Factores asociados a la calidad de vida y su predicción en pacientes renales en hemodiálisis

Background and objectiveThe present study aims to analyze the levels of health-related quality of life (HRQL) in patients with end-stage kidney disease (ESKD) in haemodialysis, and to explore what demographic, medical and psychological variables are associated with HRQL and contribute to its prediction.Matrials and methodsCross-sectional study with 302 patients with advanced chronic kidney disease (ACKD) on haemodialysis. They were assessed: (1) HRQoL (Shorter Form Health Survey Questionnaire); (2) Anxiety and depression (Goldberg Anxiety and Depression Scale); (3) Sociodemographic data and (4) Medical data. Correlational analyses, means comparison and path analyses with latent variables (PALV) were conducted.ResultsThe PALV showed that 42% of the variance in the HRQL could be explained by the variables evaluated (χ²/df = 2.10; GFI = .938; IFI = .920; CFI = .918; RMSEA = .062; SRMR = .056). Depression was the strongest predictor of HRQL (?.71; p = .002), followed by physical activity (?.19; p = .044). Age (?.122; p = .034) and comorbidity (?.206; p = .001) were weakly associated with physical HRQL. The practice of regular physical activity is related to the physical HRQoL (r = .21; p = .00) and mental (r = .12; p = .028).ConclusionsA high percentage of the variance in HRQoL is explained by the levels of depression and physical activity. Interventions to promote HRQoL in patients with ESKD should focus in promoting physical activity and taking care of patient's mental health.     

Partial revascularization plus medical treatment versus medical treatment alone in patients with multivessel coronary artery disease not eligible for CABG

AimThe purpose of this study was to compare the impact of incomplete revascularization (IR) plus optimal medical therapy (OMT) to OMT alone on 1 year clinical outcomes in patients with multivessel coronary artery disease (MVD) who were not eligible for coronary bypass graft surgery (CABG).MethodsThis is a prospective randomized study conducted on 50 selected patients with chronic stable angina with documented MVD and CABG was refused by the surgeon due to poor distal vessel quality. Patients were randomized 1:1 into two groups, group (I): 25 patients were subjected to OMT alone and group (II): 25 patients were subjected to IR plus OMT. All patients were subjected to 1 year follow up.ResultsThe baseline patients’ details were matched. At 1 year; death occurred slightly more in group II (16% versus 12%; p = 1.000), ACS occurred more in the group I (32% versus 16%; p = 0.321) while freedom from angina occurred more in group II (20% versus 4%; p = 0.189). The OMT alone did not affect neither the level of angina class nor EF; while the IR plus OMT markedly improved the decline in the level of angina class (p = 0.011), but it did not improve EF significantly (p = 0.326).ConclusionIn patients with MVD who were not eligible for CABG; IR plus OMT was not superior to OMT alone in improving the 1year clinical outcomes except the improvement in the level of angina class, which could be the adopted strategy to improve the quality of life in such patients but with close follow up.     

Health-related quality of life and disability in patients with ulcerative colitis and proctocolectomy with ileoanal pouch versus treatment with anti-TNF agents

Background and aims:We compared health-related quality of life (HRQL) and disability in ulcerative colitis (UC) patients in remission with anti-tumor necrosis factor agents (TNF) or after restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA).MethodsTwo patient cohorts were studied. The first group consisted of patients in remission after RPC with IPAA (surgery group). The second group consisted of patients in remission with infliximab or adalimumab (medical group). For inclusion in the surgery group the pouch had to be functional for ≥ 1 year and patients were excluded in case of postoperative complications. In the medical group, patients had to be on maintenance therapy with anti-TNF agents for ≥ 1 year and in clinical remission. HRQL and disability outcomes were assessed using SF-36, COREFO, WPAI:UC and EORTC questionnaires.Results60 patients were included, 30 patients in both groups. 58 out of 60 patients (97%) returned the completed questionnaires: 29 patients in the surgery group (median age 42 years [22–67]; 48% female) and 29 patients in the medical group (median age 45 years [19–68]; 65% female). Patient characteristics were comparable between the two groups. There were no significant differences in SF-36, WPAI:UC and EORTC questionnaires between both groups, except for the medication and stool frequency scale (COREFO questionnaire) that was significantly higher in the surgery vs. the medical group (p = 0.004 and p < 0.001, respectively).ConclusionHRQL and disability were not different among the medical and surgical group, except for stool frequency and anti-diarrhea medication use that was significantly higher in surgically treated patients.     

