Effects of short daily hemodialysis and extended standard hemodialysis on blood pressure and cardiac hypertrophy: a comparative study

BACKGROUND: Causes of hypertension and cardiac hypertrophy in hemodialysis (HD) patients are multiple, but the role of fluid overload appears to be crucial. Short daily HD (sDHD = 2 hr x 6/week) seems to allow reductions in left ventricular mass (LVM) through the reduction of extracellular water (ECW). Better cardiovascular stability during HD can be obtained with short, but more frequent HD sessions, but also by increasing the session length accompanied with a reduction in ultrafiltration (UF)/hr. Regardless of the method, the adequate reduction in extracellular volume should permit better control of hypertension and left ventricular hypertrophy (LVH). This study aimed to compare sDHD with an extended form of standard HD (eSHD = 4.5-5 hr x 3/week) on the reduction of fluid overload, blood pressure (BP) and LVM index (LVMi). Patients and methods:Twenty-four HD patients with hypertension and LVH were enrolled in a prospective non-randomized study. After a 3-month run-in period they were divided in two comparable groups: 12 patients treated with sDHD, and 12 patients treated with eSHD for 6 months. LVMi, 24 hr BP monitoring, ECW, determined with electrical bio-impedance, biochemical correlates and spKT/V were studied at the beginning of the study and 6 months later. RESULTS: The weekly session length was increased in eSHD from 722.9 +/- 7.5 to 877.3 +/- 35.5 min. ECW% was reduced similarly in the two groups (Delta ECW: eSHD = 4.6 +/- 2.4 L; sDHD = 4.1 +/- 2.3 L); 24 hr BP decreased significantly from 157/81 to 137/75 mmHg in eSHD, and from 149/79 to 128/72 mmHg in sDHD. The reduction in systolic BP was similar in the two groups (eSHD = 20.1 +/- 15.3 mmHg, sDHD = 21.2 +/- 16.7 mmHg). Finally, LVMi was similarly reduced (eSHD = 55 +/- 30.3 g/m(2), sDHD = 54.4 +/- 21.3 g/m(2). The number of antihypertensive drugs decreased significantly after ECW% reduction: only 2/10 patients on eSHD and 4/12 patients on sDHD were maintained on therapy (p = ns). Intra-dialysis hypotension episodes did not differentiate between SHD and DHD. The reduction in LVMi was significantly correlated to fluid volume changes when these were measured as phase angle (PA) with bio-impedance (r = -0.43, p < 0.05). CONCLUSIONS: In hypertensive HD patients with LVH, fluid overload is invariably present and its reduction allows the decrease of BP and LVM. These results can be obtained by forcing UF with eSHD and sDHD, but patients maintained on x 3/week schedules need longer dialysis sessions to avoid intra-dialysis symptoms.     

Evaluation of epoetin supplemented with oral iron in patients with solid malignancies and chronic anemia not receiving anticancer treatment

OBJECTIVE: To evaluate the effectiveness and improvement in quality of life (QOL) of epoetin alfa administration supplemented with oral iron as a therapeutic regimen for patients with solid malignancies and anemia of chronic disease (ACD), not receiving chemotherapy and/or radiotherapy. PATIENTS AND METHODS: A total of 100 patients with cancer-related anemia, not subjected to chemotherapy and/or radiotherapy, were randomized to receive for a maximum of 24 weeks either oral iron, equivalent to 200 mg elemental iron once daily, or epoetin alfa 40,000 IU subcutaneously once weekly plus oral iron once daily. RESULTS: Patients in the epoetin alfa group had, from baseline to study end, a mean increase in hemoglobin (Hb) levels of 2.4 g/dL, whereas in the control group the mean Hb level decreased by 0.1 g/dL, (p<0.001). Improvement in QOL as assessed by the LASA and the FACT-An questionnaire were greater in patients in the epoetin alfa group than in the control group (mean change, LASA-energy level: 30.4 mm vs. 0.4 mm, -daily activities: 31.7 mm vs. 0.4 mm, -overall well-being. 32.4 mm vs. 4.9, FACT-An: 43.3 vs. 13.4, respectively). As for ECOG score, patients in the epoetin alfa group had a mean improvement of 0.16 from baseline to study end (control group: 0.06). Improvement in QOL parameters and in ECOG scores correlated positively with increased hemoglobin levels. CONCLUSION: Our results suggest that weekly epoetin alfa therapy supplemented with daily oral iron increases Hb levels and improves QOL in patients with solid malignancies and ACD who are not receiving chemotherapy and/or radiotherapy. This regimen offers optimal therapy in this population taking into consideration physician's convenience and patient's compliance.     

