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Nsengiyumva N, Barakat A, Macerollo A, Pullicino R, Bleakley A, Bonello M, Ellis RJB, Alusi SH. Thalamic versus midbrain tremor; two distinct types of Holmes' Tremor: a review of 17 cases. J Neurol 2021; 268:4152-4162. [PMID: 33973107 DOI: 10.1007/s00415-021-10491-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Holmes Tremor (HT) is a unique and debilitating movement disorder. It usually results from lesions of the midbrain and its connection but can also result from posterior thalamic injury. Clinical examination can help lesion localization between these two areas. We studied the clinical features and their radiological correlations to distinguish midbrain HT (HT-m) from thalamic HT (HT-t). METHODS Retrospective review of 17 patients with a HT-type presentation was conducted. Tremor characteristics, associated clinical signs and radiological findings were studied. RESULTS Eleven patients had a myorythmic rest tremor, large amplitude proximal tremor with goal-directed worsening, with or without mild distal dystonic posturing, representing HT-m. Six patients had slow, large amplitude proximal tremors and distal choreathetoid movements, significant proximal/distal dystonic posturing, associated with proprioceptive sensory loss, representing HT-t. Haemorrhagic lesions were the predominant cause of HT-m; whereas, ischaemia was more commonly associated with HT-t. CONCLUSION When assessing patients with HT, attentiveness to the presence of associated signs in the affected limb, such as a proprioceptive sensory deficits and additional movement disorders, can aid lesion localisation, which can have implications for management.
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Affiliation(s)
- N Nsengiyumva
- Department of Neurology, People's Friendship University of Russia, Moscow, Russia.,Department of Medicine, Hope Africa University, Bujumbura, Burundi
| | - A Barakat
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - A Macerollo
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - R Pullicino
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - A Bleakley
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - M Bonello
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - R J B Ellis
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - S H Alusi
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK.
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Bonello M. Moving out of the silos through interprofessional education: what do we know and where do we go? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Interprofessional education (IPE) is increasingly being recognised as one way how to develop a collaborative health workforce better equipped to deal with the diversity and complexity of future healthcare contexts [1]. IPE could also contribute towards blurring some of the institutionally demarcated professional boundaries and silos, so widespread in most health professional education and health systems. However, despite the rhetoric of IPE, the development of this pedagogy remains variable worldwide. The challenges of developing, implementing and sustaining interprofessional education are often underestimated or overlooked. Achieving an interprofessional agenda is a wicked problem [2] and is at odds with the prevalent and privileged medical narrative, sharp professional domains, traditional curricula and scarce resources.
This presentation which stems from primary research and a systematic search and review of the literature, aims to de-construct IPE by moving beyond the rhetoric of this pedagogy; precisely by acknowledging its complexity, and the myriad of micro, meso and macro level determinants that influence its development. It will map out key recommendations of what is needed to move IPE forward. It is only when we reflect and engage in such dialogues that we can start to develop a range of context-specific IPE curricula aspiring towards a collaborative health workforce. Kuhlmann, E., Batenburg, R., Wismar, M., Dussault, G., Maier, C. B., Glinos, I. A., ... & Groenewegen, P. P. (2018). A call for action to establish a research agenda for building a future health workforce in Europe. Health research policy and systems, 16 (1), 52.Varpio, L., Aschenbrener, C., & Bates, J. (2017). Tackling wicked problems: how theories of agency can provide new insights. Medical education, 51(4), 353-365.
Key messages
Interprofessional education could contribute towards a collaborative health workforce. The road map for sustainable IPE curricula needs to be context-specific acknowledging both enablers and challenges.
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Affiliation(s)
- M Bonello
- Faculty of Health Sciences, University of Malta, Msida, Malta
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Patja K, Bonello M, Dorottya A, Orhan R, Huis int'Veld T, Soethout M. Mapping of education of health professionals in health promotion; a European survey. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Health behaviours comprise over half of risk of Non-communicable Diseases. Lifestyle interventions need collaborative approaches in healthcare; this makes health professionalś knowledge and skills in advocating lifestyle interventions crucial. However less is known about educational programs of professionals in Europe about health promotion. So, a project commissioned by Consumers, Health, Agriculture and Food Executive Agency (Chafea) in years 2018-2020 was carried out in all EU countries.
Over 15 professions were included in this study. Information was obtained from national education providers, European associations of health professionals and national authorities. Study questions included: 1) how are health professionals being trained in health promotion in the EU? 2) what competencies professions require? 3) what methods are used? 4) what are the good practices? A three-stage data collection and analyses were carried out in order to answer these questions: a) desk research b) on-line survey for education content, methods and practices c) good practices assessment.
Final report is to be concluded and published in April 2020, but first indications show that a) there are guidelines of competencies in health promotion in different levels of education (graduate, post-graduate and continuous professional development) b) good practices were found in all health professions b) all health professions provide description of health promotion competencies, c) traditional teaching methods (lectures and assignments) are most often used and d) there is a need for of digital health coaching and health economics practices.
There is a need for capacity building and joint development in the European countries. Willingness to create European network of faculties, education regulators and professional associations is obvious and all parties acknowledge the need for support developing good practices and improving professional competencies in health promotion.
Key messages
There was a need for mapping of educational programs of professionals in Europe about health promotion. There is a need for capacity building and joint development in the European countries.
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Affiliation(s)
- K Patja
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - M Bonello
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - A Dorottya
- Department of Public Health, Semmelweis University, Budapest, Hungary
| | - R Orhan
- European Medical Students' Association, Brussels, Belgium
| | | | - M Soethout
- Department of Public and Occupational Health, Amsterdam University Medical Center, Amsterdam, Netherlands
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4
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Copperstone C, Bonello M. Health inequalities within professional health education at the University of Malta. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Addressing health inequalities is a crucial public health issue. It is thus imperative that health professionals are equipped with explicit competences to recognise and address health inequalities.
