Kidney Transplantation After Hematopoietic Cell Transplantation in Plasma Cell Dyscrasias: Case Reports.

The plasma cell dyscrasias (PCDs) include a number of entities such as multiple myeloma, primary amyloidosis, and monoclonal immunoglobulin deposition disease. Hematopoietic cell transplant (HCT) is the only cure for a variety of hematologic and oncologic diseases. Clinically significant renal impairment is a common feature in plasma cell myeloma, affecting 20% to 55% of patients at initial diagnosis; 2% to 3% of patients present with failure sufficiently severe to require hemodialysis. This circumstance is associated with a high early mortality. The necessity for immunosuppression after HCT could complicate its management and may precipitate the development of complications. In some patients an effective alternative could be kidney transplant (KT); however, the presence of 2 transplants will require optimal adjustment of immunosuppression and management of complications. At present, there are few published cases of KT after HCT, and the experience of managing 2 transplants is limited. We would like to describe our experience with 4 patients who had a PCD and initially received HCT and received subsequent KT. In our experience the progress and outcome of KT after HCT were optimal. We would like to address that a higher incidence of cytopenia associated with the combination of immunosuppression (lenalidomide, tacrolimus, mycophenolate, etc.) and other drugs (ie, valganciclovir) should be considered together with an increased risk of opportunistic infections and PCD relapse.

Insomnio y calidad del sueño en médicos de atención primaria: una perspectiva de género / Insomnia and quality of sleep among primary care pshycians: A gender perspective

Objetivo. Se trata de explorar la prevalencia del insomnio y la calidad del sueño en una muestra de médicos de atención primaria desde una perspectiva de género. Sujetos y métodos. Se seleccionó una muestra representativa compuesta por 240 médicos de 70 centros de atención primaria de la Comunidad de Madrid. La tasa de respuesta fue del 71,6%. El cuestionarioincluía información sociodemográfica, síntomas de insomnio según los criterios del Manual diagnóstico y estadístico de los trastornos mentales (DSM-IV) y el índice de calidad del sueño de Pittsburgh (ICSP). Resultados. El 18,8% del total de a muestra cumplió los criterios diagnósticos de insomnio del DSM-IV, con una mayor frecuencia en las mujeres (23%) comparadascon los hombres (9,6%). El mismo patrón apareció en el despertar antes de lo deseado y en el malestar diurno. La relación entre género e insomnio se confirmó mediante análisis de regresión binaria, controlando las variables sociodemográficas. Además, los resultados indicaron que las mujeres obtuvieron puntuaciones significativamente mayores que las de los hombres en el índice ICSP y en sus componentes. Una puntuación global igual o mayor de 5 en el ICSP resulta un criterio válido desde el punto de vista clínico para discriminar entre buenos y malos durmientes. Mediante este criterio, puede considerarseque el 35,4% de los médicos encuestados era mal durmiente, y es significativamente mayor el porcentaje de mujeres que cumplía dicho criterio (el 40% frente al 25,3%). Conclusiones. Los datos indican una elevada prevalencia de las alteraciones del sueño en médicos de atención primaria, especialmente entre las mujeres

Aim. To assess insomnia and sleep quality in primary care physicians from a gender perspective. Subjects and methods. A representative sample of 240 physicians was drawn from 70 medical centers from the Madrid Autonomous region. The participation rate was 71.6%. The questionnaire included sociodemographic data, insomnia symptomatology using DSM-IVcriteria and the Pittsburgh Sleep Quality Index (PSQI). Results. 18.8% of the total sample met DSM-IV criteria for insomnia diagnosis, with higher frequency among women (23%) compared to men (9.6%). The same pattern appeared for early morning awakening and daytime impairment.Results of logistic regression analyses showed that, after controlling for sociodemographic variables, this relationship between gender and insomnia remained significant. Furthermore, the results indicate that women scored significantly higher than men on global sleep quality and on its components. A PSQI global score= or > 5 is an optimal cut-off score for distinguishing good sleepers from subjects with clinical sleep problems. Following this criteria, 35.4% of physicians had sleep problems, with a significant higher prevalence among women (40% vs. 25.3%).Conclusions. The data indicates that the prevalence of sleep disturbances is high among primary care physicians, especially among women

Relación entre variables sociodemográficas y clínicas y calidad de vida relacionada con la salud en pacientes con enfermedad inflamatoria intestinal / Relationship between socio-demographic and clinical variables, and health-related quality of life in patients with inflammatory bowel disease

Objetivo: el objetivo principal del presente trabajo consiste en evaluar la influencia de las variables sociodemográficas y clínicas en la calidad de vida relacionada con la salud de los pacientes con enfermedad inflamatoria intestinal. Pacientes y método: se trata de un estudio transversal. La calidad de vida relacionada con la salud se investigó utilizando el “Inflammatory Bowel Disease Questionnaire” (IBDQ). Un total de 120 pacientes, 60 con colitis ulcerosa y 60 con enfermedad deCrohn participaron en el estudio. Resultados: no se apreciaron diferencias significativas en la calidad de vida relacionada con la salud en las dimensiones delIBDQ en función de la enfermedad, sin embargo, tras el análisis multivariante, el sexo, el tipo de tratamiento, las manifestaciones extradigestivas, el número de recaídas anual, la satisfacción con la cirugía y la necesidad de apoyo psicológico aparecieron relacionadascon la calidad de vida relacionada con la salud.Conclusiones: la identificación de las variables de calidad de vida relacionada con la salud en pacientes con enfermedad inflamatoria intestinal parece vinculada básicamente a elementos externos al tipo de enfermedad. El conocimiento de tales elementos puede resultar muy útil para orientar y modificar factores específicosen futuras actuaciones

Objective: the principal aim of the present study is to evaluate the influence of socio-demographic and clinical variables on health-related quality of life (HRQL) in patients with inflammatory bowel disease. Patients and method: this was a cross-sectional study. health-related quality of life was measured with the Inflammatory ;;Bowel Disease Questionnaire (IBDQ). A total of 120 patients, 60 with ulcerative colitis and 60 with Crohn’s disease, participated in the study. Results: no significant differences were observed between ulcerative ;;colitis and Crohn’s disease patients in IBDQ dimensions. ;;However, a multivariate analysis revealed that sex, type of treatment, extraintestinal symptoms, number of relapses in previous year, satisfaction with surgery, and need for psychological support were related to HRQL. ;;Conclusions: the identification of these variables associated with HRQL in patients with inflammatory bowel disease shows them to be basically non-disease factors. Knowledge of such elements can turn out to be very useful in order to guide future research and modify specific factors in further interventions

Relationship between socio-demographic and clinical variables, and health-related quality of life in patients with inflammatory bowel disease.

OBJECTIVE: The principal aim of the present study is to evaluate the influence of socio-demographic and clinical variables on health-related quality of life (HRQL) in patients with inflammatory bowel disease. PATIENTS AND METHOD: This was a cross-sectional study. health-related quality of life was measured with the Inflammatory Bowel Disease Questionnaire (IBDQ). A total of 120 patients, 60 with ulcerative colitis and 60 with Crohn s disease, participated in the study. RESULTS: No significant differences were observed between ulcerative colitis and Crohn s disease patients in IBDQ dimensions. However, a multivariate analysis revealed that sex, type of treatment, extraintestinal symptoms, number of relapses in previous year, satisfaction with surgery, and need for psychological support were related to HRQL. CONCLUSIONS: The identification of these variables associated with HRQL in patients with inflammatory bowel disease shows them to be basically non-disease factors. Knowledge of such elements can turn out to be very useful in order to guide future research and modify specific factors in further interventions.