Psychometric analyses of the Mental Adjustment to Cancer (MAC) scale in a Greek palliative care unit

The purpose of the study was to assess the Mental Adjustment to Cancer (MAC) scale on a heterogeneous Greek sample of 200 advanced cancer patients. The results presented regard the validation analysis of the Greek version. The homogeneity of the original subscales proved to be satisfactory (alpha coefficients ranged from 0.81 to 0.91). A factor analysis was carried out using the LISREL 8.3 procedure. This yielded five factors, including 25 of the 40 original items (alpha coefficients 0.62-0.93). The resulting factors were called 'hopeless', 'positive attitude', 'acceptance', 'mental engagement', and 'fatalistic'. Correlations between the MAC scale and the disease severity as measured by the ECOG performance status have shown difference only between patients with 'good' versus 'poor' performance status in the 'hopeless' scale (p=0.047). The results suggest that the Greek version, as measured in advanced cancer patients attending a palliative care unit, is a reliable and valid clinical tool in Greece.     

Social determinants of peripartum depressive symptoms among Black peripartum women living with HIV

HIV infection during pregnancy, may present risk of developing depression during pregnancy and postpartum. This psychiatric mood disorder, and many others such as anxiety and HIV-related post-traumatic stress disorder (PTSD) have been reported prevalent among pregnant and non-pregnant women living with HIV (WLWH). Multiple studies have found associations between social determinants of health and depressive symptoms in this population. However, despite deleterious effects on mother and child which may include suicidal ideations and infant death, only very few studies have examined this phenomenon for peripartum women, particularly Black women- a population prone to living in poor social and economic environments. Therefore, guided by the socio-ecologic model, this study examined predictors of peripartum depressive symptoms among Black peripartum WLWH. The study was a secondary data analysis of 143 Black women seen at special prenatal and women's health clinics in Miami, South Florida, USA. More than half of the women who experienced peripartum depressive symptoms (PDS) (n = 81, 57%) were of low socio-economic status. Low income was associated with increased odds of experiencing PDS. Women who endorsed intimate partner violence/abuse (IPV/A) were 6.5 times more likely to experience PDS; and compared to women with 1 or no childcare burden, women with 2 children-care burden were 4.6 times more likely to experience PDS. These findings demonstrate the negative impact of social factors on the psychological health of Black peripartum WLWH. Burdensome interpersonal relationships may have deleterious effects and trigger PDS among these women. Implications for nursing practice, education and research are also discussed.     

Microengineered 3D Tumor Models for Anti-Cancer Drug Discovery in Female-Related Cancers

Annals of Biomedical Engineering - The burden of cancer continues to increase in society and negatively impacts the lives of numerous patients. Due to the high cost of current treatment strategies,...     

2020 edition of the Rourke Baby Record: What is new in preventive care of children up to 5 years of age?