Methods
This is a multi-phase mixed-methods study exploring health inequalities and training within professional health curricula at the University of Malta. Phase One consists of a scoping study which explores whether and how health inequalities feature within the health professions' undergraduate curricula. This involved a systematic search of undergraduate health professional curricula, including competency profiles in each programme of study, using information available in the public domain. Academic year reviewed was 2019-2020. To ensure harmonisation, the two independent reviewers used the following search strategy: a) using a keyword descriptive approach (MeSH terms divided into two levels: direct, level one, and more general keywords, level two) and b) a more subjective approach to assess wider topic elements.
Results
Preliminary results emanating from mapping of 19 different programmes of study will be presented. A wide range of occurrences, from zero occurrences in some programmes to a maximum of one occurrence for level one and 12 for level two keywords in other programmes, was observed.
Conclusions
There is a wide disparity between the awareness of and training of inequalities across different professional training programmes. This provides the groundwork for Phase Two of this research during which public health stakeholders' attitudes and perceptions on health professional training and current practices will be explored. Findings from this study will provide the evidence and the impetus for possible interdisciplinary modules and/or continuous professional development programmes in health inequalities.
Key messages
The need for developing short courses/reviewing health curricula to incorporate health inequalities is encouraged. Public health professionals have a responsibility to address health inequalities in their professional practice.
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Affiliation(s)
- C Copperstone
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - M Bonello
- Faculty of Health Sciences, University of Malta, Msida, Malta
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Macerollo A, Hammersley B, Bonello M, Somerset J, Bhargava D, Das K, Osman-Farah J, Eldridge PR, Alusi SH. Deep brain stimulation for post-thalamic stroke complex movement disorders. Neurol Sci 2020; 42:337-342. [PMID: 32654009 DOI: 10.1007/s10072-020-04572-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Affiliation(s)
- A Macerollo
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK. .,Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
| | - B Hammersley
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - M Bonello
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - J Somerset
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - D Bhargava
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - K Das
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - J Osman-Farah
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - P R Eldridge
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - S H Alusi
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
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Macerollo A, Sajin V, Bonello M, Barghava D, Alusi SH, Eldridge PR, Osman-Farah J. Deep brain stimulation in dystonia: State of art and future directions. J Neurosci Methods 2020; 340:108750. [DOI: 10.1016/j.jneumeth.2020.108750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 01/03/2023]
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Meehan J, Gray M, Turnbull AK, Martinez-Perez C, Bonello M, Ward C, Langdon SP, McLaughlin S, MacLennan M, Dixon JM, Wills J, Quinn N, Finich AJ, von Kriegsheim A, Cameron D, Kunkler IH, Murray A, Argyle D. Abstract P3-12-24: Tumor-secreted predictive biomarkers of response to radiotherapy in breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-12-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:In breast cancer (BC), radiotherapy (RT) is used adjuvantly to prevent recurrence and also in the palliative setting. Clinical signs of RT response are often not apparent for several weeks post-treatment and we currently lack tools to predict or monitor tumor response to RT early during treatment. The aim was to identify tumor-secreted biomarkers whose release reflects response to RT, which could be monitored during treatment in the blood or intratumorally by an implantable biosensor, currently under development within the Implantable Microsystems for Personalised Anti-Cancer Therapy (IMPACT) program.
Methods: A series of experiments assessed the effect of different radiation doses (2-10Gy) on 3 human BC cell lines – MDA-MB-231 (ER-), MCF-7 (ER+) and HBL-100 (ER-) –, 1 canine breast cancer and 2 sheep lung cancer lines. Culture media was collected from each dose experiment at a range of post-radiation time-points (1-24 hours). Proteins were isolated from collected media for secretome mass spectrometry (MS) analysis. A subset of treatment/time conditions were repeated in the same BC cell lines and radioresistant (RR) derivatives from which RNA was extracted and analysed using Lexogen QuantSeq for whole-genome transcriptomics.In-lab candidate biomarker validation was carried out using immuhistochemistry (IHC), immunofluorescence (IF) and western blotting (WB) using validated antibodies. Levels of candidate biomarkers were also assessed in normal and untreated BC tissues using IHC. ELISA-based methods are currently under investigation for detection of the lead candidate biomarkers in the blood of large animal cancer models treated with RT.
Results: Biomarker discovery using the MS data revealed 4 promising candidates: EIF3G, SEC24C, YBX3 and TK1. These are released from BC and animal cancer cells sensitive to radiation in a dose-dependent manner 24 hours after treatment. Analysis of the transcriptomic data showed an 8-fold higher expression of the genes encoding the 4 candidates in the radio-sensitive parental cell lines compared to the RR cell lines. IF and WB confirmed lower intracellular expression of the 4 proteins in RR cells compared to the parental lines. WB of collected culture media confirmed release of each of the 4 candidates 24 hours after a 2Gy dose of radiation in only the parental lines. GAPDH was not found in these media samples, demonstrating that protein release was not due to cell lysis.
Conclusions:
· We have identified 4 promising biomarkers which are released from cancer cells sensitive to RT and not released from RR derivatives.
· All 4 candidates are released 24 hours after a 2Gy radiation dose, which fits with the current clinical dosing schedule where radiation is administered at 24 hour intervals. Ongoing work will elucidate if these biomarkers can be reliably detected in blood or intratumorally using implantable biosensors.
· There are currently no validated predictive tools to monitor RT response during treatment. If successfully validated, these biomarkers could have a clinical role in personalising RT dosing schedules and durations for solid tumors in the neoadjuvant and palliative setting, thus optimising treatment and preventing the administration of ineffective RT and its associated side effects.
