Antiepileptic drug prophylaxis in primary brain tumor patients: is current practice in agreement to the consensus?

The role of antiepileptic drugs (AED) prophylaxis in primary brain tumor (PBT) seizure-naïve patients remains unclear. Additionally, AED are associated with severe side effects, negative impact on cognition and drug interactions. Little is known about current practice regarding prophylactic AED use in PBT. We investigated its use in a tertiary care cancer center. We reviewed medical records of 260 patients registered in our center between 2008 and 2012, focusing on prophylactic AED use. A descriptive analysis was performed with SPSS IBM version 20.0. Median age was 44.5 years (11-83). Most patients had ECOG PS ≤1 (76.4 %). Among 141 seizure-naïve patients, 70.2 % received an AED as primary prophylaxis (PP). Most commonly used drugs as PP were phenytoin (85.9 %), carbamazepine (6.1 %) and phenobarbital (5.1 %). In only 14 patients (14.1 %) AEDs were eventually discontinued, in a median time of 5.9 months (1.1-76.8 m). AED were used as PP in 60 % of low-grade gliomas, 73.3 % of anaplastic gliomas and 93.9 % of glioblastoma patients. Twenty-seven patients (27.3 %) on PP presented seizures, generally associated with tumor progression. Of the 42 seizure-naïve patients not receiving AED prophylaxis, only two presented seizures, which occurred during or within the first week post-radiotherapy. In this cross-sectional study, prophylactic AED use in PBT was extremely high. Postoperatively, AED were discontinued in a minority of patients, mostly after a prolonged period. Current prophylactic AED use patterns in PBT are not in accordance with established guidelines.

Coping with fluid restriction and the quality of life in hemodialysis patients with very low or no daily urine output.

PURPOSE: Fluid restriction is crucial to prevent circulatory overload in maintenance hemodialysis (MHD) patients with very low urine volume, but fluid restriction may result in psychological distress. We studied MHD patients with urine volume ≤ 200 ml/day to investigate if their acceptance of fluid restriction was associated with their health-related quality of life (HRQOL). METHODS: Cross-sectional study of 271 Brazilian adult MHD patients enrolled in the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO). To assess the acceptance of fluid restriction, patients were asked about the extent of feeling bothered by living on this restriction. The KDQOL was used to determine HRQOL scores. Higher scores indicate better HRQOL with differences of >3.0 points considered clinically significant. RESULTS: 52.4% reported being "moderately to extremely" bothered by fluid restriction and had lower scores for all HRQOL scales than patients less bothered by fluid restriction. The largest covariate-adjusted differences in HRQOL were 19.5 for emotional role (p<0.001), 15.1 for emotional well-being (p<0.001), and 14.1 for vitality (p<0.001). Adjusted differences were larger for mental component (7.53 points, p<0.001) than for physical component (2.07, p = 0.075) summaries. CONCLUSIONS: These results indicate that MHD patients with a lower level of acceptance of fluid restriction have poorer HRQOL, particularly in mental domains of HRQOL. The high prevalence of poor acceptance of fluid restriction in the present study underscores the need for interventions to improve acceptance of fluid restriction and determine if such interventions improve HRQOL of MHD patients with very low urine volume.

Handgrip strength at baseline and mortality risk in a cohort of women and men on hemodialysis: a 4-year study.

OBJECTIVE: The objective of this study was to investigate the association between handgrip strength (HGS) and the risk of all-cause mortality in maintenance hemodialysis (MHD) patients and its relationship with nutritional status. This study also investigated whether the association between HGS and mortality is similar in female and male patients. DESIGN AND METHODS: This was a cohort study using data from the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO) with a median follow-up of 33.81 months. The study setting was satellite dialysis units in the city of Salvador, Brazil.The sample included 443 adult patients in MHD. The main predictor variable was baseline HGS categorized into low and high groups on the basis of sex-specific optimized cutoffs, and the main outcome measure was all-cause mortality. RESULTS: In Cox regression models adjusted for age and other demographic variables, the hazard of death was significantly higher for patients with lower HGS for males (hazard ratio [HR] = 3.10, 95% confidence interval [CI] = 1.68-5.74) and for females (HR = 2.72, 95% CI = 1.03-7.19). The hazard of death for male and female patients with lower HGS was more than 2 times higher in models that included numerous covariates, with the exception of nutritional status indicators. After nutritional indicators were included, the hazard of death associated with lower HGS decreased by 6% in males and 55% in females. CONCLUSIONS: This study demonstrates that HGS predicts all-cause mortality in men and women on MHD. Differences seem to exist between women and men on MHD in the role played by nutritional status in explaining the increased risk of death associated with low HGS.