Course Of Long-term Treatment Research Articles

APPLICATION OF VITAMIN D IN DIFFERENT DOSAGE TO TREAT CHILDREN WITH ALLERGIC DISEASES

The aim:Tostudythedynamicsof thelevelof 25(ОН)D, ІL-4, ІL-10, and IgG in the bloodserum of children with allergicdiseasesandtostudytheclinicaleffectof vitamin D3 administration n different dosage in this category of patients. Materials andmethods: 153 children aged 3-16 with such allergicdiseasesasbronchialasthma, atopicdermatitisandallergicrhinitis havebeen examined. The level of 25(ОН) D was determined using the electrochemiluminescence method, while the levels of ІL-4, ІL-10 and IgG were assessed using enzyme-linked immunoassay. Results: In the contrasting of the initial level of 25(ОН)D in the blood serum of patients after administration of 2,000 IU of vitamin D3 over 2 months, after summer and after treatment with cholecalciferol in higherdoses (4,000-5,000 IU) over 2 months, significant difference wasestablishedbetween the indicators by the Friedman criterion (λ2 = 41.211; P < 0.05). In thesimilar contrasting of ІL-4 indicators, a significant difference between them was traced (P < 0.05) in the period of acute disease as well as the downward tendency in the period of remission. In the similar contrasting of ІL-10 indicators, a significant difference between them was traced (P < 0.05) in the acute period and in the period of disease remission. In the similar contrasting of IgG indicators, adownward tendency was tracedin theperiodof acutedisease and significantdecrease (P < 0.05) - in the period of disease remission. In thecontrasting of 25(ОН)D and ІL-4, ІL-10 figuresastrongreversecorrelation relationship was traced. The therapeutic effect of the administration of vitamin D3 medication in different doses in children with allergic diseases was traced. Conclusions: The data obtained shows that in the treatment of children with bronchial asthma, allergic rhinitis and atopic dermatitis the complex therapy should include vitamin D3 medications in different doses within a long-term course of treatment.

Influence of financial conditions on stress in colorectal cancer patients undergoing outpatient chemotherapy

Abstract Objective This study was performed to clarify the influence of financial conditions on stress in patients with advanced recurrent colorectal cancer undergoing outpatient chemotherapy. Methods A self-administered questionnaire survey was completed by patients with advanced and recurrent colorectal cancer receiving outpatient chemotherapy in five hospitals in the Kansai region. The questionnaire included basic information (age, sex, current employment availability, and subjective financial condition (3 choices)), and the 29-item stress scale from Japanese version of the Mastery of Stress Instrument (5-point scale with a total score of 29-140 points) . Results Responses were received from 76 outpatients (response rate: 95%). The patients’ mean age was 66.6 ± 8.5 years, and they comprised 50 men (65.8%) and 26 jobholders (34.2%). Three patients (3.9%) always had financial leeway (Yutori group), 37 (48.7%) had a satisfactory financial margin (sufficient group), and 36 (47.4%) had no financial margin (marginless group). The mean stress score was 70.0 ± 15.3 points. The stress score was significantly higher in the unemployed group than in the working group. With respect to the patients’ subjective financial condition, the stress score was significantly higher in the marginless group than in the sufficient group. The Yutory group did not differ significantly from any other groups. Discussion and Conclusion Patients with advanced recurrent colorectal cancer undergoing outpatient chemotherapy often follow a long-term treatment course. Therefore, financial problems while undergoing cancer treatment may be a heavy burden. Patients who are unemployed and have no income appear to experience stressful conditions during treatment, such as distress and confusion. These findings suggest the need to provide both mental support and employment support to patients undergoing treatment for cancer. This work was supported by KAKENHI Grant Number A16H055760.