Citation Format: Meehan J, Gray M, Turnbull AK, Martinez-Perez C, Bonello M, Ward C, Langdon SP, McLaughlin S, MacLennan M, Dixon JM, Wills J, Quinn N, Finich AJ, von Kriegsheim A, Cameron D, Kunkler IH, Murray A, Argyle D. Tumor-secreted predictive biomarkers of response to radiotherapy in breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-24.
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Affiliation(s)
- J Meehan
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - M Gray
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - AK Turnbull
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - C Martinez-Perez
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - M Bonello
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - C Ward
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - SP Langdon
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - S McLaughlin
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - M MacLennan
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - JM Dixon
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - J Wills
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - N Quinn
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - AJ Finich
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - A von Kriegsheim
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - D Cameron
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - IH Kunkler
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - A Murray
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - D Argyle
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
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Bonello M. Interprofessional education for an improved health workforce: contemplating change. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bonello M, Muscat NA. Does national culture matter for intersectorial coordination? A case study exploring interprofessional education in a small state. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Bonello
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - NA Muscat
- Faculty of Health Sciences, University of Malta, Msida, Malta
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Abstract
We studied 15 patients suffering from nephrotic syndrome (NS) in bioptically-accertained primary and secondary glomerulopathies responding poorly to the common pharmacological treatment. They were monitored for one year by assessing their immunological and kidney functionality parameters, especially proteinuria. The patients underwent 3 apheretic sittings using the cascade double-filtration technique. After the third apheretic sitting the patients received metilprednisolone 300 mg/m2. This therapy was repeated every month for 6 months. At the end of the apheretic cycle it was shown that all patients had responded well to the therapy with a dramatic decrease in proteinuria, maintenance and/or recuperation of kidney functionality and improvement of lipidic asset; these data remained unchanged over time. Considering our preliminary results, we believe that therapeutic apheresis has a precise function in refractory nephrotic syndrome and, in particular, we propose the use of the cascade double-filtration technique. (Int J Artif Organs 2000; 23: 111–3)
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Affiliation(s)
- G.E. Russo
- Plasmapheresis and Dialysis Unit, Department of Geriatrics, Institute of Clinica Medica I, University of Roma “La Sapienza”, Roma - Italy
| | - M. Bonello
- Plasmapheresis and Dialysis Unit, Department of Geriatrics, Institute of Clinica Medica I, University of Roma “La Sapienza”, Roma - Italy
| | - B. Bauco
- Plasmapheresis and Dialysis Unit, Department of Geriatrics, Institute of Clinica Medica I, University of Roma “La Sapienza”, Roma - Italy
| | - M. Bosco
- Plasmapheresis and Dialysis Unit, Department of Geriatrics, Institute of Clinica Medica I, University of Roma “La Sapienza”, Roma - Italy
| | - M. Tedaldi
- Plasmapheresis and Dialysis Unit, Department of Geriatrics, Institute of Clinica Medica I, University of Roma “La Sapienza”, Roma - Italy
| | - M.F. Bisciglia
- Plasmapheresis and Dialysis Unit, Department of Geriatrics, Institute of Clinica Medica I, University of Roma “La Sapienza”, Roma - Italy
| | - E. Vitaliano
- Plasmapheresis and Dialysis Unit, Department of Geriatrics, Institute of Clinica Medica I, University of Roma “La Sapienza”, Roma - Italy
| | - R. Russo
- Plasmapheresis and Dialysis Unit, Department of Geriatrics, Institute of Clinica Medica I, University of Roma “La Sapienza”, Roma - Italy
| | - A. De Paola
- Plasmapheresis and Dialysis Unit, Department of Geriatrics, Institute of Clinica Medica I, University of Roma “La Sapienza”, Roma - Italy
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Abstract
Continuous flow peritoneal dialysis (CFPD) is a therapy originally utilized in the sixties. It was then abandoned because of technical reasons, but, today, a new interest in this technique is emerging, because of new technical solutions and new hardware capabilities. CFPD is a peritoneal dialysis technique in which a certain amount of fluid is maintained in the peritoneal cavity, while a continuous inflow and outflow is provided via twin catheters or through a double lumen catheter. In this paper a new double lumen catheter is presented. The catheter is characterized by the presence of a diffuser in the inflow lumen, while a standard coiled shape characterizes the outflow lumen. The diffuser allows the use of high dialysate flows without peritoneal damage and with an excellent distribution of the fluid. The other feature of the catheter is the removable hub which allows for an easy subcutaneous tunneling of the catheter with a subsequent connection to the y segment. The special shape also guarantees a minimum recirculation during treatment. Data obtained in the first implanted catheter showed a progressive increase in small solute clearances in relation to an increase of the flow and the tidal volume in the peritoneal cavity. In particular, urea clearances up to 48 ml/min and creatinine clearances up to 39 ml/min were obtained. No major complications were observed after one year of use of the catheter.
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Affiliation(s)
- C Ronco
- Department of Nephrology, St. Bortolo Hospital, Vicenza, Italy.
