Reading Difficulties in Individuals with Homonymous Visual Field Defects: A Systematic Review of Reported Interventions.

Reading difficulties are amongst the most commonly reported problems in individuals with homonymous visual field defects (HVFDs). To be able to provide guidance for healthcare professionals considering offering reading training, researchers in this field and interested individuals with HVFDs, this systematic review aims to (1) provide an overview of the contextual and intervention characteristics of all published HVFD interventions and (2) generate insights into the different reading outcome measures that these studies adopted. A search on PsycINFO, MEDLINE and Web of Science was conducted up to February 2, 2023. All intervention studies for HVFD in which reading was measured were included. Data was collected about the intervention type, session duration, number of sessions, the intensity, duration, circumstance of the interventions, country in which the intervention was studied and reading measures. Sixty records are included, describing 70 interventions in total of which 21 are specifically reading interventions. Overall, adjusted saccadic behaviour interventions occur most in the literature. A wide range within all intervention characteristics was observed. Forty-nine records reported task-performance reading measures, and 33 records reported self-reported reading measures. The majority of task-performance measures are based on self-developed paragraph reading tasks with a time-based outcome measure (e.g. words per minute). Future research could benefit from making use of validated reading tests, approaching the measurement of reading mixed-methods and providing participants the possibility to supply outcomes relevant to them.

Financial dissatisfaction in people with psychotic disorders - A short report on its prevalence and correlates in a large naturalistic psychosis cohort.

Psychotic disorders have a strong negative impact on multiple aspects of daily life, including people's financial situation. This exploratory study examines the level of financial dissatisfaction and its correlates in a large cohort of people with psychotic disorders. Data from the first assessments of people with psychotic disorders (n = 5271) who were included in the Pharmacotherapy Monitoring and Outcome Survey (PHAMOUS; 2006-2020), which is conducted in the northern Netherlands, were used. The Manchester Short Assessment of Quality of Life (MANSA) was used to measure financial dissatisfaction. In addition, sociodemographic and psychiatric characteristics, substance use and global and social functioning were assessed. One-fifth to one-third of people with psychotic disorders report financial dissatisfaction, fluctuating over the year in which they were assessed. These proportions are considerably higher than in the general population. Cannabis and other substance use were associated with higher levels of financial dissatisfaction (small to medium effect). The other significant associations showed (very) small effect sizes. Therefore, we conclude that financial dissatisfaction in people with psychotic disorders appears to be relatively independent of other demographic and psychiatric characteristics, and global and social functioning. These findings are an important first step for increasing knowledge on financial dissatisfaction among people with psychotic disorders. The findings can also contribute to raising awareness about the topic for healthcare professionals working in this field.

Removal of APIs and bacteria from hospital wastewater by MBR plus O(3), O(3) + H(2)O(2), PAC or ClO(2).

The objective of this study has been to develop technologies that can reduce the content of active pharmaceutical ingredients (APIs) and bacteria from hospital wastewater. The results from the laboratory- and pilot-scale testings showed that efficient removal of the vast majority of APIs could be achieved by a membrane bioreactor (MBR) followed by ozone, ozone + hydrogen peroxide or powdered activated carbon (PAC). Chlorine dioxide (ClO(2)) was significantly less effective. MBR + PAC (450 mg/l) was the most efficient technology, while the most cost-efficient technology was MBR + ozone (156 mg O(3)/l applied over 20 min). With MBR an efficient removal of Escherichia coli and enterococci was measured, and no antibiotic resistant bacteria were detected in the effluent. With MBR + ozone and MBR + PAC also the measured effluent concentrations of APIs (e.g. ciprofloxacin, sulfamethoxazole and sulfamethizole) were below available predicted no-effect concentrations (PNEC) for the marine environment without dilution. Iodinated contrast media were also reduced significantly (80-99% for iohexol, iopromide and ioversol and 40-99% for amidotrizoateacid). A full-scale MBR treatment plant with ozone at a hospital with 900 beds is estimated to require an investment cost of €1.6 mill. and an operating cost of €1/m(3) of treated water.

Idiopathic focal segmental glomerulosclerosis: a favourable prognosis in untreated patients?

