clinical evidence. Future research in the field was discussed with the aim of establishing collaborative working groups to address unresolved questions. These recommendations are opinion-based and intended to serve as a template for planned guidelines update, based on systematic and graded literature review, on the diagnosis and management of PTDM.


Assuntos
Consenso , Diabetes Mellitus/etiologia , Transplante/efeitos adversos , Humanos
3.
Int J Obes (Lond) ; 37(4): 540-5, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23229738

RESUMO

OBJECTIVES: Early identification of pre-diabetes and insulin resistance (IR) provides an important window of opportunity for diabetes prevention. Little is known about the prevalence of pre-diabetes and IR in Native American (NA) youth. We designed a cross-sectional, community-based study of NA children to estimate the prevalence of diabetes, pre-diabetes and IR and their association with other diabetes risk factors. STUDY DESIGN: NA children (5-18 years) were screened with body mass index (BMI), blood pressure, oral glucose tolerance test (OGTT), lipids, insulin and highly sensitive C-reactive protein (hsCRP), and calculated homeostatic model assessment of IR (HOMA-IR). RESULTS: Mean age of the cohort (n=201) was 10.8 ± 3.8 years (± s.d.; 94/107 M/F). BMI percentile for age and sex (BMI%) was elevated (≥ 85 th percentile) in 58.6% of 5-11 years and 51.1% of 12-18 years, and positively correlated with HOMA-IR, blood pressure, triglycerides and hsCRP (P<0.05). The prevalence rate for pre-diabetes and diabetes were 6.5% (3.5-10.8%) and 1.0% (0.1-3.6%), respectively. Mean HOMA-IR was greater in the older than younger age group while prevalence of pre-diabetes was the same. Those with pre-diabetes and diabetes had a greater HOMA-IR, abdominal circumference and BMI% than normal youth. CONCLUSION: In the first prospective, community-based screening for pre-diabetes, IR and diabetes in United States NA youth using OGTT, while the number of diabetes cases was low, pre-diabetes was found in a significant number of youth, particularly in those with BMI ≥ 95 th%. As proportions of pre-diabetes were similar in 5-11 and 12-18 year olds, diabetes risk begins early in NA youth.


Assuntos
Glicemia/metabolismo , Proteína C-Reativa/metabolismo , Diabetes Mellitus Tipo 2/sangue , Indígenas Norte-Americanos/estatística & dados numéricos , Resistência à Insulina , Insulina/sangue , Lipídeos/sangue , Estado Pré-Diabético/sangue , Adolescente , Índice de Massa Corporal , Criança , Pré-Escolar , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/prevenção & controle , Diagnóstico Precoce , Jejum/sangue , Feminino , Teste de Tolerância a Glucose , Homeostase , Humanos , Masculino , Programas de Rastreamento , Nebraska/epidemiologia , Prevalência , Estudos Prospectivos
5.
Lupus ; 20(1): 35-43, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21233148

RESUMO

This study examined the prevalence of cognitive impairment and its association with depressive symptoms and self-reported cognitive complaints in Danish outpatients with systemic lupus erythematosus (SLE). Fifty-seven consecutive female SLE-outpatients were examined with a comprehensive neuropsychological test-battery, a 20-item self-administered Perceived Deficits Questionnaire (PDQ) and a self-rated depression scale (Major Depression Inventory). Twenty-two patients (38.5%) were classified as cognitively impaired, mostly with deficits in executive functions and attention. Among cognitively impaired patients only 18.2% had significantly higher PDQ scores than the normal range. PDQ scores were highly correlated to depressive symptoms (r = 0.67, p < 0.001). Only two neuropsychological tests were significantly correlated with subjective cognitive complaints. When these variables and self-rated depression score were entered into a regression model both depression score and Symbol Digit Modalities Test performances were significantly associated with the PDQ score. In conclusion, cognitive impairments were common in this group of (mild) SLE outpatients, but the level of significant subjective cognitive complaints was low even among patients with cognitive impairment. Affective status may influence subjective experience of cognitive functions even more than cognitive functioning itself, and absence of subjective cognitive complaints did not exclude the presence of cognitive impairments.