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Bonello M, House A, Cruz D, Asuman Y, Andrikos E, Petras D, Strazzabosco M, Ronco F, Brendolan A, Crepaldi C, Nalesso F, Ronco C. Integration of Blood Volume, Blood Pressure, Heart Rate and Bioimpedance Monitoring for the Achievement of Optimal Dry Body Weight during Chronic Hemodialysis. Int J Artif Organs 2018; 30:1098-108. [DOI: 10.1177/039139880703001210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Achieving optimal dry body weight in hemodialysis is challenging. Clinical assessment alone is inadequate, and methods such as bioimpedance monitoring may be impractical for every patient treatment. Continuous blood volume monitoring, blood pressure and heart rate variability inform clinical decision-making, but integrated use of multiple methodologies to achieve dry weight and understand patient factors has not yet been described. Methods Nineteen chronic hemodialysis patients underwent thrice-weekly treatments for two weeks. Baseline hydration status and target weight were determined by bioimpedance. During subsequent treatments, ultrafiltration was adjusted and relative blood volume, blood pressure and pulse were recorded non-invasively Bioimpedance was repeated to assess hydration. Response of variables to progressive change in weight was assessed and selected patients underwent additional autonomic function testing. Results Four distinct hemodynamic patterns emerged. Profile A: 4 patients demonstrated overhydration at baseline. With decreasing target, pulse and blood pressure remained stable while blood volume and bioimpedance demonstrated achievement of dry weight. Profile B: 8 patients demonstrated overhydration at baseline. With decreasing target, blood pressure remained stable while pulse increased. Profile C: 5 patients were overhydrated, but as weight decreased, blood pressure became unstable and heart rate failed to compensate. Further testing confirmed autonomic dysfunction. Profile D: 2 patients were dehydrated, and with increasing target demonstrated stable pulse and pressure, while blood volume and bioimpedance revealed achievement of dry weight. Conclusions Integrating existing non-invasive, continuous monitoring during hemodialysis enabled achievement of dry weight and identified distinct profiles of the patients, some with autonomic dysfunction. This strategy may contribute to achieving optimum dry weight while improving cardiovascular tolerability of hemodialysis.
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Affiliation(s)
- M. Bonello
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - A.A. House
- Department of Medicine, Division of Nephrology, University of Western Ontario, London - Canada
| | - D. Cruz
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - Y. Asuman
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - E. Andrikos
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - D. Petras
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - M. Strazzabosco
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - F. Ronco
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - A. Brendolan
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - C. Crepaldi
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - F. Nalesso
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - C. Ronco
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
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13
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Salvatori G, Ricci Z, Bonello M, Ratanarat R, D'Intini V, Brendolan A, Dan M, Piccinni P, Bellomo R, Ronco C. First Clinical Trial for a New Crrt Machine: The Prismaflex. Int J Artif Organs 2018; 27:404-9. [PMID: 15202818 DOI: 10.1177/039139880402700509] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A new CRRT machine has been designed to fulfill the expectations of nephrologists and intensivists operating in the common ground of critical care nephrology. The new equipment is called “Prismaflex” (Gambro-Dasco, Mirandola, Modena) and it is the natural evolution of the Prisma machine that has been utilized worldwide for CRRT in the last decade. We performed a preliminary “alfa trial” to establish usability, flexibility and realiability of the new device. Accuracy was also tested by recording various operational parameters during different intermittent and continuous renal replacement modalities. Forty-one runs were conducted on 13 patients and the difference between delivered and prescribed parameters was always lower than 2%. We concluded that the new Prismaflex is a well designed new machine for CRRT and can be safely and effectively utilized in the critical care nephrology setting.
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Affiliation(s)
- G Salvatori
- Department of Nephrology, St. Bortolo Hospital, Vicenza, Italy
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14
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15
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16
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Abstract
A wide range of infections of the central nervous system are responsible for both acute seizures and epilepsy. The pathogenesis and clinical semiology of the seizure disorders vary widely between the infective pathogens. The exact mechanisms underlying this are poorly understood, but appear, at least in part, to relate to the pathogen; the degree of cortical involvement; delays in treatment; and the host inflammatory response. The treatment of infective causes of seizures involves both symptomatic treatment with antiepileptic drugs and direct treatment of the underlying condition. In many cases, early treatment of the infection may affect the prognosis of the epilepsy syndrome. The greatest burden of acute and long-term infection-related seizures occurs in resource-poor settings, where both clinical and research facilities are often lacking to manage such patients adequately. Nevertheless, education programs may go a long way toward addressing the stigma, leading to improved diagnosis, management, and ultimately to better quality of life.
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Affiliation(s)
- M Bonello
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - B D Michael
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - T Solomon
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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17
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Fleming W, Bonello M, Xerri J, Tailor P, Raman A. PROPOSED GUIDELINES FOR THE ASSESSMENT AND MANAGEMENT OF IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS IN THE UNITED KINGDOM. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-304200a.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Rodighiero MP, Dell'Aquila R, Bonello M, Spanò E, Loreto PD, Nalesso F, Ronco C. Successful use of sodium hypochlorite pack plus systemic and local antibiotic therapy for the treatment of pseudomonas infection of peritoneal dialysis catheter exit-site. Contrib Nephrol 2010; 154:125-128. [PMID: 17099307 DOI: 10.1159/000096957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Peritoneal catheter exit-site and tunnel infections remain critical problems in patients undergoing peritoneal dialysis. Catheter-related peritonitis occurs in about 20% of patients and exit-site infections are responsible for catheter removal in more than one-fifth of the cases. For the last 2 years in the Department of Nephrology, San Bortolo Hospital, Vicenza, Italy, we have been treating exit-site infections caused by Pseudomonas with sodium hypochlorite packs as well as systemic and local antibiotic therapy. Considering the encouraging results obtained on Pseudomonas infection, we decided to utilize the same schedule for the treatment of exit-site infections caused by other germs which are generally difficult to eradicate to prevent peritonitis and catheter removal. Between 2003 and 2004, 10 patients contracted infection of the exit-site. All patients underwent a swab test because of the reddening and the purulent secretion of the exit-site. The swab resulted positive for Pseudomonas in 7 patients, Corynebacterium sp. in 2 patients, and Candida albicans in 1 patient. All patients were treated with systemic antibiotic therapy or antifungal therapy, local sodium hypochlorite 50% packs. After 15 days all patients were submitted to a swab test of the exit site. In all patients, the swab test resulted negative after 15 days and 1 month, and they could continue peritoneal dialysis. This procedure avoided peritoneal catheter removal and temporary switch to hemodialysis in all patients with exit site infection. The mechanism of action is related to the wide antimicrobial spectrum and the rapid action of sodium hypochlorite possibly creating a protective barrier on the exit-site.