BACKGROUND: Patients with focal segmental glomerulosclerosis (FSGS) are considered to have a poor prognosis and spontaneous remissions are seldom reported. However, FSGS is not a single disease entity. Our aim was to describe the clinical course in initially untreated patients with recently diagnosed idiopathic FSGS. METHODS: This was a retrospective study of patients with a diagnosis of FSGS by histology, who fulfilled the following criteria: proteinuria >3.5 g/day, normal renal function, duration of proteinuria or hypertension of less than one year, normal-sized kidneys, no underlying renal disease, and a negative family history. Renal biopsies were reviewed without knowledge of the clinical course. RESULTS: Twenty patients (13 male, 7 female) fulfilled the study criteria. Median age was 49.3 (range 21.8 to 73.0) years, serum creatinine 90 +/- 20 micromol/l, proteinuria 10.0 +/- 5.5 g/day and serum albumin 24 +/- 6 g/l. After a median follow-up of 9.4 (2.1-18.6) years, 13 patients (65%) were in remission of proteinuria. Renal function deterioration occurred in seven patients, and prompted treatment in four of them. The ten-year death-censored renal survival was 89%. Renal function deterioration and remission rate could be predicted by selectivity index, serum albumin at three months after renal biopsy and the percentage of glomeruli with segmental sclerosis. CONCLUSION: Focal glomerulosclerosis is not a single disease. Case definition using strict clinical criteria identifies a subgroup of patients with idiopathic FSGS who have a good prognosis. In the majority of these patients immunosuppressive therapy is not warranted.

Fibrillary-immunotactoid glomerulopathy with renal deposits of IgAlambda: a rare cause of glomerulonephritis.

We describe a 24-year-old patient who presented with a nephrotic syndrome. His renal biopsy revealed a diffuse mesangioproliferative glomerulonephritis with eosinophilic deposits. Electron microscopy showed organized, Congo-red negative deposits, forming microtubules of about 20 nm width in the capillary walls and in the mesangium, establishing a diagnosis of fibrillary-immunotactoid glomerulopathy. Fibrillary-immunotactoid glomerulopathy is a rare cause of glomerulonephritis, characterized by Congo-red-negative glomerular deposits of fibrils, sometimes organized in microtubules, predominantly containing IgG and C3. Patients clinically present with the nephrotic syndrome, hematuria and hypertension. The pathogenesis of this glomerulopathy has not been elucidated yet. In our patient, the renal deposits contained IgAlambda. This peculiar feature is suggestive of an underlying paraproteinemia. However, in the serum no paraproteins or cryoglobulins were found, and also microscopical examination and immunophenotyping of the bone marrow did not point to the presence of a monoclonal plasma cell dyscrasia. Our patient was not treated with immunosuppressive drugs and he is currently progressing to end-stage renal disease.

Unaccountable severe hypercalcemia in a patient treated for hypoparathyroidism with dihydrotachysterol.

This report describes a forty-seven-year-old female patient with a complex medical history. She was suffering from an unspecified interstitial lung disease, papillary thyroid carcinoma which had been treated, hypoparathyroidism after thyroidectomy for which she was receiving dihydrotachysterol and calcium, and atrial fibrillation and congestive heart failure as a result of mitral stenosis. Shortly after mitral valve replacement she developed a severe hypercalcemia (serum calcium 5.95 mmol/l) during a febrile illness. At that time anti-tuberculous agents were also being administered for presumed tuberculosis. The possible mechanisms for this severe elevation of the calcium level are discussed. Immobilization, while Paget's bone disease was present, and perhaps enhanced activation of dihydrotachysterol by rifampicin, could have led to increased calcium-release into the circulation. Continuous supplecation of calcium and vitamin D, provoked dehydration and the mechanism of the milk-alkali syndrome also contributed to this extremely high calcium level. It is concluded that hypoparathyroid patients being treated with vitamin D and calcium should be carefully monitored in the case of an intercurrent illness or a change in medication.

A sporadic case of acute Hantavirus nephropathy in The Netherlands.

A 32-yr-old man presented with acute renal failure preceded by a viral-like disease with high fever, bilateral loin pain, nausea, headache and slight thrombocytopenia. Renal biopsy revealed only minor tubulointerstitial abnormalities. Renal function completely normalised within 10 days after hospitalisation. The diagnosis of acute Hantavirus nephropathy was proved by serological examinations.

Outcome and complications in patients treated with continuous ambulatory peritoneal dialysis (CAPD) at a single centre during 11 years.