Factors influencing quality of life in patients with multiple myeloma

Background: Over the course of repetitive and long-term chemotherapy treatment, multiple myeloma (MM) patients experience physical and psychological problems and side effects.Objectives: The objective of this study was to investigate the levels of pain, uncertainty, social support, anxiety, depression, and quality of life (QOL) receiving chemotherapy for MM patients and to identify psychosocial factors influencing their QOL.Methods: A cross-sectional descriptive design was used. A total of 110 MM patients receiving chemotherapy were recruited into the study. The data were collected by personal interviews using questionnaires and were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson’s correlation, and hierachial multiple regression analysis.Findings: Global health status QOL was explained by uncertainty, anxiety, and depression. Functional QOL was explained by age, uncertainty, and anxiety. Symptom QOL was explained by pain, and depression. Uncertainty, anxiety and depression were the strongest predictive factors. To improve QOL of patients with MM, nurses should focus on the factors identified in this study when doing nursing care.Impact statement: This study confirmed psychological difficulties such as uncertainty, anxiety and depression affecting quality of life of MM patients receiving chemotherapy.

Evaluation of the activity of RA and sustained remission in patients ongoing biological therapy

The aim of the study is to establish the frequency and sustained remission and low disease activity in patients with RA in the course of long-term treatment with synthetic and biological means (DMARDs) in real conditions. In the conditions of retrospective data analysis of real clinical practice, there were included 209 patients suffering from RA. Activity indexes of RA in all patients were analyzed in the last year of treatment with bDMARDs. The average age of the patients is 59,01 years old. The dominants sex is female (84.6%). The beginning of treatment with biological therapy is delayed with the average of 8.21 year. In all activity indexes of RA, which were monitored in the beginning of the 6th and the 12th months, there was established a significant difference in their variation for the periods surveyed. There is a general trend towards lowering the values of our indicators. In the beginning of the monitored period, the patients going into remission (DAS28 CRP) are approximately 3 times less – 11% (n = 23) in comparison with those in the end of the study – 32.99% (n = 64) (p &lt; 0.001). In 10% of the cases a sustained remission is observed by both combined indexes (DAS28 ESR and DAS28 CRP) (p &lt; 0.001). Today the accurate way is the “treat to target” strategy. The purpose is lowering the activity of the disease to very low levels (or remission) and achieving a long-term remission which is now real and achievable.

Psychosocial Characteristic and Health Care for Unemployed Youths with Extreme Obesity - A Model Project

In clinical care, unemployed youths have limited access to available obesity treatments including obesity surgery. With the implementation of a specialized obesity outpatient unit in cooperation with five German job-centers we aim to prove whether unemployed youths are interested in obesity treatment and how they adhere to a multilevel obesity treatment in terms of participation rates. Youths (aged 15.0-24.9 years) with a body-mass-index (BMI) ≥30 kg/m2 were initially offered an individualized patient information concerning obesity treatment on the premises of the job-center. If interested, youths were included in the multicomponent treatment program (6 sessions). Those who participated in a minimum of 5 out of 6 treatment sessions were offered access to a preparation course (4 sessions) and an individualized evaluation of the indication for obesity surgery. Between 2012 and 2017, 83 youths (mean age 21.1 years, BMI 48.1 kg/m2, BMI 35.0-39.9 kg/m2: N=7, ≥40 kg/m2: N=71) were enrolled in the treatment program. 34 participated in ≥5/6 sessions in the multicomponent obesity treatment and 20 expressed an interest in obesity surgery. To date, 11 adolescents underwent obesity surgery with a mean BMI reduction of 14.3 kg/m2 between 3 and 36 months after obesity surgery (excess weight loss 27.3%) vs. 3.8 kg/m2 between 6 and 48 months after treatment initiation in the group of youths who did not receive obesity surgery. 13 youths were integrated in the primary labor market. Several unemployed youths accepted our treatment program and improved their health and vocational status in the course of their participation. The implementation of a specialized obesity outpatient unit within German job-centers is a successful strategy to characterize this high-risk-group and to determine their individual treatment needs. This finding must be confirmed with a larger sample size and by evaluating the long-term course of treatment.