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Affiliation(s)
- M P Rodighiero
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
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19
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Abstract
A case of refractory fluid overload due to congestive heart failure and consequent renal insufficiency is reported. The case was approached multidisciplinarily, at the beginning with conservative and pharmacological therapy, subsequently with extracorporeal fluid removal in which a specific attention was payed to the maintenance of circulating blood volume and achievement of dry weight, and finally with chronic peritoneal dialysis as a maintenance therapy. The case seems to summarize the pathway of many patients seen initially in intensive care and cardiology departments and subsequently in nephrological wards.
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Affiliation(s)
- G Salvatori
- Department of Intensive Care, Nephrology and Cardiology, St. Bortolo Hospital, Vicenza, Italy.
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20
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Petras D, Fortunato A, Soffiati G, Brendolan A, Bonello M, Crepaldi C, Ratanarat R, Campolo G, Amato M, Ronco C. Sequential convective therapies (SCT): a prospective study on feasibility, safety, adequacy and tolerance of on-line hemofiltration and hemodiafiltration in sequence. Int J Artif Organs 2005; 28:482-8. [PMID: 15883963 DOI: 10.1177/039139880502800509] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sequential dialysis techniques (i.e pure ultrafiltration followed by dialysis) have been used in the past, due to their capability to remove large volumes of fluids without inducing hemodynamic instability. The disadvantages of inadequate efficiency and lack of technology lead to the decline of such methods. Hemofiltration (HF) and hemodiafiltration (HDF) are recently being utilized in a greater proportion thanks to on-line fluid preparation systems. Each process (HF and HDF) has its own benefits in the removal of small, medium and high-molecular weight substances and in hemodynamic stability. Sequential convective therapies (SCT) such as hemofiltration-hemodiafiltration in sequence (HF-HDF) may combine the benefits and eliminate the disadvantages of each method and should be studied in order to explore their potential application in modern dialysis. Furthermore they can be easily applied nowadays, due to the development of new sophisticated dialysis machines. In order to evaluate the feasibility, safety, efficiency and tolerance of different SCT methods we studied 3 schedules: SCT1: 1h pre-dilution HF followed by 3h of post-dilution HDF (in the HF mode we lost 25% of the total fluid that had to be removed). SCT2: 1h pre-dilution HF followed by 3h of post-dilution HDF (in the HF mode we lost 50% of the total fluid that had to be removed). SCT3: 2h pre-dilution HF followed by 2h of post-dilution HDF (in the HF mode we lost 50% of the total fluid that had to be removed). We studied 6 chronic hemodialysis patients using the same machine (AK200 ULTRA), with on-line fluid preparation system and the same type of dialyzer (Polyflux 210). SCT schedules were compared to on-line HF, on-line HDF and high flux dialysis performed with the same dialyzers. The treatments resulted safe, easy, feasible and well tolerated with an improved hemodynamic response to high volume convective therapies. Adequacy of treatment was satisfactory in all SCT schedules while middle molecular weight solute clearance and removal resulted higher in treatments with higher convective component. SCT might represent an interesting option for the future especially in patients with hemodynamic instability and requirements for interventions during treatment.
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Affiliation(s)
- D Petras
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy.
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21
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Andrikos E, Yavuz A, Bordoni V, Ratanarat R, De Cal M, Bonello M, Salvatori G, Levin N, Yakupoglu G, Pappas M, Ronco C. Effect of Cyclosporine, Mycophenolate Mofetil, and Their Combination With Steroids on Apoptosis in a Human Cultured Monocytic U937 Cell Line. Transplant Proc 2005; 37:3226-9. [PMID: 16213354 DOI: 10.1016/j.transproceed.2005.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Transplant patient plasma produces an increased rate of mononuclear cell apoptosis despite a normal serum creatinine value. Immunosuppressive medications may be one factor that causes an altered apoptotic pattern. We evaluated the in vitro effects of various doses of cyclosporine, mycophenolate mofetil, and steroids on apoptosis of a cultured human monocytic U937 cell line, using estimates by fluorescence microscopy and annexin V assays. Increasing cyclosporine concentrations (100 to 800 ng/mL) progressively increased apoptosis rates (16% to 32%). The combination of steroid (0.01 microg/mL) and cyclosporine increased the apoptosis rate to 45%. Mycophenolate mofetil alone (0.3 microg/mL) led to an apoptosis rate of 34%. Therapeutic levels of mycophenolate mofetil from 3 to 7 microg/mL led to apoptosis rates from 56% to 67%. The combination of cyclosporine, steroid, and mycophenolate mofetil increased the rate of apoptosis to 95%. Immunosuppressive therapy may contribute to the high rate of apoptosis observed among mononuclear cells of transplanted patients. This effect may alter patient susceptibility to infections and contribute to a unique mechanism of immunosuppression.
