Summary
One hundred and fifty patients requiring maintenance haemodialysis were investigated to determine the incidence and pattern of tuberculosis. Twenty patients were found to have tuberculosis, giving an incidence of 13.3 times that of the general population. The most frequent clinical presentations of tuberculosis in these patients were pyrexia, pleural effusion and lymphadenopathy. Diagnostic difficulties were encountered in 7 patients in whom therapeutic trial with anti-tubercular drugs had to be undertaken. Two patients died from tuberculosis. Five patients received renal transplants after initial treatment of tuberculosis.
Summary:Ninety-five renal transplant recipients from an endemic area of tuberculosis were investigated to find out the prevalence and course of tuberculosis in pre-and post-transplant periods. Eleven patients had tuberculosis in the pre-transplant period -pulmonary (2), pleural (2), miliary (1), abdominal (2), lymph node (5) and pericardial (1). They were transplanted after antituberculous therapy of 3 to 6 months with satisfactory results. The anti-tuberculous treatment was usually continued for 2 years.
Background
In caring for patients with advanced cancer, accurate estimation of survival is important for clinical decision making. The purpose of this study was to assess the accuracy of 2‐year survival probabilities estimated by oncologists, patients, and caregivers and to identify demographic and clinical factors associated with prognostic accuracy.
Methods
This was a secondary observational analysis of data obtained from a cluster randomized controlled trial. Participants included 38 oncologists, 263 patients with advanced nonhematologic cancer, and 193 of their caregivers from clinics in Sacramento and Western New York. Discrimination within each group (oncologists, patients, caregivers) was evaluated using the C statistic, whereas calibration was assessed by comparing observed to predicted 2‐year mortality using the chi‐square statistic.
Results
The median survival from study entry was 18 months, and 41.8% of patients survived for 2 years. C statistics for oncologists, patients, and caregivers were 0.81 (95% CI, 0.76‐0.86), 0.62 (95% CI, 0.55‐0.68), and 0.72 (95% CI, 0.65‐0.78), respectively; oncologists’ predictions were better than the predictions of both patients (P = .001) and caregivers (P = .03). Oncologists also had superior calibration: their predictions of 2‐year survival were similar to actual survival (P = .17), whereas patients’ (P = .0001) and caregivers’ (P = .003) predictions diverged significantly from actual survival. Although most oncologists’ predictions were classified as realistic (62.0%), approximately one‐half of patients’ and caregivers’ predictions (50.0% and 46.0%, respectively) were unduly optimistic. Among patients, nonwhite race and higher levels of social well‐being predicted undue optimism (P < .05).
Conclusions
Compared with oncologists, patients and caregivers displayed inferior prognostic discrimination, and their predictions were poorly calibrated, primarily because of overoptimism.
Fifteen cases of acute renal failure follwoing scorpion sting were studied. The onset of disease was characterized by the occurrence of hemoglobinuria within 24 h of the sting. Most of the patients developed oliguria, edema, hemolytic anemia, and hemolytic jaundice. Renal failure developed within a few days after the sting, and in five patients was severe enough to need dialysis. The onset of diuresis in oliguric patients occurred between 6 and 21 days following the sting. Renal biopsies were possible in four cases and showed mesangial proliferation, variable degrees of tubular changes, and mild interstitial infiltration. The pathogenesis of acute renal failure in these patients is discussed
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