Dietary polysaccharide-rich extract from Eucheuma cottonii modulates the inflammatory response and suppresses colonic injury on dextran sulfate sodium-induced colitis in mice.

Inflammatory bowel disease (IBD) is a known medical burden in most developed countries and a significant cause of morbidity. The IBD label includes Crohn’s disease (CD) and ulcerative colitis (UC). Pharmacological and surgical intervention are the two main management approaches for IBD. Some drugs have been developed for IBD therapy, but accessibility is limited due to high costs. Furthermore, these agents have demonstrated inactivity over long-term treatment courses. Therefore, an urgent need is present for new treatment options that are safe, able to sustain clinical remission, and improve mucosal gut healing. Seaweed has received much attention in the pharmacological field owing to its various biomedical properties, including the prolongation of blood clotting time, as well as antitumor, anti-inflammation, and antioxidant effects. This study therefore aimed to examine the effects of a dietary polysaccharide-rich extract obtained from Eucheuma cottonii (EC) on a model of colitis. Colitis was induced in male BALB/c mice by the administration of 2.5% (w/v) dextran sulfate sodium (DSS) for 7 days. DSS-induced mice were treated with either one of three different doses of EC extracts (0.35, 0.70, and 1.75 g/kg body weight) or curcumin as a positive control (0.10 g/kg). Mice were sacrificed post-treatment and blood samples were collected. The disease activity index (DAI) and inflammatory cytokine levels (tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, IL-10) were measured. After treatment for 7 days, EC extract administration protected against weight loss and decreased the colon weight per length ratio. EC extract administration also decreased pro-inflammatory cytokine expression, increased IL-10 levels, and reduced colonic damage. Therefore, a dietary polysaccharide-rich extract from E. cottonii reduced DSS-induced bowel inflammation, thereby becoming a promising candidate for the treatment of colitis.

Long-term dienogest administration in patients with symptomatic adenomyosis.

Adenomyosis is a common gynecological disorder that causes dysmenorrhea, hypermenorrhea and metrorrhagia. Previously, we reported that 24 weeks of dienogest treatment is highly effective for pain in symptomatic adenomyosis. Up to present, there is no report that describes treatment of adenomyosis with long-term dienogest administration for more than 2 years. In this retrospective cohort study, we investigated the course of long-term dienogest treatment in patients with symptomatic adenomyosis. This is a retrospective cohort study. Dienogest was continuously administered at a dose of 2 mg daily for patients with symptomatic adenomyosis. The outcome of long-term administration of dienogest was investigated, and the characteristics of patients were compared between discontinued cases and long-term administration cases. Two patients were excluded from this study because of transfer to another hospital or discontinuation due to infertility treatment. Twelve of 18 patients (66.7%) received dienogest until menopause or for a period of >80 months. Four cases (22.2%) discontinued dienogest treatment because of severe metrorrhagia. In the discontinued cases because of severe metrorrhagia, the pain score for dysmenorrhea and serum CA125 level at baseline significantly elevated, and the hemoglobin level at baseline and the frequency of type 2 adenomyosis significantly decreased, compared to those with long-term use. Moreover, long-term dienogest use did not decrease the serum estradiol level. Our report suggests that dienogest is tolerable for long-term use until menopause and can be an alternative treatment option in some patients, especially those with type 2 adenomyosis, to avoid hysterectomy.

ЭФФЕКТИВНОСТЬ ХИМИОТЕРАПИИ С ПРИМЕНЕНИЕМ БЕДАКВИЛИНА У БОЛЬНЫХ ТУБЕРКУЛЕЗОМ ЛЕГКИХ С ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТЬЮ ВОЗБУДИТЕЛЯ