ObjectiveTo update primary care providers practising well-child and well-baby clinical care on the evidence that contributed to the recommendations of the 2020 edition of the Rourke Baby Record (RBR).Quality of evidencePediatric preventive care literature was searched from June 2016 to May 2019, primary research studies were reviewed and critically appraised using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, and recommendations were updated where there was support from the literature.Main messageNotable changes in the 2020 edition of the RBR include the recommendations to limit or avoid consumption of highly processed foods high in dietary sodium, to ensure safe sleep (healthy infants should sleep on their backs and on a firm surface for every sleep, and should sleep in a crib, cradle, or bassinette in the parents’ room for the first 6 months of life), to not swaddle infants after they attempt to roll, to inquire about food insecurity, to encourage parents to read and sing to infants and children, to limit screen time for children younger than 2 years of age (although it is accepted for videocalling), to educate parents on risks and harms associated with e-cigarettes and cannabis, to avoid pesticide use, to wash all fruits and vegetables that cannot be peeled, to be aware of the new Canadian Caries Risk Assessment Tool, to note new red flags for cerebral palsy and neurodevelopmental problems, and to pay attention to updated high-risk groups for lead and anemia screening.ConclusionThe RBR endeavours to guide clinicians in providing evidence-informed primary care to Canadian children. The revisions are rigorously considered and are based on appraisal of a growing, albeit still limited, evidence base for pediatric preventive care.

Primary prevention, through primary care and public health interventions, plays a key role in preventing many of the leading causes of death and morbidity in childhood.^1-5 For example, each year, more children die in Canada from injuries than any single disease.¹ Motor vehicle–related deaths are the leading cause of injury in children, and numerous studies spanning several decades have demonstrated significantly reduced risk of death when children are properly restrained in car seats compared with children restrained by seat belts or unrestrained children.^2,3 Primary prevention in early childhood might also reduce the risk of disease and morbidity in later adult life. A compelling case for the latter is supported by longitudinal studies that have demonstrated how cardiometabolic risk factors in childhood such as high body mass index (BMI), blood pressure, lipid level, and blood glucose level can track into adulthood, resulting in further health issues including metabolic syndrome, type 2 diabetes, and atherosclerotic disease.^6,7For the past 3 decades, primary care providers (PCPs) across Canada have used the Rourke Baby Record (RBR) to guide the provision of evidence-informed preventive care in children younger than 6 years of age.^8-10 The RBR can be accessed at no cost online (www.rourkebabyrecord.ca) and is endorsed by the College of Family Physicians of Canada, the Canadian Paediatric Society, and Dietitians of Canada. The RBR knowledge translation tools for PCPs to support well-baby and well-child visits include RBR structured forms (Guides I to IV) in a printable version or embedded within electronic medical records, an immunization chart (Guide V), and a summary of supporting evidence and websites for the recommendations (Resources 1 to 4). There are supplemental resources for parents and caregivers on the RBR website. The RBR is also a teaching tool for undergraduate and postgraduate trainees across Canada, as exemplified by LearnFM, a matrix of educational resources developed by the Canadian Undergraduate Family Medicine Education Directors and supported by the College of Family Physicians of Canada.¹¹This current clinical review aims to highlight the updates of the 2020 RBR. Our goal is to update busy PCPs with the current evidence and recommendations included in this newest version of the RBR.     

Building a sports medicine team

There have been a growing number of participants in high school and collegiate athletics in recent years, placing ever-increasing demands on the sports medicine team. Building a winning sports medicine team is equally as important to the success of an athletic organization as fielding talented athletes. Acquisition of highly qualified, motivated, and hard-working individuals is essential in providing high quality and efficient health care to the athlete. Maintaining open paths of communication between all members of the team is the biggest key to success and an optimal way to avoid confusion and pitfalls.     

Oral Transmucosal Fentanyl Citrate: Overview of Pharmacological and Clinical Characteristics

Oral transmucosal fentanyl citrate (OTFC; brand name Actiq®, Cephalon, UT) is a new opioid formulation that incorporates fentanyl into a lozenge and allows drug delivery through the buccal mucosa. This kind of absorption avoids first-pass metabolism, yielding a bioavailability substantially greater than oral administration. OTFC has a rapid onset of action and a short duration of effect. These characteristics, which resemble the course of a typical breakthrough pain episode, resulted in making OTFC the first opioid analgesic formulation specifically developed and approved for control of breakthrough pain in cancer patients. Apart from that, OTFC has been used in a variety of clinical situations of noncancer pain. This review article presents the synthesis; clinical pharmacology; pharmacokinetic and pharmacodynamic properties, toxicity, and clinical efficacy of this novel agent.