Impact of smoking status on early and late outcomes after isolated coronary artery bypass graft surgery

BackgroundThere are limited data on the impact of smoking status on outcomes after isolated coronary artery bypass graft (CABG) surgery.MethodsData obtained prospectively between June 2001 and December 2009 by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database Program were retrospectively analyzed. Demographic and operative data were compared between patients who were non-smokers, previous smokers, and current smokers. The independent impact of smoking status on 14 short-term complications and long-term mortality was determined using binary logistic and Cox regression, respectively.ResultsIsolated CABG surgery was performed in 21 534 patients; smoking status was recorded in 21 486 (99.8%). Of these, 7023 (32.6%) had no previous smoking history, 11 183 (59.1%) were previous smokers, and 3290 (15.2%) were current smokers. The 30-day mortality rate was 1.8% in non-smokers, 1.5% in previous smokers, and 1.5% in current smokers (p = NS). The incidence of peri-operative complications was generally similar in the three groups, but current smokers were at an increased risk of pneumonia (p < 0.001), and multisystem failure (p = 0.003). The mean follow-up period for this study was 37 months (range, 0–106 months). After adjusting for differences in patient variables, the incidence of late mortality was higher in previous smokers [hazard ratio (HR), 1.73; 95% confidence interval (CI), 1.47–2.05; p < 0.001] or current smokers (HR, 1.41; 95% CI, 1.26–1.59; p < 0.001) compared to non-smokers.ConclusionSmoking status is not associated with early mortality after isolated CABG. It is, however, associated with an increased risk of pulmonary complications and reduced long-term survival.     

Impact of a patient-support program on mesalamine adherence in patients with ulcerative colitis — A prospective study

BackgroundPatient adherence to medications, particularly mesalamine, is reported to be low in patients with ulcerative colitis. We sought to determine whether a nurse-delivered patient-support program could improve medication adherence in these patients.MethodsPatients prescribed mesalamine for ulcerative colitis prospectively received either a 23 week, nurse-delivered, patient support program (PSP) by phone, or standard care (SC). Medication adherence and quality of life were measured before and at 3 and 6 months after the program started.ResultsEighty-one patients completed the study; 60 who received standard care, and 21 who received the PSP. Patients were in remission (mean SCAI score 3) at enrollment. Mean % of prescribed mesalamine refilled was 71% and 74% in the SC and PSP groups at 3 months (p = 0.7), and 73% and 84% at 6 months (p = 0.4). The proportion of adherent patients at 3 months (39% vs 44%, p = 0.7) and 6 months (50% vs 67%, p = 0.3) were similar between the SC and PSP groups. There was no association between use of the PSP and adherence at 3 (OR 1.2, 95% CI 0.4 to 3.8) or 6 months (OR 2, 95% CI 0.6 to 7). The change from baseline in SIBDQ scores were similar between SC and PSP groups at 3 months (+ 0.3 vs + 0.2, p = 0.8), and 6 months (+ 0.6 vs + 0.2, p = 0.2).ConclusionsThis nurse-delivered patient-support program did not significantly improve medication adherence or quality-of-life beyond standard care at short and medium-term time-points. Simply discussing and measuring adherence improved mesalamine adherence in both groups in this study.     

One-year metabolic outcomes in patients with type 2 diabetes treated with exenatide in routine practice