The objective: to evaluate the efficiency of chemotherapy with bedaquiline in pulmonary tuberculosis patients with multiple drug resistance Subjects and methods. The chemotherapy efficiency was studied in 70 tuberculosis patients with extensive (XDR) or multiple (MDR) drug resistance who were treated in clinics of Central Tuberculosis Research Institute All patients were divided into 3 groups: Group 1 (10 persons) included MDR TB patients, Group 2 (32 persons) included pre-XDR TB patients, Group 3 (28 persons) included XDR TB patients Results of the study. High treatment efficiency in this difficult category of pulmonary tuberculosis patients with MDR and XDR was achieved when bedaquiline was added to the chemotherapy regimen Upon the completion of the main treatment course with bedaquiline, in the group of patients with MDR and pre-XDR the sputum conversion was achieved in 100%, and in XDR tuberculosis patients the sputum conversion rate made 893% The long-term treatment course with bedaquiline promoted the fastest sputum conversion, healing of cavities in the lungs of patients with disseminated tuberculosis and XDR, and it was not associated with a higher frequency of adverse events

INFLUENCE OF MEDICO-SOCIAL RISK FACTORS ON PSYCHOEMOTICAL STATE AND SELF-ESTEEM OF FEMALE PATIENTS OF REPRODUCTIVE AGE WITH TUBERCOLOSIS OF THE RESPIRATORY SYSTEM

Aim - to study the influence of medical and social risk factors on the psychoemotional state and selfesteem of female patients of reproductive age with tuberculosis of the respiratory system. Material and methods. The main group consisted of 93 women aged 18-44 with tuberculosis of the respiratory system who received treatment in one of the anti-tuberculosis institutions of the Nizhny Novgorod region in 2013. The comparison group consisted of 82 almost healthy women of the corresponding age. To assess the psychoemotional state, we carried out a survey using the SAM test method (state of health, activity, mood); to evaluate personality traits - the test «Self-assessment of the personality» by O.I. Motkov. The questionnaire included additional questions of medical and social nature. Results. It was proven that the presence of unfavorable medical and social risk factors in this category of patients causes a decrease in self-evaluation of the positive aspects of the personality, and has a negative impact on the psychoemotional state of patients, causing poor health (lowest evaluated), low activity, bad mood. In the course of long-term treatment, women feel tired and exhausted. Among the medical and social risk factors that have adverse impact on the psychoemotional state and self-esteem of women, the following factors should be highlighted: low level of education, poor financial situation, lack of awareness about prophylaxis of tuberculosis, intense interpersonal relationships in the family, frequent exposure to stress and rueful feelings, irregularity of the prophylactic chest X-ray examinations, violation of the work-rest regime, dietary regimen and quality of nutrition, the history of tubercular contact and incarceration. Conclusion. The results of the research demonstrate the need for developing and implementation of measures of providing psychological assistance to the female patients of reproductive age with active tuberculosis of the respiratory system, as well as new approaches to the prevention of this disease, based on established psychological risk factors for the emergence of tuberculous process and its recurrence.

Therapeutic Utility of Opioids for Restless Legs Syndrome.

Restless legs syndrome (RLS) is a sensorimotor neurologic disorder characterized by an unpleasant urge to move the legs, often accompanied by leg dysesthesias. Symptoms predominate in the evening or at night and often cause significant distress and disruption of sleep. Several non-opioid classes of drugs provide initial relief from the symptoms of RLS. Among these, however, the efficacy ofdopamine agonists can wane over time or even paradoxically 'augment' the severity of symptoms during the course of long-term treatment. Opioids can alleviate RLS symptoms, even in patients who have become refractory to, or do not tolerate, other drugs. In a carefully selected group of patients with severe RLS that has not been effectively managed with other therapies, opioids may be an appropriate treatment.

Synthesis and defect structure of quasi-one-dimensional composite material ZnO/ZnS

Nanostructured composite material ZnO/ZnS based on ZnO nanocrystalline nanotubes has been produced by the chemical bath deposition method. To retain the morphology of ZnO nanotubes, their surface was modified through chemical substitution of sulfur atoms for surface oxygen atoms and oxygen vacancies. The content of deposited ZnS nanoparticles depends on the nature of the sulfiding agent, pH, and the type of ligand. The morphological features of polycrystalline ZnO nanotubes remain unaltered in the course of long-term treatment of ZnO nanotubes in a sulfiding agent solution.