Assuntos
Transtornos Cognitivos/fisiopatologia , Cognição/fisiologia , Lúpus Eritematoso Sistêmico/fisiopatologia , Pacientes Ambulatoriais , Adulto , Idoso , Transtornos Cognitivos/psicologia , Depressão/diagnóstico , Feminino , Humanos , Lúpus Eritematoso Sistêmico/psicologia , Pessoa de Meia-Idade , Exame Neurológico , Testes Neuropsicológicos , Inquéritos e Questionários , Adulto Jovem
6.
J Fish Dis ; 29(5): 285-91, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16677318

RESUMO

The spread of the emerging pathogen Vibrio vulnificus biotype 2 serovar A in Danish anguilliculture is reported. Serovar A was originally isolated in a Spanish eel farm in 2000 and occurred in Denmark in the summer of 2004, affecting eels of 5-10 g body weight cultured in fresh water. The Danish eels showed clinical signs different from those reported for Spanish eels, such as severe haemorrhages in the head and gill region with necrosis of the soft tissues. Danish isolates were biochemically and serologically identical to Spanish serovar A strains and also highly virulent for eels by both intraperitoneal injection and immersion challenges. Vaccination with Vulnivaccine, a vaccine against V. vulnificus serovar E, cross-protected eels against serovar A. The LD(50) for experimentally infected vaccinated animals was significantly higher than for non-vaccinated animals.


Assuntos
Doenças Transmissíveis Emergentes/veterinária , Enguias/microbiologia , Doenças dos Peixes/microbiologia , Pesqueiros , Vibrioses/veterinária , Vibrio vulnificus/patogenicidade , Animais , Vacinas Bacterianas/imunologia , Vacinas Bacterianas/normas , Doenças Transmissíveis Emergentes/microbiologia , Doenças Transmissíveis Emergentes/prevenção & controle , Dinamarca/epidemiologia , Surtos de Doenças/veterinária , Doenças dos Peixes/epidemiologia , Doenças dos Peixes/prevenção & controle , Testes de Sensibilidade Microbiana , Sorotipagem/veterinária , Vacinação/normas , Vacinação/veterinária , Vibrio/patogenicidade , Vibrioses/epidemiologia , Vibrioses/prevenção & controle , Vibrio vulnificus/imunologia , Vibrio vulnificus/isolamento & purificação , Virulência
7.
J Appl Microbiol ; 95(4): 693-703, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12969281

RESUMO

AIM: The aim of the present study was to clarify the taxonomic status of Vibrio strains isolated from an aquaculture system and to compare the results of the identifications made by phenotypic and molecular methods. METHODS AND RESULTS: Fifty-one Vibrio strains isolated from a turbot (Scophthalmus maximus) aquaculture system were characterized by ribotyping and 16S rRNA gene sequencing. The strains had been identified phenotypically in a previous numerical taxonomy analysis as Vibrio anguillarum, V. mediterranei, V. splendidus, V. aestuarianus, V. ordalii, V. fischeri and V. scophthalmi. Cluster analysis of ribotype patterns showed that the strains were separated into two main groups: V. splendidus-V. lentus and V. scophthalmi groups. The use of 16S rRNA gene sequence allowed differentiation among V. splendidus biovar I and V. lentus strains. CONCLUSIONS: The molecular methods identified strains of V. splendidus biovar I, V. lentus and V. scophthalmi, showing discrepancies with phenotypic characterization. SIGNIFICANCE AND IMPACT OF THE STUDY: The molecular methods, as 16S rRNA gene sequence analysis, are necessary for the identification of phenotypically close species to avoid mis-identifications. Interestingly, this is the first report of V. lentus strains associated to turbot culture.


