Objective: to analyze the occurrence of depression and quality of life in renal patients before and after transplantation. Method: quantitative, descriptive, exploratory, cross-sectional study. Three instruments were used to collect data: a questionnaire for characterization of the sample, the Beck depression inventory (BDI) and the SF-36 questionnaire, to evaluate the quality of life. The sample consisted of two groups: one in pre-transplant patients (59 patients) and the other in renal transplant patients (63 patients), totaling 122 patients. Results: the majority of patients, in both groups, did not present depression, corresponding to 88.9% of the transplanted patients and 79.6% of the pre-transplant patients. Quality of life was higher in transplant patients than in those awaiting the procedure. The SF-36 domains that determined the best quality of life in the transplanted patients were functional capacity (p = 0.001), pain (p = 0.027), general health status (p = 0.049) and vitality (p = 0.000). Conclusion: this study showed a low occurrence of depression in patients both in the pre-and post-renal transplantation. Quality of life was higher in the transplant group. Descriptors: Depression, Quality of Life; Organ Transplantation; Chronic Disease. RESUMOObjetivo: analisar a ocorrência de depressão e a qualidade de vida em pacientes renais no pré e pós-transplante. Método: estudo quantitativo, descritivo, exploratório, de coorte transversal. Foram aplicados três instrumentos para a coleta de dados: um questionário para caracterização da amostra, o inventário Beck de depressão (BDI) e o questionário SF-36, para avaliação da qualidade de vida. A amostra foi composta por dois grupos, um de pacientes no pré-transplante renal (59 pacientes) e o outro de transplantados renais (63 pacientes), totalizando 122 pacientes. Resultados: a maioria dos pacientes, em ambos os grupos, não apresentava depressão, correspondendo a 88,9% dos transplantados e 79.6% de pacientes no pré-transplante. A qualidade de vida mostrou-se superior nos pacientes transplantados em relação aos que aguardavam o procedimento. Os domínios do questionário SF-36 que determinaram a melhor qualidade de vida nos pacientes transplantados foram capacidade funcional (p = 0,001), dor (p = 0,027), estado geral de saúde (p = 0,049) e vitalidade (p = 0,000). Conclusão: esse estudo mostrou uma baixa ocorrência de depressão nos pacientes tanto no pré, como no pós-transplante renal. A qualidade de vida mostrou-se superior no grupo de transplantados. Descritores: Depressão, Qualidade De Vida; Transplante de Órgãos; Doença Crônica. RESUMENObjetivo: analizar la ocurrencia de depresión y la calidad de vida en pacientes renales en el pre y posttrasplante. Método: estudio cuantitativo, descriptivo, exploratorio, de cohorte transversal. Se aplicaron tres instrumentos para la recolección de datos: un cuestionario para la caracterización de la muestra, el inventario Beck de depresión (BDI) y el cuestionario SF-36, para la evaluación de la calidad de vida. La muest...
We aimed to investigate and compare the effects of chronic antiepileptic therapy on bone health in pediatric patients using quantitative ultrasound of the phalanges (QUS) and controlling for potential confounding factors, particularly nutrient intake. The amplitude-dependent speed of sound (Ad-SoS) was measured in 33 epileptic children and 32 healthy children aged 6.5 ± 3.1 and 6.3 ± 1.1 (mean ± SD) years, respectively. There were no significant differences in the demographics such as age, weight and height between epileptic children and the control group children. None of the children in the epileptic or the treatment group were found to have a vitamin D deficiency. There were no significant differences in laboratory tests between groups. Lower QUS figures were found in the epileptic children (p = 0.001). After further adjustment for potential confounders such age, height, weight, calcium intake, vitamin D intake, physical activity and sex, the differences remained significant (p < 0.001). After further classification of the participants based on the tertile of calcium intake, no significant differences were found between patients and healthy controls in the greatest tertile of calcium intake (p = 0.217). We conclude that anticonvulsant therapy using valproate may lead to low bone mass in children and that an adequate intake of calcium might counteract such deleterious effects.