AimThe study objective was to analyze, in everyday practice, the long-term metabolic effects of exenatide (for 9 and 12 months) in patients with type 2 diabetes not responding to treatments with metformin and sulphonylurea at maximum dosages.MethodsA total of 299 type 2 diabetics were recruited from 14 centres specializing in diabetes care across Belgium. Main study endpoints were changes in HbA_1c, weight and waist circumference, and tolerability and compliance. Two patient cohorts were analyzed for effectiveness, with data available at 9 (n = 90) and 12 (n = 94) months of follow-up.ResultsSignificant decreases in HbA_1c of −1.3% and −1.6% were observed in the 9- and 12-month cohorts, respectively (P < 0.001). The decrease in HbA_1c was greater in patients with higher baseline levels (P < 0.001), and the response was independent of baseline weight, body mass index (BMI), age, gender and diabetes duration. A progressive reduction of weight (4.9 kg) was also observed in the two cohorts at 9 and 12 months (P < 0.001), with greater weight loss in patients with higher baseline BMI (P = 0.046) and in female subjects (P = 0.025). Waist circumference also decreased from baseline to endpoints. A correlation was observed between reduction in HbA_1c and weight loss (P = 0.019). Side effects, mainly of gastrointestinal origin, were reported in 33% (93/284 patients in the safety cohort). The rate of hypoglycaemia was 3.5%. Treatment was discontinued in 27% of patients (n = 77) mainly due to drug inefficacy (53%, n = 41) or adverse events (26%, n = 20), or both (8%, n = 6).ConclusionExenatide leads to long-term improvement of glycaemic control as well as weight loss in a majority of patients not responding to combined oral drug therapy in real-world clinical practice. However, no baseline factors predictive of response could be identified. Exenatide can be considered an effective treatment option in such patients, including those with high baseline HbA_1c and long duration of diabetes.     

Correlation Between Quantitative Anti-dsDNA Levels with Severity of Proteinuria in Systemic Lupus Erythematosus Patients

ObjectiveTo evaluate the correlation of quantitative anti-dsDNA level with proteinuria levels in patients with lupus nephritis in a tertiary care hospital.Study designIn this prospective cross-sectional study, 76 patients of newly diagnosed SLE coming to Fatima Memorial Hospital were included in the study period between January 2020 to June 2020. Demographic data such as age, gender, lupus manifestations such as serositis, arthritis, mucocutaneous disease, and neuropsychiatric manifestations were recorded. Quantitative anti-dsDNA was measured by enzyme-linked immunosorbent assay and proteinuria was estimated by 24 h urinary protein collection. Data was analyzed by SPSS 23. Association between categorical variables was assessed using chi-square test. For comparison of categorical independent and continuous dependent variable t-test or Mann–Whitney U test was applied.ResultsThe median age of the cohort was 29 (with inter quartile range – IQR – of 13) years. The female gender comprised of 68 (89.4%) of the cohort population. The median anti-dsDNA level was 54.9 (183.6 IQR) IU, and baseline proteinuria of the cohort was 520 mg/dL (1.49 IQR). There was a significant association of anti-dsDNA level with systemic features such as arthritis (p = <0.01), serositis (p = <0.01) and, Raynaud's phenomenon (p = <0.01). NPSLE and mucocutaneous features did not show statistically significant association (p = 0.91 and 0.14 respectively). Baseline anti-dsDNA showed a statistically significant correlation with baseline proteinuria levels (p = <0.01).ConclusionQuantitative anti-dsDNA is directly correlated with nephritis measured as proteinuria, and can be detected even before organ involvement. Hence, it can determine disease course and guide early treatment.     

The burden of inpatient costs in inflammatory bowel disease and opportunities to optimize care: A single metropolitan Australian center experience

Background and aimsInflammatory bowel disease (IBD) causes significant morbidity, frequently resulting in hospital admission and resection surgery. However, little is known about: 1. how IBD patients' inpatient healthcare utilisation compares to other inpatients and 2. whether there are potentially modifiable factors which may influence this.MethodsOver five months a cohort of admitted IBD patients were acquired and each assigned five admitted, age and gender matched controls at a single tertiary center. Data compared over 15 months included: total cumulative length of stay (TLoS), number of admissions (index and subsequent re-admissions), inpatient costs, care complexity (defined by relative stay index [RSI]), and disease-specific factors amongst the IBD cohort. Data were confirmed by case notes review.ResultsThere were 102 IBD patients and 510 controls (median age 44 years, 57% female). IBD patients had more re-admissions (mean 1.72 vs 1.55, p = 0.002) and longer TLoS (median 6.8 vs 3.4 days, p < 0.0001) than controls. Both median cumulative cost of inpatient healthcare and RSI were also higher in IBD compared to controls ($7052 vs $5470 and RSI 362% vs 293%, each p < 0.008). IBD patients seen by a gastroenterologist prior to their index admission had fewer re-admissions (mean 1.37 vs 2.02, p = 0.016,) and tended to have lower total cumulative inpatient costs than those without prior Gastroenterologist review (median $6439 vs $9479, p = 0.069).ConclusionsIBD patients have significantly greater inpatient healthcare utilization, complexity and costs than age and gender matched, hospitalized controls. Prior gastroenterologist care in IBD may reduce subsequent admission rates, and inpatient-related costs.     

