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Exploring patient characteristics and barriers to Hepatitis C treatment in patients on opioid substitution treatment attending a community based fibro-scanning clinic

population ranges from 62-81% [ 42 , 43 ] with risk factors similar to those reported elsewhere. These are injecting drug use, [ 42 , 43 - 47 ] frequency and length of time injecting, [ 45 , 48 , 49 ] needle sharing and having a history of imprisonment. [ 45 ] Low uptake of screening and follow up assessments are also reported [ 51 - 53 ] In Ireland, the treatment with DAAs is restricted to those with more advanced liver disease, determined by fibroscan score, with current guidelines identifying those with scores of > 8.5 kPa as being eligible for the treatment

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Early detection of liver damage in Mexican patients with chronic liver disease

regardless of etiology. Finally, the diagnostic values of these biochemical parameters were compared with scores for the detection of liver fibrosis in Table 6 . In general, the sensitivity and specificity values were similar, fundamentally with the GPRI-Score and the FORNS-Index, but the PPV and concordance values were higher as compared to the other scores. Table 5 Cut-off values and ROC curve of biochemical parameters related to advanced liver damage using TE Variable AUCs P -value Optimal Sensitivity Specificity PPV NPV Concordance

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Changes in Health-Related Quality of Life in Greek Adult Patients Two Years after Successful Renal Transplantation

Abstract

Introduction. This study was undertaken to compare and evaluate the heath-related quality of life (HRQOL) in Greek adult transplant recipients before and 2 years after successful renal transplantation (RT). The SF-36 survey score was used. Methods. Eighty-five Greek hemodialysis patients underwent RT at the Transplant Unit of Evangelismos General Hospital of Athens, including 44 men and 41 women (mean age 43.8 years; range 21-59 years). The scale scores of a Greek version of the SF-36 survey were compared between the transplant and the hemodialysis patients. We also examined the relationships of the scale scores with the patients′ age and the type of donor. Results. According to the SF-36 health survey, transplant recipients had better results for general health perception (p≤0.001), role-physical functioning (p≤0.01), role-emotional functioning (p≤0.01), and vitality (p≤ 0.01). In addition, the scale score of physical functioning, general health and vitality of the patients who were younger than 30 years at the time of transplantation were significantly higher than those of the patients who were older than 30 years, while the scores of bodily pain, general health, and physical functioning were significantly lower in cadaveric graft recipients compared with living-related recipients. Conclusions. The SF-36 health survey is a validated and comprehensive instrument for evaluating renal transplant patients′ HRQOL. Our data demonstrated an improvement in HRQOL in renal transplant patients 2 years after successful renal transplantation. The data also confirmed that the recipients′ age at transplantation and the type of donor were important factors affecting the HRQOL.

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Alexithymia Construct in Dialysis Patients

Abstract

Introduction. The concept of alexithymia means dysfunction in emotional awareness, social attachment, and interpersonal relating. The study was performed to evaluate the alexithymia construct in patients treated with chronic maintenance haemodialysis.

Methods. TAS-20 was applied as a measure of alexithymia to a group of 230 patients, mean age 55.5±13.5 years, recruited from three dialysis centers.

Results. The results obtained showed that 50% of patients were alexithymic, and 18% had possible alexithy-mia. A small positive correlation was shown between age and obtained scores for alexithymia (r=0.025). Duration of dialysis also positively influenced the alexithymia scores (r=0.013). In addition, the duration of dialysis was significantly influenced by age (ANOVA 0.004, p<0.05). Factors analysis showed that F1 and F2 were not influenced by age or duration of dialysis. Only factor F3 (externally oriented thinking) was very perceptible and influenced by the age and the duration of dialysis (ANOVA p=0.016; <0.05).

No significant differences in scores between males and females were obtained. Only F1 was higher in males (p<0.05). The scores obtained for alexithymia were compared between healthy population and cancer and dialysis patients. Patients with chronic diseases were more alexithymic than healthy people (p< 0.05).

Conclusions. The alexithymia construct is a permanent personality trait related to neurobiological brain specifics. An alexithymia construct can influence the prognosis and outcome of dialysis patients as well as of other diseases. The psychological support for mediating alexithy-mia should be included in the therapeutic protocols, especially for end-stage renal diseases.

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High incidence of malnutrition in elective vascular surgery patients: An observational auditing study

Abstract

Background:Malnutrition has been shown to have an adverse effect on the clinical outcome of surgical patients. A >10% body weight loss in the previous 6 months is a significant preoperative predictor of worse post-operative outcome. There are limited data on malnutrition in vascular surgery patients. The current study was designed to investigate the prevalence of malnutrition in elective vascular surgery patients. Materials and Methods: This is a prospective, observational, auditing study carried out in department of vascular surgery of a tertiary, university and teaching hospital. All patients scheduled to undergo vascular surgery in a 4-month period were screened for malnutrition using the Nutritional Risk Score 2002. Nutritional status was assessed by body weight, body mass index, serum albumin and physical examination by a member of the hospitals’ nutrition team. The body weight was determined daily until 30 days post-operatively. Statistical analysis was performed using SPSS Statistics, Release Version 20.0.0. Results: On admission, 14 of 23 patients (61%) were at risk of malnutrition (Nutritional Risk Score 2002 ≥ 3). Assessment revealed no false-positive results. The mean post-operative body weight declined until Day 9. Afterwards, it rose with a mean weight gain of 1.32 kg. Conclusions: Malnutrition remains a largely unrecognized problem in vascular surgery patients. Given its detrimental effect, screening for malnutrition should be implemented in the pre-operative workup and therapeutic flow charts should be made available. Clear guidelines should also been made available for the bedside clinician.