Assuntos
Linguados/microbiologia , Vibrio/classificação , Animais , Sequência de Bases , Meios de Cultura , DNA Bacteriano/análise , Fenótipo , RNA Bacteriano/análise , RNA Ribossômico 16S/análise , Ribotipagem/métodos , Análise de Sequência de RNA/métodos , Vibrio/genética , Vibrio/isolamento & purificação
9.
Biochem Soc Trans ; 31(Pt 4): 763-7, 2003 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12887299

RESUMO

Mannan-binding lectin (MBL) is a plasma protein involved in the innate immune response. It binds to a number of micro-organisms and promotes killing of these through complement activation either directly or through opsonization. Clinical evidence indicates that in a variety of situations genetically determined low MBL levels are associated with increased susceptibility to infections. Infusions of plasma-derived MBL into MBL-deficient individuals was found to be safe in preliminary trials, but we considered that sufficient production and product safety could only be achieved through synthesis of recombinant MBL. A transfected human cell line produces MBL showing the same biological activity as plasma-derived MBL, and an essentially identical profile on MS. The production has been scaled up and clinical trials will start this year.


Assuntos
Lectina de Ligação a Manose/imunologia , Lectina de Ligação a Manose/uso terapêutico , Proteínas Recombinantes/imunologia , Proteínas Recombinantes/uso terapêutico , Animais , Linhagem Celular , Temperatura Baixa , Ativação do Complemento/efeitos dos fármacos , Ativação do Complemento/imunologia , Complemento C4/imunologia , Complemento C4/metabolismo , Estabilidade de Medicamentos , Humanos , Lectina de Ligação a Manose/química , Lectina de Ligação a Manose/genética , Proteínas Recombinantes/química , Proteínas Recombinantes/genética , Valores de Referência , Serina Endopeptidases/química , Serina Endopeptidases/metabolismo , Fatores de Tempo
10.
Appl Environ Microbiol ; 67(12): 5675-82, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11722922

RESUMO

A collection of 313 motile aeromonads isolated at Danish rainbow trout farms was analyzed to identify some of the genes involved in high levels of antimicrobial resistance found in a previous field trial (A. S. Schmidt, M. S. Bruun, I. Dalsgaard, K. Pedersen, and J. L. Larsen, Appl. Environ. Microbiol. 66:4908-4915, 2000), the predominant resistance phenotype (37%) being a combined oxytetracycline (OTC) and sulphadiazine/trimethoprim resistance. Combined sulphonamide/trimethoprim resistance (135 isolates) appeared closely related to the presence of a class 1 integron (141 strains). Among the isolates containing integrons, four different combinations of integrated resistance gene cassettes occurred, in all cases including a dihydrofolate reductase gene and a downstream aminoglycoside resistance insert (87 isolates) and occasionally an additional chloramphenicol resistance gene cassette (31 isolates). In addition, 23 isolates had "empty" integrons without inserted gene cassettes. As far as OTC resistance was concerned, only 66 (30%) out of 216 resistant aeromonads could be assigned to resistance determinant class A (19 isolates), D (n = 6), or E (n = 39); three isolates contained two tetracycline resistance determinants (AD, AE, and DE). Forty OTC-resistant isolates containing large plasmids were selected as donors in a conjugation assay, 27 of which also contained a class 1 integron. Out of 17 successful R-plasmid transfers to Escherichia coli recipients, the respective integrons were cotransferred along with the tetracycline resistance determinants in 15 matings. Transconjugants were predominantly tetA positive (10 of 17) and contained class 1 integrons with two or more inserted antibiotic resistance genes. While there appeared to be a positive correlation between conjugative R-plasmids and tetA among the OTC-resistant aeromonads, tetE and the unclassified OTC resistance genes as well as class 1 integrons were equally distributed among isolates with and without plasmids. These findings indicate the implication of other mechanisms of gene transfer besides plasmid transfer in the dissemination of antibiotic resistance among environmental motile aeromonads.