OBJECTIVE: To evaluate outcome and complications in patients treated with CAPD at our centre a retrospective study was performed. METHODS: Relevant data from all 123 consecutive patients on the CAPD program from 1982 to 1994 were reviewed. RESULTS: Patient survival after 1, 2, 3 years was 89, 78, 69 and 50% respectively. The probability of having a functioning catheter after 1, 2, 3 and 5 years was 90, 77 and 68%, respectively. We observed 179 technical complications (42 intra-abdominal pressure, 137 catheter-related). Peritonitis (220 episodes, 62% gram-positive) occurred with a mean incidence of 1 episode in 13 treatment months and was the main reason (26 cases, 68% gram-positive) for catheter removal. (Mixed) Gram-negative peritonitis was associated with a higher mortality, and relatively more often resulted in termination of CAPD treatment when compared to gram-positive peritonitis. Introduction in 1988 of a new fluid exchange system (Twin Bag) and alcohol disinfection of hands was accompanied by a decreased incidence of peritonitis and exit-site infections, but to date patient, technique and catheter survival have not improved. CONCLUSION: Although therapeutic measures have resulted in a reduced incidence of peritonitis and exit-site infections, infectious and technical complications remain a serious threat to patient and technique survival in CAPD treatment.

Successful pregnancy after renal transplantation in a patient with a urinary diversion.

A successful pregnancy is reported in a patient following renal transplantation and urinary diversion. The second half of pregnancy was complicated by hypertension, impaired renal function and obstruction of the ureter in the 35th wk. The latter complication required early termination of pregnancy by cesarean section. A healthy infant was delivered who survived without complications. Maternal renal function returned to pre-pregnancy levels following delivery.

Isolation of pure IgG subclasses from mouse alloantiserum and their activity in enhancement and hyperacute rejection of skin allografts.

B6AF1 anti-B10.D2 ascites fluid was fractionated by molecular sieving. From the 7S fraction, IgG subclasses were isolated by affinity chromatography with specific antisera against mouse immunoglobulin subclasses coupled to CNRr-activated Sepharose 4B. Thus, 7S IgG1, 7S IgG2, 7S IgG2a, and 7S IgG2b were obtained which were completely pure by criteria of immunodiffusion and immunoelectrophoresis. In the in vitro tests the 7S IgG1 completely lacked cytotoxic activity. All the other subclasses were able to induce lysis of B10.D2 cells in the presence of rabbit complement. All subclasses were tested for their capacity to induce enhancement and hyperacute destruction of B10.DI skin grafts in B6AF1 recipient mice, and for the dose-dependency of these effects. 7S IgG1, although showing clearcut enhancing activity, was completely inactive in inducing hyperacute destruction of the grafts, even if high doses were administered. By contrast, 7S IgG2 (IgG2a as well as IgG2b) was not only able to induce enhancement but also hyperacute destruction of the frafts. The results obtained with 7S IgG2 demonstrate that opposite biologic activities can be present within a single subclass.

Passive enhancement of mouse skin allografts by alloantibodies is Fc dependent.

The capacity of F(ab')2 fragments of alloantibodies to enhance mouse allografts was studied in B6AF1 recipients of B10.D2 skin grafts. F(ab')2 obtained by digestion of B6AF1 anti-B10.D2 antibodies was purified by means of affinity chromatography, with anti-subclass antisera and protein A. The degree of contaminating IgG was less than 0.02%. Administration of F(ab')2 with an antigen-binding capacity similar to the IgG from which it originated, inhibited acute antibody-mediated graft rejection but was unable to induce enhancement. Even a dose that was 130 times the molar amount of the minimal enhancing dose of undigested IgG2 was ineffective. We conclude, therefore, that passive enhancement of mouse skin allografts by alloantibodies requires the Fc part.

The action of 1,25 (OH)2D3 on turnover kinetic, remodelling surfaces and structure of trabecular bone in chronic renal failure.

Fibroosteoclasia as well as osteoidosis are reduced by 1,25(OH)2D3 treatment if secondary hyperparathyroidism preexists. Fibrosteoclasia completely disappeared after 6 months therapy in some cases. 1,25(OH)2D3 has no or only a very slight effect on the disturbed mineralization in type II of renal bone disorder (osteoidosis only, no signs of secondary hyperparathyroidism). The appositional rate of the osteoblasts increases under 1,25(OH)2D3 treatment if serum PTH values are raised. 1,25(OH)2D3 seemed to have, in the chosen dosage of this study, a self-limiting effect by reducing the bone-forming cells, i.e. the osteoblasts. This state already represents an overtreatment of the underlying bone disease.