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Affiliation(s)
- E Andrikos
- Department of Nephrology, "G. Hatzikosta" Hospital, Ioannina, Greece
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22
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Amato M, Brendolan A, Campolo G, Petras D, Bonello M, Crepaldi C, Ronco C. Sequential hemofiltration-hemodiafiltration technique: all in one? Contrib Nephrol 2005; 149:115-120. [PMID: 15876835 DOI: 10.1159/000085471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Sequential dialysis techniques (i.e. pure ultrafiltration followed by dialysis) have been used in the past, due to their capability to remove large volumes of fluids without inducing hemodynamic instability. The disadvantages of the inadequate dialysis and the lack of technology lead to the decline such methods. Hemofiltration (HF) and hemodiafiltration (HDF) are recently being utilized in a greater proportion thanks to the on line fluid preparation systems. Each process (HF and HDF) has its own benefits in the removal of small, medium and high-molecular weight substances and in the hemodynamic stability. Sequential hemofiltration/ hemodiafiltration (SHF/HDF), may combine the benefits and eliminate the disadvantages of each method. Furthermore they can be easily applied nowadays, due to the development of new high technological hemodialysis machines. In order to evaluate the feasibility and the effects of SHF/HDF we studied 7 chronic hemodialysis patients (6 months of treatment with SHF/HDF switched to 6 months of SHDF/HF), using the same machine (AK200 ULTRA), with on line fluid preparation system and the same type of dialyzer (Polyflux 210). The feasibility of such techniques (SHF/HDF or vice versa) resulted excellent. All sessions left the patients in a condition of well-being making fulltime work. No difference was observed between the different period of treatment, but a reduction in pre value was observed in calcium-phosphorous product, C-reactive protein and beta2-microglobulin, at the end of the sequential techniques. SHF/HDF therapy is a very promising technique. Further studies are needed to better explore the potential of such a therapeutic approach in the quality of life, the hemodialysis adequacy and the hemodynamic stability of our patients.
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Affiliation(s)
- M Amato
- Nephrology Department, Prato Hospital, Prato, Italy
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23
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Ronco C, D'Intini V, Bellomo R, Ricci Z, Bonello M, Ratanarat R, Salvatori G, Bordoni V, Andricos E, Brendolan A. [Rationale for the use of extracorporeal treatments for sepsis]. Anesteziol Reanimatol 2005:87-91. [PMID: 15938108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Sepsis is the leading cause of disability and mortality among critical patients; moreover, it causes high economic expenditures. Although very much is known about the pathophysiology of this condition and its mediators despite great investments directed to its control, mortality rates remain high. Recent treatment manuals emphasize the value of early goal-oriented therapy and also point to the high efficacy of activated protein C. Extracorporeal blood clearance may potentially become a new approach to treating this condition. There are reports on its positive clinical results that are likely associated with the effective removal of septic mediators. Human and animal studies, few and rather alike as they are, have yielded promising results. It is evident that the use of these procedures is justified; however, their efficiency in sepsis requires large-scale, correctly conducted studies.
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24
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Brendolan A, D'Intini V, Ricci Z, Bonello M, Ratanarat R, Salvatori G, Bordoni V, De Cal M, Andrikos E, Ronco C, Salvadori G. Pulse high volume hemofiltration. Int J Artif Organs 2004; 27:398-403. [PMID: 15202817 DOI: 10.1177/039139880402700508] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The sepsis syndrome is the most common cause of acute renal failure and multiple organ dysfunction in critically ill subjects and continues to have an alarmingly high mortality. Normal immune homeostasis is interrupted by a complex storm of inflammatory mediators responsible for the deleterious effects. Extracorporeal blood purification techniques can confer benefits in sepsis by proven non-specific removal of these mediators (pro- or anti-inflammatory), and provide a logical and adequate approach to treat this syndrome. High volume hemofiltration (HVHF) has had the most dramatic effect conferring benefits in hemodynamics, reduction in vasopressor doses and improvement in survival. "Pulse HVHF" is the latest approach which may offer the most efficient results: a daily schedule of 6-8 hours followed by standard CVVH. This paper describes the rationale and potential of this technique. Reliability and tolerance of this technique and biological effects are described.
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Affiliation(s)
- A Brendolan
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy
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25
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Ricci Z, Bonello M, Salvatori G, Ratanarat R, Brendolan A, Dan M, Ronco C. Continuous renal replacement technology: from adaptive devices to flexible multipurpose machines. CRIT CARE RESUSC 2004; 6:180-7. [PMID: 16556119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To review the evolution of technologies in the development of renal replacement therapies. DATA SOURCES Articles and published reviews on renal replacement therapies. SUMMARY OF REVIEW Continuous arterio-venous haemofiltration (CAVH) was the first continuous renal replacement technique capable of overcoming the traditional haemodialysis-related side effects, making possible the treatment of critically ill patients safely and with less physiological instability. The evolution of technology and the progress experienced in intensive care units (ICUs) has made it possible to start renal replacement therapy programs in the absence of a chronic dialysis facility or a trained nephrological team. Initial limitations and draw-backs of CAVH, stimulated the ICU staff to explore new avenues for better therapy. Extracorporeal therapies are today a routine experience in the ICUs: continuous renal replacement therapies are a broadly accepted treatment for acute renal failure. Furthermore, alternative indications for extracorporeal blood circulation (e.g. sepsis, liver failure, congestive heart failure, drug intoxications, hyperthermia, immuno-mediated syndromes) are becoming more and more popular. The ideal machine has yet to be completed, but progress has occurred and has opened a new era for critical care nephrology and the further expansion of blood purification technology in the ICU. CONCLUSIONS Technical advances in renal replacement therapies have increased their functionality (i.e. used in hepatic failure, sepsis, cardiac failure and immuno-mediated syndromes), are easier to operate and have less side-effects compared with their standard extracorporeal counterparts. Further improvements may see them become a routine part in the management of the critically ill patient.
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Affiliation(s)
- Z Ricci
- Department of Nephrology, St Bortolo Hospital, Vicenza, Italy
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26
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D'Intini V, Bonello M, Salvatori G, Ronco C. Management of vascular catheters for acute renal replacement therapy. Contrib Nephrol 2004; 144:191-202. [PMID: 15264408 DOI: 10.1159/000078887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- V D'Intini
- Department of Nephrology, Dialysis and Transplantation San Bortolo Hospital, Vicenza, Italy.