Impact of nutritional parameter variations during definitive chemoradiotherapy in locally advanced oesophageal cancer

BackgroundUndernutrition is frequently observed in patients with a locally advanced oesophageal carcinoma. However, variations of nutritional parameters during chemoradiotherapy have not been thoroughly investigated.AimTo evaluate the characteristics and the impact of nutritional variations during treatment.MethodsWeight loss, body mass index (BMI), serum albumin level and daily food intake at baseline and during treatment (T1 = week 1; T2 = week 5 or 8; T3 = week 11) were retrospectively analyzed in 101 patients with oesophageal carcinoma.ResultsSignificant variations occurred during chemoradiotherapy with a decrease in serum albumin level (p < 0.001), body mass index (p < 0.001) and weight (p < 0.001). Response rate to treatment was significantly lower in patients with undernutrition at T1 (p = 0.05), from T1 to T2 (p = 0.01) and from T1 to T3 (p = 0.04). Median overall survival was 25 months in patients with persistent undernutrition from T1 to T2 vs 42 months in wellnourished patients from T1 to T2 and those malnourished only at T1 or T2 (p = 0.05). In responders, patients presenting with a lower weight or a lower food intake from T1 to T3 had worse survival (33 vs 59 months, p < 0.001 and 29 vs 61 months, p = 0.001, respectively).ConclusionSignificant variations of nutritional parameters occurred during chemoradiotherapy with a worse impact on response and survival.     

The short-term and long-term effects of bariatric/metabolic surgery on subcutaneous adipose tissue inflammation in humans

ContextThe mechanisms mediating the short- and long-term improvements in glucose homeostasis following bariatric/metabolic surgery remain incompletely understood.ObjectiveTo investigate whether a reduction in adipose tissue inflammation plays a role in the metabolic improvements seen after bariatric/metabolic surgery, both in the short-term and longer-term.DesignFasting blood and subcutaneous abdominal adipose tissue were obtained before (n = 14), at one month (n = 9), and 6–12 months (n = 14) after bariatric/metabolic surgery from individuals with obesity who were not on insulin or anti-diabetes medication. Adipose tissue inflammation was assessed by a combination of whole-tissue gene expression and flow cytometry-based quantification of tissue leukocytes.ResultsOne month after surgery, body weight was reduced by 13.5 ± 4.4 kg (p < 0.001), with improvements in glucose tolerance reflected by a decrease in area-under-the-curve (AUC) glucose in 3-h oral glucose tolerance tests (− 105 ± 98 mmol/L * min; p = 0.009) and enhanced pancreatic β-cell function (insulinogenic index: + 0.8 ± 0.9 pmol/mmol; p = 0.032), but no change in estimated insulin sensitivity (Matsuda insulin sensitivity index [ISI]; p = 0.720). Furthermore, although biomarkers of systemic inflammation and pro-inflammatory gene expression in adipose tissue remained unchanged, the number of neutrophils increased in adipose tissue 15–20 fold (p < 0.001), with less substantial increases in other leukocyte populations. By the 6–12 month follow-up visit, body weight was reduced by 34.8 ± 10.8 kg (p < 0.001) relative to baseline, and glucose tolerance was further improved (AUC glucose − 276 ± 229; p < 0.001) along with estimated insulin sensitivity (Matsuda ISI: + 4.6 ± 3.2; p < 0.001). In addition, improvements in systemic inflammation were reflected by reductions in circulating C-reactive protein (CRP; − 2.0 ± 5.3 mg/dL; p = 0.002), and increased serum adiponectin (+ 1358 ± 1406 pg/mL; p = 0.003). However, leukocyte infiltration of adipose tissue remained elevated relative to baseline, with pro-inflammatory cytokine mRNA expression unchanged, while adiponectin mRNA expression trended downward (p = 0.069).ConclusionBoth the short- and longer-term metabolic improvements following bariatric/metabolic surgery occur without significant reductions in measures of adipose tissue inflammation, as assessed by measuring the expression of genes encoding key mediators of inflammation and by flow cytometric immunophenotyping and quantification of adipose tissue leukocytes.     