Application of physiotherapy in onychomycosis

Onychomycosis is a kind of finger or toe nail disorders caused by the infection with dermatophytes or other fungi. The current treatment of onychomycosis can be divided into pharmacotherapy and physiotherapy. Pharmacotherapy, including oral and topical antifungal agents, has definite therapeutic effects and is the most effective approach at present. However, pharmacotherapy has some disadvantages, such as a longterm course of treatment, obvious side effects, and poor patient compliance. Physiotherapy, as a secondline therapy, includes laser therapy, photodynamic therapy and adjuvant physical therapy. Many experiments and clinical studies have shown that physiotherapy is effective for the treatment of onychomycosis with few adverse effects and wide applicability, and has been gradually becoming a new hotspot in the treatment of onychomycosis. Key words: Onychomycosis; Physical therapy modalities; Laser therapy; Photochemotherapy; Nails

Qualitative interviews with non-national tuberculosis patients in Cairo, Egypt: understanding the financial and social cost of treatment adherence.

Limited data are available about the challenges of non-national TB patients undergoing long-term treatment courses in an urban setting. This study aimed to understand the financial and social cost of adherence of non-national TB patients in Cairo, Egypt as a means to inform the development of context-specific interventions to support treatment adherence. In 2011, 22 in-depth interviews were conducted with TB patients from Sudan, Ethiopia, Eritrea, Somalia and Djibouti to obtain qualitative data. Analysis was based on thematic analysis that aimed to identify recurrent themes and codes from the narratives. The study identified a number of factors that influence TB treatment adherence. Uncertain financial status due to limited or no employment was frequently discussed in interviews, which resulted in fear of not being able to support family, loss of pride, dependence on family and friends, fear of losing housing, food insecurity and limited food options. Respondents also feared infecting other household members and longed for opportunities to discuss their illness and treatment experiences with other individuals but their social networks were often limited. TB-related stigma was driven by shame and blame of infection. Respondents also believed stigma was based on their foreign origin. Stigma manifested in distancing and exclusion in various ways, resulting in isolation, psychological distress and reluctance to disclose TB status to others. Poverty-related factors and social context with a special focus on stigma should be considered when developing strategies for supporting long-term treatment courses for non-national patients in Cairo and other similar urban settings.

Effect of adapalene 0.1%/benzoyl peroxide 2.5% topical gel on quality of life and treatment adherence during long-term application in patients with predominantly moderate acne with or without concomitant medication - additional results from the non-interventional cohort study ELANG.

In addition to physical long-lasting effects such as permanent scarring and disfigurement, acne has acute and long-term psychosocial effects that affect the individual's quality of life. As with other chronic diseases, treatment success is often compromised by poor adherence. Two main objectives of this non-interventional study were to assess the long-term effect of the fixed-dose combination adapalene 0.1%/benzoyl peroxide 2.5% (adapalene-BPO gel) on quality of life and treatment adherence. Patients with moderate to severe facial acne receiving adapalene-BPO alone or in combination with other drugs were enrolled in this non-interventional study. Data were documented at baseline and after 3 and 9 months of adapalene-BPO treatment. The secondary outcomes reported here include quality of life determined by the Cardiff Acne Disability Index (CADI), treatment adherence assessed by the ECOB (Elaboration d'un outil d'evaluation de l'observance des traitements medicamenteux) questionnaire, and patient satisfaction. In total, 5131 patients were included in the efficacy evaluation. After 9 months, mean (±SD) quality of life (CADI) improved significantly from 5.9 ± 3.0 to 2.4 ± 2.7 (P < 0.0001). Patients with more severe acne at baseline tended to achieve a greater improvement in quality of life. Long-term adherence was found to be good in 83.9% of patients. Adherence had a significant effect on efficacy and quality of life (P < 0.0001 respectively). The vast majority of patients (92.1%) reported subjective improvement at the interim analysis. Accordingly, most patients (84.8%) were satisfied or very satisfied with adapalene-BPO by the end of the observation period. The clinical improvement of the disease led to an increase in quality of life among acne patients. The treatment success may be a motivation factor for patients to stay adherent over the long-term treatment course, indicating the qualification of adapalene-BPO topical gel as an appropriate medication also in the long-term usage.