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Are Depression and Anxiety Common in Hemodialyzed Patients?

Abstract

Researchers confirmed that depression and anxiety are two common comorbid disorders in chronic kidney patients. The aim of our study was to screen the level of depression and anxiety in a group of end-stage kidney diseases treated with hemodialysis. The evaluated sample comprised 230 participants; 110 females (mean age 55.5±13.5 years), and 120 males (mean age 54.5±14.3 years). The mean duration of maintenance dialysis was 8.3±5.8 years (from 0.5 to 24 years). Patients were selected randomly from three dialysis centers in R. Macedonia. As psychometric instruments Beck Depression Inventory (BDI) and scores from Minnesota Multiphasic Personality Inventory (MMPI-201) were used. Our study confirmed that majority of evaluated dialyzed patients are depressed and anxious in different level, but unfortunately the mental problems are frequently unrecognized. We suggested some response measures for management of these conditions in order to avoid risks for complications as well of suicide.

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Successful pharmacotherapy for multiple acute decompensation events in a cirrhotic patient with acute-on-chronic liver failure: A case report

, a diagnosis of ACLF grade 1 secondary to infection was considered ( Table 1 ). Child-Pugh score was 12 and model for end-stage liver disease (MELD) score was 25.4. He was treated with ademetionine for liver dysfunction, L-Ornithine-L-Aspartate for hepatic encephalopathy, montmorillonite powder and bifidobacterium lactobacillus tripterygium for diarrhea, and ceftriaxone sodium for infection. Table 1 Progression and remission of ACLF in this patient according to the criteria of CLIF-SOFA (Chronic Liver Failure-Sequential Organ Failure Assessment) Organ

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Clinical characteristics of tobacco smoke-induced versus biomass fuelinduced chronic obstructive pulmonary disease

Abstract

Objective: To investigate differences in clinical features between tobacco smoke-induced and biomass fuel-induced chronic obstructive pulmonary disease (COPD).

Methods: We retrospectively analyzed 206 patients with COPD caused by exposure to tobacco smoke and 81 cases of COPD caused by exposure to biomass fuels who received treatment in our hospital between 2011 March and 2014 March. Difference in general health status, clinical symptoms, the dyspnea score, and comorbidities between the two groups were compared. In addition, pulmonary function, grading, and acute exacerbations were also compared.

Results: (1) Difference in general health status: Male and female patients with COPD caused by exposure to tobacco smoke were 83.5 and 16.5%, respectively. Male and female patients with COPD caused by exposure to smoke from biomass fuels were 14.8 and 85.2% (χ2 = 27.2, P < 0.05), respectively. Tobacco smoke-induced COPD was more prevalent in men, and COPD caused by exposure to smoke from biomass fuels was more prevalent in women. After gender adjustment, body mass index (BMI) was lower in women with COPD caused by exposure to smoke from biomass fuels than those by tobacco smoke. There was no statistically significant difference in other indicators, such as age. (2): Difference in clinical symptoms: No statistically significant difference in the modified British Medical Research Counsel (mMRC) Questionnaire, a measure of breathlessness, was observed between the two groups. Dyspnea was more common in COPD patients that was caused by exposure to biomass fuels (38.3%) than by tobacco smoke (11.1%) (χ2 = 17.9, P < 0.05). The comorbidities of allergic diseases (such as allergic rhinitis, bronchial asthma) were more prevalent in COPD patients that was caused by exposure to smoke from biomass fuels (43.2%) than by tobacco smoke (18%) (χ2= 16.1, P < 0.05). However, COPD comorbid with lung cancer was more prevalent in those cases that were caused by exposure to tobacco smoke (7.77%) than in cases caused by exposure to smoke from biomass fuels (3.7%) (χ2 = 9.7, P < 0.05). (3) Differences in grading of pulmonary function: After gender adjustment, patients with COPD caused by exposure to biomass fuels were mostly in grade B or D. (4) Exacerbations: No significant difference in exacerbations per year was noted between the two groups.

Conclusions: Marked differences exist between patients with COPD caused by exposure to tobacco smoke and smoke from biomass fuels. Patients with COPD caused by exposure to biofuels are mostly females with lower BMI and often with many clinical symptoms and complications, such as allergic rhinitis and bronchial asthma. Such patients are often in stage B or D. Tobacco smoke-induced COPD is more prevalent in male patients, often with complications in the form of lung cancer.

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The 2016 revision to the World Health Organization classification of myelodysplastic syndromes

also selection of the most effective therapy; thus, a complete BM karyotype remains the standard work up evaluation procedure of the patient with MDS. Cytogenetic prognostic groups have been proposed in the revised international score (IPSS-R) scheme, which include 5 different subgroups including 20 different alterations ( Table 3 ).[ 7 ] Table 3 Cytogenetic prognostic groups in the IPSS-R Prognostic groups Chromosomal categories Median survival time (months) Very good del(11q), −Y 60.8 Good Normal, del(5q), double

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Timing of transjugular intrahepatic portosystemic stent-shunt in Budd–Chiari syndrome: A UK hepatologist's perspective

also be considered as first-line therapy in patients who present with fulminant liver failure. Figure 1 Stepwise management of BCS . *Consider referral for early liver transplant in suitable candidates if the BCS-TIPS score is >7. BCS, Budd–Chiari syndrome; TIPS, transjugular intrahepatic portosystemic shunt. Medical treatment Patients with BCS would require anticoagulant therapy for an indefinite period of time, even after radiological or surgical interventions. [ 1 , 20 ] Anticoagulation alone is sufficient in controlling the mild form of liver

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