Assuntos
Aeromonas/efeitos dos fármacos , Conjugação Genética , Integrases/genética , Oncorhynchus mykiss/microbiologia , Resistência a Tetraciclina/genética , Microbiologia da Água , Aeromonas/isolamento & purificação , Aeromonas/fisiologia , Animais , Antibacterianos/farmacologia , Aquicultura , Combinação de Medicamentos , Farmacorresistência Bacteriana/genética , Incidência , Oxitetraciclina/farmacologia , Plasmídeos , Sulfadiazina/farmacologia , Trimetoprima/farmacologia
11.
J Pediatr Endocrinol Metab ; 14(8): 1163-7, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11592577

RESUMO

BACKGROUND: Idiopathic hypothalamic dysfunction is a rare syndrome that has been described in young children. This syndrome is characterized by a disturbance of thirst regulation with hypernatremia, hyperosmolarity, and altered hypothalamic function. PATIENT REPORT: At age 6 years the reported patients presented with precocious puberty, by age 12 years she had hypernatremia presumed secondary to central diabetes insipidus and was treated with DDAVP, and at age 14 was identified to have hyperprolactinemia. At age 19 she presented with serum sodium of 185 mg/dl during an episode of illness associated with dehydration. After hydration, her sodium remained elevated. Arginine vasopressin was measurable but inappropriate to serum sodium, while urinary cyclic AMP response to vasopressin was appropriate. CONCLUSIONS: This is the first case of precocious puberty identified in association with the more classic features of idiopathic hypothalamic dysfunction, including later-onset hypernatremia, poor thermoregulatory function, obesity, and hyperprolactinemia.


Assuntos
Hipernatremia/complicações , Doenças Hipotalâmicas/complicações , Doenças Hipotalâmicas/diagnóstico , Puberdade Precoce/complicações , Arginina Vasopressina/sangue , Criança , AMP Cíclico/urina , Desamino Arginina Vasopressina/uso terapêutico , Ingestão de Líquidos , Feminino , Homeostase , Humanos , Hiperglicemia/complicações , Hipernatremia/tratamento farmacológico , Hipertensão/complicações , Hipertrigliceridemia/complicações , Obesidade/complicações , Puberdade Precoce/diagnóstico , Puberdade Precoce/tratamento farmacológico , Sódio/sangue , Síndrome , Sede , Vasopressinas
12.
Dis Aquat Organ ; 46(1): 23-9, 2001 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-11592699

RESUMO

The significance of Aeromonas hydrophila in association with disease outbreaks in aquaculture production in the Zhejiang province of China was investigated. Bacteriological examination of moribund fish and crabs resulted in 95 bacterial isolates: 88 bacterial isolates from fish and 7 isolates from crabs. PCR and traditional biochemical methods were used for identification of A. hydrophila. Out of 69 motile aeromonads, 35 isolates were identified as A. hydrophila by biochemical tests. However, 6 of those were not identified as A. hydrophila by a species specific PCR method. Serotyping revealed 2 dominant serotypes (O9 and O97) among A. hydrophila isolates. The data presented show that approximately 42% of the motile aeromonads isolated from disease outbreaks among various fish species were A. hydrophila. It is noteworthy that A. hydrophila accounted for more than 50% of the isolated aeromonands isolated from crucian carp Carassius carassius and Wuchang bream Megalobrama amblycephala with haemorrhagic septicaemia. Although this species was the most frequently isolated organism from internal organs of diseased fish and crabs in the present study, other motile Aeromonas spp. were also found. The PCR assay was useful in preventing misidentification of A. hydrophila, which may occur when only phenotypic tests are employed.


Assuntos
Aeromonas hydrophila/classificação , Aquicultura , Braquiúros/microbiologia , Surtos de Doenças/veterinária , Doenças dos Peixes/epidemiologia , Infecções por Bactérias Gram-Negativas/veterinária , Aeromonas hydrophila/isolamento & purificação , Animais , China/epidemiologia , Doenças dos Peixes/microbiologia , Peixes , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Movimento , Reação em Cadeia da Polimerase/veterinária , Sorotipagem/veterinária , Frutos do Mar/microbiologia
13.
Dis Aquat Organ ; 45(3): 183-9, 2001 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-11558727