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27
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Brendolan A, D'intini V, Ricci Z, Bonello M, Ratanarat R, Salvatori G, Bordoni V, De Cal M, Andrikos E, Ronco C. Pulse High Volume Hemofiltration. Int J Artif Organs 2004. [DOI: 10.1177/039139880402700614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A. Brendolan
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza - Italy
| | - V. D'intini
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza - Italy
| | - Z. Ricci
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza - Italy
| | - M. Bonello
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza - Italy
| | - R. Ratanarat
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza - Italy
| | - G. Salvatori
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza - Italy
| | - V. Bordoni
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza - Italy
| | - M. De Cal
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza - Italy
| | - E. Andrikos
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza - Italy
| | - C. Ronco
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza - Italy
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28
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Bordoni V, Bolgan I, Brendolan A, Crepaldi C, Gastaldon F, D'intini V, Pilotto L, Inguaggiato P, Bonello M, Galloni E, Everard P, Bellomo R, Ronco C. Caspase-3 and -8 activation and cytokine removal with a novel cellulose triacetate super-permeable membrane in an in vitro sepsis model. Int J Artif Organs 2004; 26:897-905. [PMID: 14636005 DOI: 10.1177/039139880302601005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pro-apoptotic molecules are generated during sepsis which may be responsible for alteration of organ function in sepsis. Removal of systemic apoptotic activity may affect recovery from sepsis. Current high flux membranes might not be sufficiently permeable to eliminate pro-apoptotic factors. We evaluated the elimination of pro-apoptotic factors induced by LPS in human whole blood by a super-permeable cellulose triacetate membrane (SUREFLUX FH 150, Nipro, Osaka, Japan) in comparison to a standard high flux cellulose triacetate membrane (UT 700, Nipro, Osaka, Japan) and a polyethersulfone plasmafilter (Bellco, Mirandola Italy) in an in vitro blood circulation. We spiked human whole blood with lipopolysaccharide from Escherichia coli (Serotype 026-86, 10 mg/ml), incubated it for 3 hours to allow cytokine generation and recirculated it at 300 ml/min for 3 hours. The UF line was first returned to the blood module at 10 min. After this, the UF was drained from 10 to 60 min at a rate of 1000 ml/h. Zero balance was obtained by re-infusion of bicarbonate buffered hemofiltration fluid. Apoptosis was assessed on U937 monocytes (incubated with plasma or ultrafiltrate) by fluorescence microscopy dyes (Hoechst 33342, propidium iodide) and annexin V flow cytometry. Caspase-3 and Caspase-8 activity was assessed on the recirculated blood monocytes by spectrophotometric methods. IL-2, IL-10 and TNFalpha were determined by commercially available ELISAs. Sieving coefficients and clearances were determined for the different cytokines. Caspase-3 and Caspase-8 were activated by LPS and remained either stable or increased during in vitro circulation. Apoptosis activity of U937 cells, when incubated with the ultrafiltrate, increased in parallel with arterial plasma values (for Uf: UT700 = 23.1%; Sureflux FH150 = 42.5%). However, by 60 min the apoptotic activity recorded with the ultrafiltrate was reduced to the levels of arterial plasma (for Uf: UT700 = 19.8%; Sureflux FH150 = 11.2%). Sieving coefficients in the super-permeable membrane were significantly higher for all measured cytokines in comparison to the standard high flux membrane (e.g. TNFalpha 0.72 vs 0.03 p < 0.001) and close to the values observed for the plasmafiltration membrane. Nevertheless protein losses measured by albumin leakage were much lower with the Sureflux filter in comparison to the plasmafilter. In conclusion, pro-apoptotic factors can be eliminated by dialytic membranes with the removal rate maximized by using super high flux dialysers which may represent a compromise between hemofiltration and plasmafiltration membranes.
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Affiliation(s)
- V Bordoni
- Department of Nephrology, San Bortolo Hospital, Vicenza, Italy
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29
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Tetta C, D'Intini V, Bellomo R, Bonello M, Bordoni V, Ricci Z, Ronco C. Extracorporeal treatments in sepsis: are there new perspectives? Clin Nephrol 2003; 60:299-304. [PMID: 14640234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
Sepsis continues to provide a major challenge to clinicians. Despite vast advancements achieved in the understanding of its pathways and mechanisms, the incidence of sepsis is increasing and the mortality and morbidity rates remain high, generating a considerable burden to health budgets worldwide. Unfortunately, no definitive therapy yet exists that can successfully treat sepsis and its complications. At variance with targeting single mediators, therapeutic intervention aimed at the non-selective removal of pro- and anti-inflammatory mediators seems a rational concept and a possible key to successful extra-corporeal therapies. A further advantage may lie in the continuous nature of such therapy. With such continuous therapy, sequentially appearing peaks of systemic mediator overflow may be attenuated and persistently high plasma levels reduced. This theoretical framework is proposed as the underlying biological rationale for a series of innovative modalities in sepsis. In this editorial, we will review recent animal and human trials which lend support to this concept. We will also review the importance of treatment dose during continuous renal replacement therapy as a major factor affecting survival in critically ill patients with acute renal failure. We will also review novel information related to other blood purification techniques using largo pore membranes or plasma filtration with adsorbent perfusion. Although these approaches are still in the early stages of clinical testing, they are conceptually promising and might represent an important advance.
