Prognostic factors correlated with survival in AIDS patients

The authors present the AIDS cases (CDC '93) observed in Brescia from 1983 to 1994. They observed 1189 subjects (M 84%, F 16%) with a mean age of 32.7 years (intra-venous drug users 75.1%, heterosexuals 14%, homosexuals 9.6%). The mean survival observed was 56.7 weeks from the diagnosis of AIDS (mortality per year 78%). The most frequent AIDS-defining events were Visceral Candidiasis, P.carinii Pneumonia (PCP) and Neurotoxoplasmosis, while the longest and shortest mean survival was for Kaposi's Sarcoma (89 weeks) and Wasting Syndrome (8.4). The mean value of CD4+ lymphocyte counts on AIDS diagnosis was 72.6/l (1166 cases) and the highest and lowest were in non-Hodgkin's Lymphoma (NHL; 147.6/l) and Cryptosporidiosis (18.8/l). Antiretroviral therapy had been given for at least a month in 41.4% subjects (mean treatment duration of 74.8 weeks). The Cox model has demonstrated the favourable effect on survival of high CD4+ lymphocyte counts on diagnosis, antiretroviral therapy, the diagnosis of Tuberculosis (TBC) and PCP as initial markers and the diagnosis of TBC, PCP or Cytomegalovirus infection (CMV) during the entire clinical evolution. Moreover, the unfavourable effect of high age, diagnosis of Progressive Multifocal Leucoencephalopathy (PML), Wasting Syndrome and NHL as initial markers and diagnosis of PML or NHL in any moment of the disease has been demonstrated.     

Use of ibritumomab tiuxetan anti-CD20 radioimmunotherapy in a non-Hodgkin's lymphoma patient previously treated with a yttrium-90-labeled anti-CD22 monoclonal antibody

Ibritumomab tiuxetan is a novel radioimmunotherapeutic agent that has a high response rate in relapsed or chemotherapy-refractory CD20+ B-cell non-Hodgkin's lymphoma. Whereas chemotherapy agents can successfully be used multiple times in a given patient, there are few data on the repeated use of radioimmunotherapy in terms of efficacy or morbidity, and no reports as yet involving radioconjugates that target different antigens We report on a patient who was treated successfully with yttrium-90-labeled humanized anti-CD22 monoclonal antibody (90Y-epratuzumab). Upon relapse 3 years later, the patient was treated again with radioimmunotherapy consisting of 90Y-ibritumomab tiuxetan anti-CD20 monoclonal antibody, with a good response and acceptable bone marrow suppression. This case report demonstrates the potential for repeated treatments with radioimmunotherapy agents in patients with chemotherapy-refractory non-Hodgkin's lymphoma.     

Portion Control Eating—a Determinant of Bariatric Outcomes

Introduction

Bariatric surgery leads to significant weight loss but the results vary. Application of dietary principles like portion-controlled eating leads to greater weight loss and fewer complications.

Aims

To evaluate the improvement in weight loss outcomes by incorporating portion-controlled eating behavior in postbariatric patients.

Methods

All patients who underwent bariatric surgery from January 2012 to December 2013 were included in the study. Portion-controlled eating behavior was incorporated in the post-bariatric nutritional protocol. Their demographic, preoperative, and postoperative data were prospectively maintained on Microsoft Office Excel and analyzed statistically.

Results

Three hundred and seventy-two (89.6%) underwent laparoscopic sleeve gastrectomy (LSG), while 43 (10.4%) underwent laparoscopic Roux-en-Y gastric bypass (RYGB). In the LSG group, lowest (nadir) BMI was 28.99?±?5.6 kg/m² and % Excess weight loss (EWL) was 87.3?±?27.2%, achieved between 1 and 2 years. In the RYGB group, lowest (nadir) BMI was 27.5?±?12.09 kg/m and % EWL was 94.32?±?33.12%. Surgical failure (less than 50% EWL) were 10 (3.27%) in the LSG group and 1 (3%) in the RYGB group. There were no leaks reported in our study.

Conclusion

Our study highlights the importance of postoperative nutritional interventions like portion-controlled eating for successful bariatric outcome.

     

Serum cholesterol concentration and distress in the initial days after childbirth

The link between mood disorders and cholesterol is characterized by some contradictory data. In particular, it is not clear whether health factors are responsible for lowered cholesterol levels and mood swings. The present study tests the association between serum cholesterol level and psychological distress in women in two different post-delivery hospital settings: rooming-in (RI) and no rooming-in (no-RI). On day 3 after childbirth, 147 RI and 209 no-RI women completed the Kellner Symptom Questionnaire (SQ), which evaluates anxiety, depression, somatic symptoms and hostility. Plasma cholesterol concentration was measured on the same day. There was a significant negative correlation between cholesterol and depressive symptoms in no-RI women, but not in the RI group. However, this correlation is characterized by an extremely small effect size (-0.15). The findings of this study cast further doubt on the hypothesis of a possible association between cholesterol and depression in the general population and in mothers who have just given birth.     

Intravesical hyaluronic acid and chondroitin sulphate for bladder pain syndrome/interstitial cystitis: long-term treatment results

Introduction and hypothesis

Reconstruction of the glycosaminoglycan layer plays a role in the successful treatment of bladder pain syndrome/interstitial cystitis (BPS/IC). Intravesical instillations of hyaluronic acid (HA) and chondroitin sulphate (CS) have given results in the short term. We hypothesise that these benefits continue in the longer term.

Methods

With the aim of evaluating this therapy over a longer period we treated 12 BPS/IC patients refractory to other treatments with a combination of HA 1.6?% and CS 2.0?% over a period of 3?years assessing symptoms and quality of life using a visual analogue scale, 3-day voiding diaries and validated questionnaires.

Results

Improvements in bladder function were sustained for 3?years (mean number of daily voids decreased from 17.8 at baseline to 15.5 at 9?months and 11.9 at 3?years, and mean volume per void from 136.8?ml at baseline to 143.9?ml at 9?months and 180.9?ml at 3?years). Quality of life assessments confirmed these improvements.

Conclusions

Intravesical instillations of HA and CS produced a sustained improvement of the symptomatology, up to 3?years, in patients with BPS/IC refractory to previous treatments. Further confirmation would be expected from larger controlled trials.     

Intensive graft-versus-host disease prophylaxis is required after unrelated-donor nonmyeloablative stem cell transplantation

Nonmyeloablative stem cell transplantation (NST) harnesses the graft-versus-tumor effect while minimizing regimen-related toxicity, and can result in donor chimerism and remission. Acute graft-versus-host disease (GVHD) and infections are major complications after sibling NST. Toxicity of unrelated-donor (UD) NST and the most appropriate GVHD prophylaxis in this setting remain poorly defined. We describe 25 patients who received UD-NST conditioned with fludarabine and cyclophosphamide. The first six patients received cyclosporine (Cs) and mycophenolate mofetil (MMF) (n=5) or methotrexate (MTX) (n=1) as GVHD prophylaxis (group 1) and all developed grade III-IV acute GVHD. The next 19 patients received the same conditioning regimen with the addition of alemtuzumab, and all received Cs/MTX post-transplant. Engraftment and donor chimerism were achieved in all but one evaluable patient. In all, 15 patients died: five of six deaths in group 1 were attributable to acute GVHD, while deaths in group 2 were due to infection or progressive disease (P=0.05). The combination of Cs/MMF is inadequate GVHD prophylaxis for UD-NST. The use of Cs, MTX, and alemtuzumab eliminated severe acute GVHD; its impact on response merits further study.