RESUMO

The field results of a vaccination programme against Vibrio vulnificus serovar E (biotype 2) in a Spanish eel farm are reported. A total of 9.5 million glass eels were vaccinated from January 1998 to March 2000 by prolonged immersion followed by 2 subsequent reimmunisations after 12 to 14 and 24 to 28 d, respectively. The acquired protection and the immune response against serovar E were estimated over a period of 6 mo after vaccination. A similar vaccination schedule was conducted with elvers in a Danish eel farm. In this case, the acquired protection and the immune response against serovar E and the new eel-pathogenic serovars, recently described in Denmark, were evaluated over a short term. The overall results show that the vaccine against V. vulnificus serovar E induces a satisfactory protective immunity during the main growth period of eels (around 6 mo) with a relative percentage survival of 62 to 86% and protects them against the new eel-pathogenic serovars. Vaccination of eels by immersion seems to be the best strategy to prevent diseases caused by V. vulnificus.


Assuntos
Vacinas Bacterianas , Enguias , Doenças dos Peixes/prevenção & controle , Vibrioses/veterinária , Vibrio/imunologia , Animais , Anticorpos Antibacterianos/análise , Vacinas Bacterianas/imunologia , Peso Corporal , Fatores de Tempo , Vacinação/veterinária , Vibrioses/prevenção & controle
14.
Fish Shellfish Immunol ; 11(5): 415-31, 2001 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-11478517

RESUMO

The sensitivity of Vibrio anguillarum serogroup O2a to killing by rainbow trout macrophages in the presence or absence of specific antibodies and complement components was evaluated using an in vitro assay. Fluorescence microscopy revealed that V. anguillarum serogroup O2a was phagocytosed by rainbow trout macrophages. In the absence of specific antibodies and complement components the bacteria were killed to a limited extent by the macrophages and there was no increased killing if the bacteria were opsonised with either antibodies or antibodies and complement. Furthermore, activated macrophages did not show enhanced ability to kill the bacteria. Vibrio anguillarum serogroup O2a were susceptible to both cell-free superoxide anion (O2-) and hydrogen peroxide (H2O2), which might be generated during the macrophage respiratory burst and the bacteria did not quench cell-free O2-. However, the production of O2- by macrophages was undetectable during the first 30 min following infection and no respiratory burst was inducible by phorbol myristate acetate (PMA) 4 h after infection with V. anguillarum. This suggests that the bacteria were able to inhibit the production of O2- by the infected macrophages. Naive fish were protected when passively immunised with anti-V. anguillarum serogroup O2a antiserum. However, previous results suggest that antibodies are unlikely to provide the fish with protective immunity directly through activation of the complement system and lysis of the bacterial cells. The present in vitro findings suggest that the protective mechanisms of antibody against V. anguillarum serogroup O2a may not involve the opsonising effect of antibodies for enhanced killing by macrophages. However, the possibility exists that such antibodies may prevent the attachment of the pathogen to the host's tissues.


Assuntos
Macrófagos/imunologia , Oncorhynchus mykiss/imunologia , Vibrio/imunologia , Animais , Anticorpos Antibacterianos/imunologia , Células Cultivadas , Ativação do Complemento , Proteínas do Sistema Complemento/imunologia , Microscopia de Fluorescência/veterinária , Antígenos O , Oncorhynchus mykiss/microbiologia , Proteínas Opsonizantes , Fagocitose , Espécies Reativas de Oxigênio , Explosão Respiratória
15.
J Appl Microbiol ; 91(2): 322-7, 2001 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11473597

RESUMO

AIMS: To compare two selective agars, cellobiose-colistin (CC) agar and a modification of the Vibrio vulnificus medium (VVMc agar), for the isolation of Vibrio vulnificus from environmental samples. METHODS AND RESULTS: The efficiencies of recovery of V. vulnificus collection strains on CC, VVM, VVMc and on thiosulphate-citrate-bile salts-sucrose (TCBS) agar were compared and similar efficiencies were obtained. A slightly higher recovery was observed on VVMc agar. The detection of V. vulnificus in environmental samples (eels and water) was performed by combining culture-based methods (CC and VVMc agars) with DNA-based methods using species-specific probes based on the cytolysin-haemolysin and the 16S rDNA genes. A lower accompanying microbiota was found on CC agar than on VVMc agar. CONCLUSION: The comparison between CC and VVMc agars confirms that both are useful for the detection of V. vulnificus in environmental samples. However, the use of any of these media should be combined with a species-specific probe. SIGNIFICANCE AND IMPACT OF THE STUDY: The combined use of a selective medium and a specific probe provides a feasible method for the detection of V. vulnificus for epidemiological and ecological studies.