Effects of 10 to 30 years of lithium treatment on kidney function.

Long-term lithium treatment is associated with end-stage renal disease, but there is little evidence of a clinically significant reduction in renal function in most patients. We previously found that 1.5% of people who took lithium from the 1960s and 1970s developed end-stage renal disease; however, none of the patients who started after 1980 had end-stage renal disease. Here we aimed to study the prevalence and extent of kidney damage during the course of long-term lithium treatment since 1980. We retrieved serum lithium and creatinine levels from 4879 patients examined between 1 January 1981 and 31 December 2010. Only patients who started their lithium treatment during the study period and had at least 10 years of cumulative treatment were included. The study group comprised 630 adult patients (402 women and 228 men) with normal creatinine levels at the start of lithium treatment. There was a yearly increase in median serum creatinine levels already from the first year of treatment. About one-third of the patients who had taken lithium for 10-29 years had evidence of chronic renal failure but only 5% were in the severe or very severe category. The results indicate that a substantial proportion of adult patients who are treated with lithium for more than a decade develop signs of renal functional impairment, also when treated according to modern therapeutic principles. Our results emphasise that lithium treatment requires continuous monitoring of kidney function.

An Overview of Quality of Life in Vitiligo Patients ? At Glance

Vitiligo is an acquired depigmentary skin disorder characterized by white maculae on the skin associated with social stigma. Vitiligo has major impact on the quality of life due its high cosmetic value, chronic nature of disease and long term ineffective treatments. Vitiligo patients suffer from low self-esteem and poor body image that affects their emotional and psychological well-being. To investigate quality of life of Vitiligo patients, psychological impact of unpredictable course of disease and long term treatment among South Indian population. A total of 155 Vitiligo patients, undertaking treatment in dermatology clinic at the Central Research Institute of Unani Medicine (CRIUM), who completed the Dermatology Quality of Life Index (DLQI) questionnaire, participated in this study. Patients with Vitiligo averaged at about 27.4% of maximum psychological impairment as measured by the DLQI summary score. Disability in patients was highest in treatment category with 54.6% of impairment followed by symptoms and feelings (41.83%). Dark skin, unmarried, slow responders to the treatment and those having chronicity more than 5 years showed worse quality of life and had 70%, 61%, 62%and 76.5% of impairment in the treatment front of DLQI respectively when compared to light skin (50%), married (52.5%), rapid responders (26%) and chronicity less than 5 years (52%). There was no significant difference in the quality of life between male and female Vitiligo patients (p=0.88). Our results show that Vitiligo patients suffer in all aspects of life especially in treatment aspect of DLQI. Psychological impairment strongly affects the social well-being of Vitiligo patients.

Reduction of Granulocyte-Colony Stimulating Factor Requirement in the Course of Long-Term Treatment for More Than 5 Years in Congenital Neutropenia Patients Harbouring ELANE Mutations