Isovaleric acidemia (IVA) is a rare disorder of leucine metabolism. We carried out a multicenter study of IVA patients diagnosed by newborn screening (NBS) or symptoms clinics over a period of 28 years in Spain. Evaluated at diagnosis, data included age, detection method, levels of C5 and IVG, enzymatic studies, clinical presentation parameters and genotype in 16 patients. Follow-up data included C5 levels, intellectual quotient and correlation genotype-phenotype. IVA was detected by NBS in 8 patients (prevalence of 1/326 629). Except 1, all the 8 patients identified by NBS were asymptomatic at diagnosis and had isovalerylcarnitine (C5) levels of 1.6-6.4 μM and isovalerylglycine (IVG) levels <1100 mmol per mol creatinine; they remained asymptomatic with a natural protein intake ⩾1.5 g kg per day. Symptomatic patients with chronic intermittent or acute neonatal IVA had C5 levels of 3.9-16.3 μM and IVG levels >3400 mmol per mol creatinine. The percentage of isovalerate incorporation in fibroblasts was 64-80% in patients detected by NBS and 4.9-13% in symptomatic patients. Cognitive function was within normal ranges in all patients but was negatively correlated with IVG at detection (-0.592; P<0.05). The genetic analysis revealed nine novel mutations. The clinical/biochemical phenotype correlated fairly well with the phenotype predicted by the mutations found. In conclusion, although blood C5 levels have traditionally been considered the prognostic marker of choice, urine IVG levels would appear to be a better predictor, as they correlated well with severity of mutations and were associated with a lower incorporation rate of IVA in fibroblasts and a less favorable clinical course.
Objective: to present the scientific production on quality of life, some historical, ethical, legal and emotional involving the transplantation of organs and tissues. Methods: this is a descriptive and exploratory study that it was sought in Medline, Scielo and Lilacs, involving adults, to search using the following descriptors depression, quality of life, transplantation of kidney and chronic disease as well as consultation on text books and articles cited in the references obtained in the review. Results: the scientific production presented had two relevant aspects: the significant technological and evolution and policies concerned with the transplantation of organs and tissues in Brazil and the evidence of an insignificant value people give to emotional and social aspects in patient’s life quality. It was also observed a disproportional between the number of viable organs and the crescent waiting list, related to the failure in the notification of cases of cerebral deaths and to the failure in approaching the families to donate the organs of their family member. Conclusion: Despite the also technological development of dialysis treatment, renal transplantation has been described as the best option in order to provide better quality of life for chronic kidney patient. But it is valid to emphasize that, like any treatment, the transplant has implications that need to be clarified in order to avoid future frustrations and complications or emotional and psychological. Descriptors: depression; quality of life; organ transplantation; chronic disease.
The worldwide prevalence of asymptomatic coeliac disease (CD) is increasing, which is in part due to the routine screening of children with risk factors. Both symptomatic and asymptomatic patients with CD are at risk of long-term complications. The objective of this study was to compare the clinical characteristics of asymptomatic and symptomatic children at the time of CD diagnosis. A case–control study was conducted using data from a cohort of 4838 CD patients recruited from 73 centers across Spain between 2011 and 2017. A total of 468 asymptomatic patients (cases) were selected and matched by age and sex with 468 symptomatic patients (controls). Clinical data, including any reported symptoms, as well as serologic, genetic, and histopathologic data were collected. No significant differences were found between the two groups in most clinical variables, nor in the degree of intestinal lesion. However, the asymptomatic patients were taller (height z-score −0.12 (1.06) vs. −0.45 (1.19), p < 0.001) and were less likely to have anti transglutaminase IgA antibodies ≥ 10 times the upper normal limit (66.2% vs. 758.4%, p = 0.002). Among the 37.1% of asymptomatic patients who were not screened for CD due to the absence of risk factors, only 34% were truly asymptomatic, while the remaining 66% reported non-specific CD-related symptoms. Therefore, expanding CD screening to any child who undergoes a blood test could reduce the burden of care for some children, as many of those considered asymptomatic reported non-specific CD-related symptoms.
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