Assuntos
Técnicas de Cultura de Células/métodos , Vibrio/crescimento & desenvolvimento , Vibrio/isolamento & purificação , Contagem de Colônia Microbiana , Meios de Cultura , Sondas de DNA , DNA Bacteriano/genética , DNA Ribossômico/genética , Meio Ambiente , Genes de RNAr/genética , Vibrio/classificação , Vibrio/genética
16.
J Antimicrob Chemother ; 47(6): 735-43, 2001 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-11389105

RESUMO

Class 1 integrons were found in 26 of 40 antibiotic-resistant isolates of the fish pathogen Aeromonas salmonicida from Northern Europe and North America. Three different dhfr genes, conferring trimethoprim resistance, and one ant(3")1a aminoglycoside resistance gene were identified as gene inserts. The gene cassettes tended to be conserved among isolates from a particular geographical area. Nineteen isolates transferred R-plasmids carrying different tet determinants to Escherichia coli in filter mating assays, and in 15 cases, the class 1 integrons were co-transferred. Transferable sulphadiazine, trimethoprim and streptomycin resistances were invariably encoded by integrons. It thus appears that integron-encoded antibiotic resistance genes contribute substantially to the horizontal spread of antimicrobial resistance within this species, being associated with conjugative plasmids.


Assuntos
Aeromonas/genética , Resistência a Múltiplos Medicamentos/genética , Plasmídeos/genética , Aeromonas/efeitos dos fármacos , Antibacterianos/farmacologia , Elementos de DNA Transponíveis/genética , Resistência Microbiana a Medicamentos/genética , Testes de Sensibilidade Microbiana , Estreptomicina/farmacologia , Resistência a Trimetoprima/genética
18.
Spine (Phila Pa 1976) ; 26(12): 1356-63, 2001 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-11426152

RESUMO

STUDY DESIGN: Quantitative and qualitative cross-sectional interview study. OBJECTIVES: To investigate how patients who are referred for plain radiography because of low back pain perceive the importance and usefulness of the examination. SUMMARY OF BACKGROUND DATA: Up to 50% of plain radiography examinations for low back pain may be unnecessary based on clinical criteria. However, many patients have great confidence in these examinations. A further exploration of the patients' views may indicate how their needs can be met without unnecessary use of radiography. METHODS: Ninety-nine patients (65 women, 34 men) 14-91 years of age who were referred from Norwegian general practitioners for plain radiography of the lumbosacral spine were asked to rate the examination as slightly/fairly or very important (93 responded). Chi-squared tests were used to evaluate differences in rating according to age, gender, clinical history, and clinical appropriateness of the examination, as determined by comparing information in the referral form with Norwegian (NR) and British (BR) recommendations for use of radiography. Each of the 99 patients also underwent a semistructured interview that was based on questions about importance, usefulness, and reasons for the radiography referral. Answers were categorized and described using a qualitative method (template analysis). RESULTS: Seventy-two percent (68 of 93) of patients rated radiography as very important. The proportion was higher for men than women (85% vs. 65%, P = 0.04), higher for those with worsening than those with improving/unchanged symptoms (86% vs. 65%, P = 0.03), and higher for inappropriately than appropriately referred patients (NR: 76% vs. 61%, P = 0.17; BR: 81% vs. 56%, P = 0.01). The qualitative analysis showed that the patients related their views on the importance and usefulness of receiving radiography to seven different issues: symptoms and clinical history, information and advice (especially from health care providers), need for emotional support from the physician, need for certainty and reassurance, need for symptom explanation and diagnosis, reliability of radiography compared with clinical evaluation, and expected practical consequences of the radiologic examination. CONCLUSIONS: The finding that inappropriately referred patients tended to rate their radiography referral as more important than appropriately referred patients indicates that the patient's view may be a substantial barrier to appropriate use of radiography. The study identified seven issues underlying the patients' views on importance and usefulness of receiving radiography. Strategies to prevent unnecessary use of plain radiography for low back pain that address these issues are suggested.