Ehancement and hyperacute rejection of skin grafts in the mousefailure to separate cytotoxic and enhancing antibodies from alloantiserum with physicochemical methods.

B6AF1 anti-B10.D2 ascites fluid was fractionated by molecular sieving and cation exchange chromatography in an attempt to separate cytoxic and enhancing antibodies. Five fractions were obtained which showed no overlap on analysis with isoelectric focusing. Despite this complete physicochemial separation all fractions contained detectable amounts of 7S IgG1 and 7S IgG2. Furthermore, exhancement of B10.D2 skin grafts in B6AF1 recipients could be induced with all the fractions. Cytotoxic activity was also present in the fractions. This was not only shown in vitro by the cytolysis of B10.02 lymphoid cells in the presence of rabbit complement, but also by the ability of the different fractions to induce hyperacute destruction of B10.02 skin grafted onto B6AF1 mice after i.v. injection together with rabbit complement. Thus, we were unable to separate the alloantiserum in cytotoxic and enhancing fractions by physicochemical means.

Familial nephropathy differing from minimal change nephropathy and focal glomerulosclerosis.

BACKGROUND: Nephrotic syndrome in childhood is mainly due to minimal change nephropathy. In general, it is characterized by selective proteinuria, by steroid responsiveness, and histologically by podocytic foot process effacement. Familial presentation is rare and mainly restricted to one generation. METHODS: We describe the occurrence of a familial nephropathy in a mother and two daughters. An initial diagnosis of minimal change nephropathy was made, but subsequently unique features became apparent. During follow-up, detailed studies of renal function and urinary protein excretion were performed. Available frozen renal biopsy material was revised and processed for immunofluorescence to detect abnormalities in the expression of heparan sulfate proteoglycans. The latter results were compared with renal biopsies of a control group composed of five adult patients with minimal change nephropathy. RESULTS: The mother and two daughters were proteinuric since their early childhood. The mother revealed a persistent nephrotic syndrome for more than 20 years despite treatment with various immunosuppressive drugs. Likewise, treatment with prednisone was ineffective in the daughters. All three patients retained normal renal function during follow-up. Detailed measurements revealed that the proteinuria was incredibly selective (selectivity index approximately 0.01), and there was no evidence of tubulointerstitial damage, as reflected by a normal excretion of the low-molecular weight proteins beta(2)-microglobulin and alpha1-microglobulin. Renal biopsy performed in the mother and one daughter was thought to be compatible with minimal change nephropathy. However, histologically, two remarkable findings were made. By electron microscopy, there was no evidence of foot process retraction; specifically, the foot process width and slit pore diameter were normal. Furthermore, in contrast to the control patients, the expression of heparan sulfate polysaccharide side chains, as reflected by the staining with monoclonal antibody JM403, was normal. CONCLUSIONS: We propose that this family represents a new familial nephropathy. The molecular basis of the permeability defect remains to be identified.

Hyperacute rejection and enhancement of mouse skin grafts by antibodies with a distinct specificity.

Pure 7S IgG2 was prepared from B6AF1 anti-B10.D2 ascites fluid by affinity chromatography. This preparation was extensively absorbed with B10.D2 red blood cells to remove the antibodies directed against the serologically defined antigens of the major histocompatibility complex. After absorption the serum had retained in vitro cytotoxic activity against 45 percent of B10.D2 spleen cells. The absorbed and unabsorbed 7S IgG2 antibodies were tested for their capacity to induce enhancement and, in the presence of rabbit complement, hyperacute rejection of B10.D2 skin grafts in B6AF1 recipient mice. The enhancing capacity of 7S IgG2 was completely unimpaired after absorption. However, the absorbed preparation was unable to induce hyperacute rejection of the grafts even if very high doses were administered. The results show that hyperacute rejection of skin grafts in this model is mediated by antibodies directed against the serologically defined antigens (i.e., H-2K antigens) of the H-2 complex. They further support the hypothesis that immunologic enhancement is mediated by antibodies directed against Ir-region-as-sociated antigens.

Familial hypokalemia/hypomagnesemia and chondrocalcinosis.