Congenital neutropenias include a heterogeneous group of diseases characterized by a decrease in circulating neutrophils and different underlying germ-line gene mutations. Since 1988 recombinant human G-CSF is available for the treatment of severe chronic neutropenia patients. In phase I/II/III studies in patients with severe congenital and cyclic neutropenia, treatment with recombinant human granulocyte colony-stimulating factor (r-metHuG-CSF) resulted in a rise in the absolute neutrophil counts (ANC) and a reduction in infections. The Severe Chronic Neutropenia International Registry collects clinical information on patients suffering from severe chronic neutropenia since 1994. 312 of 379 CN and 65 of 79 CyN patients receive long-term G-CSF treatment for a median duration of 8,26 years in CN and 9,37 in CyN. Median G-CSF doses vary by neutropenia subtype and gene mutation. Patients with congenital neutropenia revealing ELANE mutations require the highest G-CSF doses compared to other subtypes (median G-CSF dose 5 µg/kg/day in 88 patients). SCNIR follow-up data suggest that pediatric ELANE-CN patients were maintained at a particular G-CSF dose per kg body weight for longer than expected by the gain of body weight. We therefore analysed the reported yearly G-CSF doses in all treated ELANE-CN patients to evaluate the dose trend:From 88 G-CSF treated patients with ELANE-CN we excluded 16 patients with nonresponse (ANC remained below 0.5 x 109 /L) and partial response (ANC remained between 0.5 and 0.99 x 109 /L). Since the gain of body weight is highest during the first 5 years of life with and 10-fold increase we divided G-CSF good responders by age at G-CSF initiation (0-5 years vs above 6 years) and compared G-CSF doses at the end of the dose finding period with the last dose reported. 51 of the remaining 72 patients started G-CSF treatment between the first and 5th year of life with a median G-CSF treatment duration of 9.76 years. 37 of the 51 patients were treated for at least 5 years. In 21 of the 72 patients G-CSF treatment was initiated after their 10thbirthday with a median follow up of 20.45 years. 19 of the 21 patients were treated for at least 5 years. All patients with a treatment duration of less than 5 years were excluded from further analysis.In ELANE-CN patients with treatment start at an age of 0-5 years the mean G-CSF dose decreased significantly from 13.47 µg/kg/day at the time of ANC-response to 7.96 µg/kg/day at the last report (median G-CSF dose decreased from 6.85 µg/kg/day to 4.42 µg/kg/day) during a treatment duration of at least 5 years.In summary, a significant decrease in the individual G-CSF doses could be observed in ELANE-CN patients who started G-CSF treatment during the first five years of their lives suggesting an age dependent alleviation of the severity of the disease as judged by the response to G-CSF. DisclosuresNo relevant conflicts of interest to declare.

Incidence and Predictors of Vancomycin-Associated Nephrotoxicity

Earlier studies reported a low incidence of vancomycin-associated nephrotoxicity (VAN); however, recent studies have reported higher incidences exceeding 30%. Predictors of nephrotoxicity are not well defined. In this study we aimed to better estimate the incidence and evaluate predictors of VAN in a cohort of patients predominated by long treatment courses. We conducted a retrospective study on patients treated with vancomycin while in the hospital and who were observed closely through the Outpatient Parenteral Antibiotic Therapy program. Nephrotoxicity was defined as an increase in the serum creatinine level of 0.5 mg/dL or 50% from baseline on at least two consecutive readings while taking vancomycin. We compared the patients who developed nephrotoxicity with those who did not with regard to vancomycin dosing, trough levels, baseline serum creatinine, underlying infection, residence in the critical care unit, comorbid conditions, concurrent nephrotoxic treatments, and baseline characteristics. Of 579 patients, 154 (26.6%) developed nephrotoxicity. Ninety patients developed VAN within the first 14 days of treatment, whereas 64 patients developed nephrotoxicity after 14 days of treatment. The median time to development of nephrotoxicity was 9 days. Admission to the intensive care unit, concurrent use of loop diuretics, and comorbidity with cirrhosis were independently associated with nephrotoxicity. A higher baseline creatinine value was unexpectedly associated with a lower incidence of nephrotoxicity (P = 0.0016). VAN is not an uncommon outcome in both short- and long-term treatment courses. Admission to the intensive care unit while receiving treatment, concurrent treatment with a loop diuretic, an underlying diagnosis of cirrhosis, and the initial trough level appear to be the main risk factors for nephrotoxicity. Unexpectedly, elevated baseline creatinine levels appeared to be protective and this could be the result of careful use of vancomycin among individuals with relatively higher baseline creatinine values.