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Affiliation(s)
- C Tetta
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy
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30
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Affiliation(s)
- M Bonello
- Department of Nephrology, St. Bortolo Hospital, Vicenza, Italy
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Dell�Aquila R, Rodighiero M, Bonello M, Ronco C. Automated Peritoneal Dialysis Technology. Contributions to Nephrology 2003. [DOI: 10.1159/000071401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Dell�Aquila R, Rodighiero M, Bonello M, Ronco C. Conditions Leading to Catheter
Removal or Substitution. Contributions to Nephrology 2003. [DOI: 10.1159/000074858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Russo GE, Bauco B, Bosco M, Bonello M, Bisciglia MF, De Paola A, Villatico Campbell S, Fava D, Vitaliano E. Pyelonephritis caused by mesalazine. Nephron Clin Pract 2000; 86:228-9. [PMID: 11015014 DOI: 10.1159/000045763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Russo GE, Bonello M, Bauco B, Bosco M, Tedaldi M, Bisciglia MF, Vitaliano E, Russo R, DePaola A. Nephrotic syndrome and plasmapheresis. Int J Artif Organs 2000; 23:111-3. [PMID: 10741806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
We studied 15 patients suffering from nephrotic syndrome (NS) in bioptically-accertained primary and secondary glomerulopathies responding poorly to the common pharmacological treatment. They were monitored for one year by assessing their immunological and kidney functionality parameters, especially proteinuria. The patients underwent 3 apheretic sittings using the cascade double-filtration technique. After the third apheretic sitting the patients received metilprednisolone 300 mg/m2. This therapy was repeated every month for 6 months. At the end of the apheretic cycle it was shown that all patients had responded well to the therapy with a dramatic decrease in proteinuria, maintenance and/or recuperation of kidney functionality and improvement of lipidic asset; these data remained unchanged over time. Considering our preliminary results, we believe that therapeutic apheresis has a precise function in refractory nephrotic syndrome and, in particular, we propose the use of the cascade double-filtration technique.
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Affiliation(s)
- G E Russo
- Department of Geriatrics, Institute of Clinica Medica I, University of Roma La Sapienza, Italy
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Russo GE, Bonello M, Vitaliano E, Bosco M, Maresca L, De Paola A, Tedaldi M, Bisciglia MF, Bauco B. [Plasmapheresis combined with pharmacology in the treatment of lupus nephritis: a new therapeutic protocol]. Clin Ter 2000; 151:9-13. [PMID: 10822875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Systemic Lupus Erythematosus (SLE) is a pathology of unknown cause, characterized by tissue and cellular damage, secondary to production of autoantibodies and to deposition of immunocomplexes. Lupus nephritis is one of the most common complications of SLE. Our purpose is to propose a therapeutic protocol for patients suffering from Lupus nephritis. This consists of Plasmapheresis associated with pharmacological therapy so that dosage of immunosuppressors can be reduced and consequently also the side effects of the pharmacological therapy.
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Affiliation(s)
- G E Russo
- Istituto di I Clinica Medica, Ambulatorio di Plasmaferesi e Dialisi, Policlinico Umberto I Roma, Università degli Studi di Roma La Sapienza, Italia.
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Russo GE, Giusti S, Vitaliano E, Maurici M, De Marco CM, Caramiello MS, Bonello M, Pennacchia M, Bruno C, Scuteri A, Marigliano V. [Comparative study of the modification of arterial pressure in adult and aged subjects treated with hemofiltration. Preliminary results]. Clin Ter 1997; 148:225-8. [PMID: 9377857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Haemodynamics modifications in 49 patients divided in two groups consisting of 21 young people (average age 43 +/- 12 yrs.) and 28 elderly people (average age 72 +/- 7 yrs.) who have undergone at least three treatments with haemofiltration for congestive cardiac decompensation and chronic renal failure have been evaluated. Systolic and diastolic blood pressure and heart rate have been monitored for each patient in a length of time of iT, T30 min., T60 min., fT. The results show a statistically significant reduction of the systolic pressure during the time interval iT-T30 min. in subjects over 65, contrary to the control group. Such preliminary results can be justified by the haemodynamic modifications correlated to the elderly process. In any case the hypothesis cited by the authors need further testing even if confirming the indication of the dialytic treatment on patients over 65 through haemofiltration techniques.
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Affiliation(s)
- G E Russo
- Istituto Clinica Medica I, Università di Roma La Sapienza
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Russo GE, Giusti S, Vitaliano E, Caramiello MS, Maurici M, De Marco CM, Pennacchia M, D'Auria F, Bonello M, Bruno C, Marigliano V. [Efficacy of recombinant erythropoietin on the quality of life in patients over 60 years of age undergoing hemodialysis]. Clin Ter 1997; 148:89-93. [PMID: 9377845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We followed for a period of six months, 54 patients of over 60 years old, submitted to hemodialitic treatment. We gave human recombinant erythropoietin, average dosage 50 UI/Kg subcutaneously on alternative days, folic acid and iron supplements together with a proteic supply of 1.2 g/Kg/die (35 Kcal/Kg). The medullary response has been monitored with hematochemical tests; blood pressure and nutritional conditions have been evaluated. Furthermore, the patients were given a questionnaire to evaluate their quality of life. At the end of the follow up, 50 patients responded positively to therapy. These patients showed an increase of RBC (from 2,789,780 +/- 259,310 to 3,313,110 +/- 472,780 p < 0.001) of HCT (from 21.86% +/- 2.16% to 27.18 +/- 2.74% p < 0.0001) and of Hb (from 7.72 +/- 1.12 g/dl to 9.28 +/- 0.98 g/dl p < 0.006). Total protein and albumin increased too. Furthermore they showed a progressive increase of "performance status". Our results confirm efficacy of erythropoietin in the treatment of anemia in elderly hemodialized patients.
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Affiliation(s)
- G E Russo
- Istituto Clinica Medica I, Ambulatorio di Dialisi e Plasmaferesi, Università di Roma La Sapienza
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