Assuntos
Dor Lombar/diagnóstico por imagem , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Radiografia/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Encaminhamento e Consulta
19.
Transplantation ; 71(7): 892-5, 2001 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-11349722

RESUMO

BACKGROUND: Lipoatrophic diabetes is an insulin resistance syndrome characterized by the complete or partial lack of adipose tissue and disturbances in lipid and glucose metabolism. Nonalcoholic steatohepatitis (NASH) is a well-described change in liver pathology consisting of steatosis, hepatitis, and fibrosis that can be associated with lipoatrophic diabetes. RESULTS: This article describes the first reported case of lipoatrophic diabetes with NASH leading to liver failure and liver transplantation. Before transplantation, the patient required 600-700 U of insulin/day. After transplantation, a dramatic decline in her insulin requirements was observed, despite corticosteroids. Eighteen months after transplantation, her glycemic control worsened, and she developed recurrent NASH on serial liver biopsies. CONCLUSIONS: NASH associated with lipoatrophic diabetes can recur after liver transplantation, and in this case, was accompanied by increased insulin requirements. These results suggest that the development of NASH itself may contribute to the insulin resistance observed in lipoatrophic diabetes.


Assuntos
Diabetes Mellitus Lipoatrófica/etiologia , Fígado Gorduroso/complicações , Hepatite/complicações , Falência Hepática/etiologia , Falência Hepática/cirurgia , Transplante de Fígado , Adulto , Diabetes Mellitus Lipoatrófica/fisiopatologia , Feminino , Humanos , Resistência à Insulina , Fígado/patologia , Cirrose Hepática/etiologia , Cirrose Hepática/patologia , Recidiva
20.
Clin Transplant ; 15(1): 28-31, 2001 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11168312

RESUMO

BACKGROUND: The selection of patients for solitary pancreas transplantation (PTA) requires identification of individuals who will not develop acute renal dysfunction in response to immunosuppressants. A cyclosporine challenge test (CCT) was developed to predict post-PTA kidney dysfunction secondary to calcineurin inhibitor immunosuppressants. We now report on the long-term follow-up of patients who received a PTA after undergoing a CCT. METHODS: Twelve potential PTA recipients were administered cyclosporine A (CsA) for 6 wk. Creatinine clearance (CrCl) was measured at 2, 4, and 6 wk. Those who did not fail the CCT received PTA. Baseline and post-transplant CrCl were retrospectively evaluated in the original cohort and in a group of matched patients who received PTA without a CCT. RESULTS: Of the original 12 recipients evaluated with the CCT, 6 received PTA. CrCl was followed for a mean of 45.8 months. Of the 4 who remained alive, 2 went on to develop renal failure (CrCl < 30 mL/min) at 18 and 65 months post-transplant. The baseline CrCl was higher in PTA recipients who had not been selected to be studied with CCT than those that were (117 +/- 32 vs 78 +/- 13 mL/min). By 12 months post-PTA, the CrCl was no longer different between the groups selected to be screened with CCT and those that were not. CONCLUSIONS: CCT may help predict risk for short-term changes in renal function (< 18 months) in response to CsA. CCT may be most helpful in candidates for PTA with borderline renal insufficiency (60-80 mL/min).


Assuntos
Ciclosporina/efeitos adversos , Imunossupressores/efeitos adversos , Transplante de Pâncreas , Insuficiência Renal/induzido quimicamente , Adulto , Creatinina/metabolismo , Diabetes Mellitus Tipo 1/complicações , Feminino , Humanos , Masculino , Complicações Pós-Operatórias , Valor Preditivo dos Testes
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