Prognostic factors for significant 6-month recovery in dysthyroid optic neuropathy in a tertiary center: A series of 69 eyes in 38 patients

PurposeTo identify initial features associated with significant recovery in patients with Graves’ disease dysthyroid optic neuropathy (DON) treated according to EUGOGO guidelines by intravenous glucocorticoids (ivGC) and decompression surgery in first and second-line, respectively.Patients and methodsConsecutive patients referred to our expert multidisciplinary consultation over a 6-year period underwent systematic exploration: endocrine assessment, ophthalmic examination and radiological exploration. Visual recovery, based on best-corrected visual acuity (BCVA) and visual field (VF), were evaluated at baseline, 1 week and 6 months. Baseline parameters were then tested for prognostic value on univariate and multivariate analyses.ResultsThirty-eight patients (69 eyes) with DON were included. Significant recovery at 6 months was found in 48/69 eyes (70%), partial recovery in 18/69 (26%), and no recovery in 3/69 (4%). Fifty-one eyes (28 patients) required surgical decompression after ivGC. These patients showed more severe presentation at diagnosis, had received significantly less GC for Graves’ orbitopathy before onset of DON, and showed greater fat prolapse on CT scans compared to non-operated patients. On multivariate analysis, male gender (P = 0.001), cumulative GC dose > 1 g before DON diagnosis (P = 0.048) and initial BCVA ≤ 0.3 (P = 0.004) were significantly associated with better outcomes, whereas Clinical Activity Score > 5 (P = 0.013) was associated with a poorer outcome.ConclusionThis study confirms a generally favorable 6-month recovery rate in DON treated according to EUGOGO guidelines and provides new information on baseline predictors of poor evolution. These results may help the respective indications for medical and surgical treatment to be more effectively combined in the future.     

The impact of opiate pain medications and psychoactive drugs on the quality of colon preparation in outpatient colonoscopy

BackgroundSuboptimal colon preparation is a significant barrier to quality colonoscopy. The impact of pharmacologic agents associated with gastrointestinal dysmotility on quality of colon preparation has not been well characterized.AimsEvaluate impact of opiate pain medication and psychoactive medications on colon preparation quality in outpatients undergoing colonoscopy.MethodsOutpatients undergoing colonoscopy at a single medical centre during a 6-month period were retrospectively identified. Demographics, clinical characteristics and pharmacy records were extracted from electronic medical records. Colon preparation adequacy was evaluated using a validated composite colon preparation score.Results2600 patients (57.3 ± 12.9 years, 57% female) met the inclusion and exclusion criteria. 223 (8.6%) patients were regularly using opioids, 92 antipsychotics, 83 tricyclic antidepressants and 421 non-tricyclic antidepressants. Opioid use was associated with inadequate colon preparation both with low dose (OR = 1.4, 95%CI 1.0–2.1, p = 0.05) and high dose opioid users (OR = 1.7, 95%CI 1.1–2.9, p = 0.039) in a dose dependent manner. Other significant predictors of inadequate colon preparation included use of tricyclics (OR = 1.9, 95%CI 1.1–3.0, p = 0.012), non-tricyclic antidepressants (OR = 1.5, 95%CI 1.1–2.0, p = 0.013), and antipsychotic medications (OR = 2.2, 95%CI 1.4–3.4, p = 0.001).ConclusionsOpiate pain medication use independently predicts inadequate quality colon preparation in a dose dependent fashion; furthermore psychoactive medications have even more prominent effects and further potentiates the negative impact of opiates with concurrent use.     