OBJECTIVE: Familial occurrence of Bartter's syndrome is well known, but the simultaneous occurrence of hypokalemia/hypomagnesemia and chondrocalcinosis in one family has not been described. We present the clinical, laboratory and radiological findings of a family, in which 7 members were affected by disease. METHODS: A total of 43 members of the family could be interviewed concerning their general health, past diseases and joint complaints. Serum potassium and magnesium were determined in all and radiographic studies were performed in those who had hypokalemia and hypomagnesemia or those with merely articular complaints. Urinary excretion of potassium, magnesium and calcium were determined in the affected persons. RESULTS: Seven patients were found with hypokalemia and hypomagnesemia. Urinary potassium and magnesium excretion was inappropriately high when compared to the serum levels of these electrolytes. All patients had hypocalciuria and extensive chondrocalcinosis, mainly in the knees, elbows and shoulders. In one patient, most probably as a result of magnesium supplementation, a striking reduction of chondrocalcinosis was observed during a followup of 10 years. CONCLUSION: A family with familial hypokalemia/hypomagnesemia and chondrocalcinosis is described. The reduction of chondrocalcinosis, after years of magnesium supplementation in one patient, suggests that hypomagnesemia is an important factor in the pathogenesis of chondrocalcinosis in these patients.

Molecular microbial diversity of an agricultural soil in Wisconsin.

A culture-independent survey of the soil microbial diversity in a clover-grass pasture in southern Wisconsin was conducted by sequence analysis of a universal clone library of genes coding for small-subunit rRNA (rDNA). A rapid and efficient method for extraction of DNA from soils which resulted in highly purified DNA with minimal shearing was developed. Universal small-subunit-rRNA primers were used to amplify DNA extracted from the pasture soil. The PCR products were cloned into pGEM-T, and either hypervariable or conserved regions were sequenced. The relationships of 124 sequences to those of cultured organisms of known phylogeny were determined. Of the 124 clones sequenced, 98.4% were from the domain Bacteria. Two of the rDNA sequences were derived from eukaryotic organelles. Two of the 124 sequences were of nuclear origin, one being fungal and the other a plant sequence. No sequences of the domain Archaea were found. Within the domain, Bacteria, three kingdoms were highly represented: the Proteobacteria (16.1%), the Cytophaga-Flexibacter-Bacteroides group (21.8%), and the low G+C-content gram-positive group (21.8%). Some kingdoms, such as the Thermotogales, the green nonsulfur group, Fusobacteria, and the Spirochaetes, were absent. A large number of the sequences (39.4%) were distributed among several clades that are not among the major taxa described by Olsen et al. (G.J. Olsen, C.R. Woese, and R. Overbeek, J. Bacteriol., 176:1-6, 1994). From the alignments of the sequence data, distance matrices were calculated to display the enormous microbial diversity found in this soil in two ways, as phylogenetic trees and as multidimensional-scaling plots.

Successful haemodialysis and renal transplantation in a patient with haemophilia A.

A 19-year old male with severe haemophilia A (factor VIII activity less than 1%) developed terminal renal insufficiency and was subsequently dialysed via an external arteriovenous shunt for one year. To prevent bleeding he received cryoprecipitate (2000-2500 units of factor VIII) three times a week during dialysis. After one year of uneventful dialysis he received a kidney graft from a cadaver donor that was matched for the B locus antigens. During the first two weeks after transplantation his factor VIII level was kept at approximately 70% by daily cryoprecipitate infusions. Thereafter he was free from bleeding at a level of 20% with prophylactic cryoprecipitate treatment (1000 units 3 times a week). He was discharged from the hospital five weeks after transplantation with excellent renal function (ECC 75 ml/min). No rejection crisis occurred. His factor VIII requirements remained unchanged after transplantation, indicating that the human kidney does not substantially contribute to the production of clotpromoting factor VIII.

Esclerose tuberosa / Tuberous sclerosis

Os autores relatam o caso de um paciente de 35 anos, pardo, pedreiro, portador de adenomas sebáceos na face diagnosticados por biópsia, com poucos sintomas respiratórios, cuja radiografia de tórax revelou infiltrado interticial de base e a prova funcional respiratória, padräo restritivo leve. A seguir, tecem comentários sobre a esclerose tuberosa em suas formas completa e incompleta e o envolvimento pulmonar nesta doença correlacionando com o quadro em questäo.