Position paper on the importance of psychosocial factors in cardiology: Update 2013.

Background: The rapid progress of psychosomatic research in cardiology and also the increasing impact of psychosocial issues in the clinical daily routine have prompted the Clinical Commission of the German Heart Society (DGK) to agree to an update of the first state of the art paper on this issue which was originally released in 2008.Methods: The circle of experts was increased, general aspects were implemented and the state of the art was updated. Particular emphasis was dedicated to coronary heart diseases (CHD), heart rhythm diseases and heart failure because to date the evidence-based clinical knowledge is most advanced in these particular areas. Differences between men and women and over the life span were considered in the recommendations as were influences of cognitive capability and the interactive and synergistic impact of classical somatic risk factors on the affective comorbidity in heart disease patients.Results: A IA recommendation (recommendation grade I and evidence grade A) was given for the need to consider psychosocial risk factors in the estimation of coronary risks as etiological and prognostic risk factors. Furthermore, for the recommendation to routinely integrate psychosocial patient management into the care of heart surgery patients because in these patients, comorbid affective disorders (e.g. depression, anxiety and post-traumatic stress disorder) are highly prevalent and often have a malignant prognosis. A IB recommendation was given for the treatment of psychosocial risk factors aiming to prevent the onset of CHD, particularly if the psychosocial risk factor is harmful in itself (e.g. depression) or constrains the treatment of the somatic risk factors. Patients with acute and chronic CHD should be offered anti-depressive medication if these patients suffer from medium to severe states of depression and in this case medication with selective reuptake inhibitors should be given. In the long-term course of treatment with implanted cardioverter defibrillators (ICDs) a subjective health technology assessment is warranted. In particular, the likelihood of affective comorbidities and the onset of psychological crises should be carefully considered.Conclusions: The present state of the art paper presents an update of current empirical evidence in psychocardiology. The paper provides evidence-based recommendations for the integration of psychosocial factors into cardiological practice and highlights areas of high priority. The evidence for estimating the efficiency for psychotherapeutic and psychopharmacological interventions has increased substantially since the first release of the policy document but is, however, still weak. There remains an urgent need to establish curricula for physician competence in psychodiagnosis, communication and referral to ensure that current psychocardiac knowledge is translated into the daily routine.

Long-term follow-up on Cushing disease patient after transsphenoidal surgery.

Cushing disease is caused by excessive adrenocorticotropic hormone (ACTH) production by the pituitary adenoma. Transsphenoidal surgery is its first-line treatment. The incidence of Cushing disease in children and adolescents is so rare that long-term prognoses have yet to be made in most cases. We followed-up on a 16-year-old male Cushing disease patient who presented with rapid weight gain and growth retardation. The laboratory findings showed increased 24-hour urine free cortisol and lack of overnight cortisol suppression by low-dose dexamethasone test. The serum cortisol and 24-hour urine free cortisol, by high-dose dexamethasone test, also showed a lack of suppression, and a bilateral inferior petrosal sinus sampling suggested lateralization of ACTH secretion from the right-side pituitary gland. However, after a right hemihypophysectomy by the transsphenoidal approach, the 24-hour urine free cortisol levels were persistently high. Thus the patient underwent a total hypophysectomy, since which time he has been treated with hydrocortisone, levothyroxine, recombinant human growth hormone, and testosterone enanthate. Intravenous bisphosphonate for osteoporosis had been administered for three years. At his current age of 26 years, his final height had attained the target level range; his bone mineral density was normal, and his pubic hair was Tanner stage 4. This report describes the long-term treatment course of a Cushing disease patient according to growth profile, pubertal status, and responses to hormone replacement therapy. The clinical results serve to emphasize the importance of growth optimization, puberty, and bone health in the treatment management of Cushing disease patients who have undergone transsphenoidal surgery.