Elderly-onset sarcoidosis: A single center comparative study

ObjectivesSarcoidosis rarely affect patients older than 65 years old. The purpose of this study is to compare and evaluate the demographic, clinical and laboratory features of elderly-onset (EOS) and young-onset sarcoidosis (YOS) patients.MethodsOne hundred and thirty one patients diagnosed with sarcoidosis according to clinical, radiologic and histopathological evaluation were included in this study. The patients with initial symptoms started after age 65 were accepted as EOS.ResultsTwenty (15.3%) of 131 patients were diagnosed as EOS, and 111 (84.7%) patients were evaluated as YOS. Fifteen of 20 EOS patients were female and 5 of them were male. Average duration of the disease was determined as 38.4 months for YOS and 22.5 months for EOS (p = 0.556). Delay of the diagnosis was 12 months for YOS while it was 3 months for EOS (p = 0.001). Higher rates of fatique, comorbid diseases and more hydroxychloroquine (HQ) use were detected in EOS patients comparing to YOS (p = 0.010, p = 0.003 and p = 0.039 respectively).ConclusionsEOS patients are characterized with higher rates of fatique and comorbid diseases, less inflammatory sign and delayed diagnosis, and less DMARDs use.     

Relationship between BNP level and renal function in diabetic nephropathy with microalbuminuria

AimsWe examined the relationship between the brain natriuretic peptide (BNP) level and renal function in diabetic nephropathy with microalbuminuria.MethodsThe subjects were 97 Japanese type 2 diabetes mellitus outpatients with microalbuminuria. Associations between the annual rate of decline in estimated glomerular filtration rate (eGFR) and various metabolic parameters at baseline (BMI, systolic blood pressure, HbA1c, LDL cholesterol, urine albumin–creatinine ratio, BNP and eGFR) were examined.ResultsAmong the baseline factors, eGFR and BNP had significant associations with the annual rate of decline in eGFR in Pearson correlation analysis (r = 0.295, p = 0.003; r = 0.223, p = 0.028, respectively). Multiple linear regression analysis also showed the significance of baseline eGFR and BNP as independent predictors of renal function (β = 0.340, p = 0.001; β = 0.278, p = 0.005, respectively). In multivariate logistic regression analysis, eGFR and BNP were independently associated with the risk of a decline in GFR (p = 0.003, p = 0.011, respectively). ROC curve analysis showed a cutoff value of BNP is 17.0 pg/mL for predicting a decline in GFR.ConclusionsThe BNP level at baseline is an independent predictor of the annual rate of decline in eGFR. Therefore, monitoring of BNP can play an important role in management of diabetic nephropathy.     

Colistimethate sodium and acute kidney injury: Incidence,risk factors,outcome and prognosis of renal function

BackgroundColistimethate sodium (CMS) treatment has increased over the last years, being acute kidney injury (AKI) its main drug-related adverse event. Therefore, this study aimed to evaluate the incidence and risk factors associated with AKI, as well as identifying the factors that determine renal function (RF) outcomes at six months after discharge.Materials and methodsThis retrospective study included adult septic patients receiving intravenous CMS for at least 48 h (January 2007–December 2014). AKI was assessed using KDIGO criteria. The glomerular filtration rate (GFR) was estimated by the 4-variable MDRD equation. Logistic and linear models were performed to evaluate the risk factors for AKI and chronic kidney disease (CKD).ResultsAmong 126 patients treated with CMS; the incidence of AKI was 48.4%. Sepsis–severe sepsis (OR 8.07, P = 0.001), sepsis–septic shock (OR 42.9, P < 0.001), and serum creatinine (SCr) at admission (OR 6.20, P = 0.009) were independent predictors.Eighty-four patients survived; the main factors for RF evolution at the 6-month follow-up was baseline eGFR (0.58, P < 0.001) and at discharge (0.34, P < 0.001). Fifty-six percent (34/61) of the patients that developed AKI survived. At six months, 32% had CKD.ConclusionsThe development of AKI in septic patients with CMS treatment was associated with sepsis severity and SCr at admission. Baseline eGFR and eGFR at discharge were and important determinant of the RF at the 6-month follow-up. These predictors may assist in clinical decision making for this patient population.     

Adverse effects of pneumonia on physical functioning in nursing home residents: Results from the INCUR study

BackgroundPneumonia is a very common infection in the nursing home, but little is known about its effects on levels of individual functioning. The aim of this study was to examine adverse effects of pneumonia events on physical functioning in nursing home residents.MethodsData were used from the INCUR study, a 1-year prospective cohort study of older residents from 13 nursing homes in France. The sample consisted of 716 residents, who were assessed at baseline, 6 and 12 months. Pneumonia diagnosis was based on clinical conditions documented in medical records. Physical functioning was measured by Activities of Daily Living (ADL). Longitudinal associations between pneumonia and physical functioning were explored using Generalized Estimating Equations (GEE).ResultsOf 716 participants, 145 (20%) had one or more pneumonia events during 12 months follow-up. Mean age of the participants was 86.0 (SD = 7.4) years, and 76% of them were female. Overall, participants had relatively low levels of physical functioning at baseline (Mean ADL = 2.4 out of 6, SD = 1.8). The GEE analyses adjusted for age, gender, baseline physical functioning, and hospitalization during follow-up showed that pneumonia events had adverse effects on ADL functioning (B = −0.21, SE = 0.08, p = 0.008). Pneumonia events were mainly associated with loss of independence in transferring from bed to chair and bathing.ConclusionsIn a population of nursing home residents where levels of physical functioning were already relatively low, pneumonia events were associated with loss of physical functioning. These results highlight the importance of preventive interventions aimed at reducing pneumonia in nursing home residents.     

Transition from angiotensin-converting enzyme inhibitor/angiotensin-II-receptor-blocker to sacubitril/valsartan in chronic heart failure patients: Initial experiences in clinical practice

BackgroundSacubitril/valsartan (S/V) therapy has been demonstrated to improve prognosis of systolic heart failure (HF) patients when compared to standard therapy with ACEi. The purpose of this investigation was to document the safety and consequences of transition from ACEi/angiotensin-II receptor blocker (ARB) to S/V in chronic stable HF patients.MethodsA group of 12 stable HF outpatients (11 males, 1 female) was enrolled (NYHA 2.7 ± 0.7, 42% with coronary artery disease (CAD), average left-ventricle ejection fraction (LVEF) 26.5%). Patients were converted from ACEi/ARB to S/V. Laboratory evaluation, Minnesota Living with Heart Failure Questionnaire (MLHFQ), six-minute walk test (6MWT) were performed before the conversion and at 3-month follow-up visit.ResultsConversion from ACEi/ARB to S/V was not associated with any adverse event. After 3 months, S/V therapy decreased blood pressure (−14.8 mmHg for systolic BP, −9.6 mmHg for diastolic BP) and serum potassium (−0.27 mmol·l⁻¹, all p < 0.05). No worsening of renal function occurred (creatinine −7.8 μmol·l⁻¹, p = 0.12, estimated glomerular filtration rate +0.08 ml·s⁻¹·1.73 m⁻², p = 0.14). B-type natriuretic peptide (BNP) level remained unchanged (p = 0.18), but NT-proBNP level decreased significantly (median 1012 ng·l⁻¹ at baseline, 559.4 ng·l⁻¹ at follow-up, p = 0.005). A slight but significant decrease in high-sensitivity cardiac troponin T (hs-cTnT) was observed (median 14.76 ng·l⁻¹ at baseline, 12.63 ng·l⁻¹ at follow-up, p = 0.001). An improvement in MLHFQ total score (−8 points, p = 0.006) and in 6MWT by 55 m (p = 0.0007) was noted, which was not due to increased effort.ConclusionThe transition from ACEi/ARB to S/V therapy appears to be safe and leads to an improvement in exercise tolerance and quality of life.     

Effects of a fish-based diet and administration of pure eicosapentaenoic acid on brachial-ankle pulse wave velocity in patients with cardiovascular risk factors

Background and purposeBrachial-ankle pulse wave velocity (baPWV) and ratio of plasma eicosapentaenoic acid to arachidonic acid (EPA/AA ratio) are surrogate markers for coronary artery disease (CAD). We aimed to evaluate the effects of a fish-based diet and administration of EPA on baPWV and plasma EPA/AA ratio.Methods and resultsThe changes in baPWV and plasma EPA/AA ratio were compared before and after a 6-month fish-based diet in 191 patients with cardiovascular risk factors. A fish-based diet resulted in significant increment of plasma EPA/AA ratio (0.40 ± 0.18 vs. 0.49 ± 0.27, p < 0.001), with baPWV remaining unchanged. Multivariate analysis revealed that systolic blood pressure (SBP) (6-month SBP-baseline SBP) and CAD were positively associated with increased baPWV (CAD: odds ratio = 2.040, p = 0.0436, SPB: odds ratio = 1.056, p = 0.0003). When the patients were divided into three groups: CAD, low-risk, and high-risk with no prior history of CAD according to the number of risk factors at baseline, comparison among the three groups disclosed an inter-group difference in the magnitude of change in baPWV (low-risk: −35 ± 164 cm/s, high-risk: −14 ± 190 cm/s, CAD: 39 ± 164 cm/s, p = 0.0071 for trend). In 191 patients who had received a 6-month fish-based diet, 21 patients (primarily CAD patients) sequentially received high purity EPA (1800 mg/day) for 6 months. It resulted in marked increment of plasma EPA/AA ratio (0.65 ± 0.57 vs. 1.19 ± 0.46, p < 0.001), accompanied by significant reduction in baPWV (1968 ± 344 cm/s vs. 1829 ± 344 cm/s, p = 0.0061). There was a significant negative correlation between changes in baPWV and changes in plasma EPA/AA ratio in patients with a fish-based diet and sequential administration of EPA (r = −0.446, p = 0.017).ConclusionA fish-based diet was effective against increased baPWV only in low-risk patients, with slight increment of plasma EPA/AA. In high-risk patients and CAD patients, administration of EPA for preventing progression of baPWV endorsed the validity of high purity EPA administration recommended in the current guidelines.     

Related factors to atazanavir plasma levels in a cohort of HIV positive individuals with undetectable viral load

ObjectiveTo evaluate the factors associated with plasma concentrations of atazanavir (ATV) in a cohort of well-controlled HIV infected subjects (undetectable viremia).DesignCross-sectional study where 69 subjects were consecutively enrolled between April and November, 2011.MethodsPatients had to be on atazanavir for at least six months, undetectable viral load for a period equal to or longer than 12 months, T CD4+ lymphocyte count higher than 200 cells/mm³, and aged between 18 years and 70 years old. Exclusion criteria were pregnancy, any neurologic disease, active opportunistic disease, hepatitis or cancer. Atazanavir plasma levels were measured by ultra-performance liquid chromatography.Results and discussionOverall, 54 patients (mean age of 47 years and 50% women) were included in the analysis. Those without ritonavir (unboosted atazanavir) had statistically lower plasma concentrations than those with ritonavir boosted atazanavir (p = 0.001) and total and indirect bilirubin were statistically associated with plasma concentration of atazanavir (r = 0.32 and r = 0.33 respectively; p < 0.05 in both cases). No statistical association was found among gender, ethnicity, age, weight, body mass index (BMI), lipid profile, and the plasma concentration of atazanavir.ConclusionIn summary, as expected, concomitant ritonavir use was the only factor associated with atazanavir plasma levels. Prospective studies with a larger sample size might help to observe an association of atazanavir concentrations to other characteristics such as body weight, since the p-value showed to be close to significance (p = 0.068).     

Assessment of response to sorafenib in advanced hepatocellular carcinoma using perfusion computed tomography: Results of a pilot study

AimsThis prospective pilot study investigated the feasibility of perfusion computed tomography parameters as surrogate markers of angiogenesis and early response following sorafenib administration in patients with advanced hepatocellular carcinoma.MethodsTen patients were evaluated with perfusion computed tomography before starting sorafenib and after 3 months. Blood flow, blood volume, mean transit time, hepatic arterial fraction, and permeability surface-product were compared in tumour lesions and in hepatic parenchyma at baseline and at follow-up. Correlation between these parameters and changes in alpha-fetoprotein levels was calculated.ResultsAt baseline, blood volume, blood flow, hepatic arterial fraction and permeability surface values were higher in lesions compared to those in hepatic parenchyma, while mean transit time was lower (p < 0.05). After sorafenib treatment, only mean transit time was significantly increased versus baseline (p < 0.05). At follow-up, plasma alpha-fetoprotein levels decreased in all patients. At follow-up, an inverse correlation was observed between baseline mean transit time and changes in alpha-fetoprotein (r = ?0.6685, p = 0.0125), as well as a correlation between baseline blood flow and alpha-fetoprotein (r = 0.6476, p = 0.0167).ConclusionThis pilot study suggests that after sorafenib treatment an increase in mean transit time observed in tumour lesions is inversely correlated with alpha-fetoprotein reductions after therapy. Mean transit time may represent a possible marker of response irrespectively of alpha-fetoprotein values.