scholarly journals Living with transplant

2020 ◽  
Vol 7 (2) ◽  
Author(s):  
Laura L. Heinemann
Keyword(s):  
Side Effects ◽  
Organ Transplantation ◽  
Graft Failure ◽  
Daily Life ◽  
Work Life ◽  
Illustrative Case ◽  
Close Monitoring ◽  
Organ Rejection ◽  
Biomedical Intervention ◽  
Kidney Recipient

Organ transplantation is often held to epitomize the power and promise of biomedicine. Yet life after transplant does not so clearly mark an ‘after’ to illness, and instead requires close monitoring and treating for organ rejection, graft failure, or the side effects of medication regimens. Such medical domains are counterbalanced, in turn, by relations of kinship, friendship, home and work life. In this Position Piece, I call for attention to the interconnected tensions among these domains, focusing on one illustrative case example: that of Janet, a three-time kidney recipient. By detailing Janet’s lifelong imbrication of daily life with vulnerability and biomedical intervention, I delineate the mismatch between popular imaginings of transplant as ‘cure’ and the realities of living a life that is never quite beyond illness.

scholarly journals AB0287 HEMATOLOGICAL SIDE EFFECTS OF BIOLOGICAL THERAPY IN RHEUMATOLOGY: DATA FROM THE TUNISIAN REGISTER

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1442.2-1442
Author(s):  
H. Bettaieb ◽  
S. Boussaid ◽  
S. Jemmali ◽  
S. Rekik ◽  
E. Cheour ◽  
...  
Keyword(s):  
Side Effects ◽  
Biological Treatment ◽  
Blood Count ◽  
Biological Therapy ◽  
National Registry ◽  
Close Monitoring ◽  
Female Ratio ◽  
Therapy Initiation ◽  
Male Female Ratio ◽  
The Mean

Background:During the last decade, the treatment of chronic inflammatory rheumatism (CIR) has been greatly improved with the advent of biotherapy.However, the use of biological treatment can lead to a number of side effects including abnormalities in the blood count.Objectives:The aim of this study was to assess the different hematological side effects of biological treatment in patients with rheumatoid arthritis (RA) and spondyloarthitis (SA).Methods:This study included patients with RA (ACR/EULAR 2010) and SA (ASAS 2009) registred with the Tunisian Biologic National Registry (BINAR).Patients were followed and treated with biologics for 2 years of less. Clinical data relative to biological treatment, including haematological side effects, have been collected.Results:Two hundred and ninety-eight patients (178 women and 111 men) were included in the study.The mean age was 49.2 ± 14.1 years. The male/female ratio was 0.6. The mean diseases durations for RA and SA were respectively 6.7 ± 3.5 years and 6.5 ±3.6 years.Anti-TNFα agents were prescribed in 87.9% of patients (n = 263) with respectively: Infliximab (20.4%) Etanercept (23.1%), Adalimumab (24.6%) and Certolizumab (26.5%).Tocilizumab and Rituximab were prescribed in 10.4% and 5% of the patients, respectively.Blood count abnormalities were noted in 15.4 % of patients (n=46).Neutropenia was the most frequently anomaly met on the hemogram (9.1%) followed by anemia (3.4%) and thrombocytopenia (3%). Pancytopenia was found in 11.4% of patients (n=34).The median time between biological therapy initiation and the onset of hematologic manifestations was 4.8 months [1-12]. Biological treatment was interrupted in two patients.In the other cases, the biological treatment was maintained with close monitoring of blood cell count. No case of death related to these hematological disturbances has been reported.Conclusion:In our registry, hematological side effects of biological treatment were found in 15.4% of cases and were noted with a median delay of 4.8 [1-12] months after the treatment initiation. Further studies are needed to confirm our preliminary results.Disclosure of Interests:None declared

scholarly journals AB0894-HPR THE JOURNEY OF PATIENTS WITH RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1470.2-1471
Author(s):  
M. Fusama ◽  
S. Oliver ◽  
H. Nakahara ◽  
Y. Van Eijk-Hustings ◽  
Y. Kuroe
Keyword(s):  
Rheumatoid Arthritis ◽  
Side Effects ◽  
Social Life ◽  
Life Story ◽  
Daily Life ◽  
Financial Burden ◽  
Psychological State ◽  
Self Management ◽  
Stable Phase ◽  
Management Skills

Background:The course of rheumatoid arthritis (RA) differs from patient to patient, and each patient has a unique story. The disease condition affects psychological and social aspects, greatly affecting the quality of life. The disease course is unpredictable, and each patient’s story can be seen as a lifelong journey, full of ups and downs. Therefore, it is crucial to know what kind of support is required during the course of their life.Objectives:The aim of this study is to examine the life story of patients with RA and clarify a common situation in their stories in order to consider what kind of support is needed.Methods:This is a qualitative study using life story interview for patients with RA in Japan. Interview included disease history, patients’ behaviors, effects on daily life, the patients’ perspectives regarding psychological considerations and useful support. Data were analyzed using content analysis. This study was approved by the ethics committee and informed consent was obtained.Results:Eight patients participated in this study. They were all females and the average age was 57 years old. As a result of the categorization, we extracted the following eight situations: (1) Emergence of symptom; patients thought joint pain would go away, however, the symptom did not improve and began to affect their daily life and work, (2) Choose a hospital to visit; pain and anxiety have continued and decided to visit a hospital, (3) Encounter with their doctors; patients expected their doctor to relieve their pain, while they were afraid of being told that they were suffering from a serious disease. (4) Diagnosis of RA; patients were shocked when diagnosed and anxious about what would happen and wondered why they had such a disease, (5) Choice of treatment; patients were afraid of the side effects. They wanted to make a decision discussing with their doctor, but they could not understand the explanation about drugs well and, therefore, followed the doctor’s opinion. (6) Change of treatment; a biological agent was often recommended. Patients were also worried about side effects and the financial burden. (7) Remission or stable phase; they felt better mentally too, however, they often felt anxiety about disease flare, side effect of drugs and financial burden, and (8) Flare and remission; patients felt shocked and disappointed when RA flared, and then, they noticed that patients with RA had alternating periods of relapse and remission and they had to live with RA.These interviews revealed repeated worsening and improvement of symptoms and many similar repeated psychological reactions such as anxiety, shock, denial, conflict, acceptance, giving up and relief. To cope with these fluctuating disease and mental conditions, patients were supported by educational and psychological assistance, timely consultations, social life help from nurses and support from their family. The patients considered a trusting relationship with their doctors is necessary. The patients had also realized through their experience the importance of enhancing their own abilities, such as decision-making, prevention of infections and self-management skills. Moreover, they noticed that it is important to have their own goals including hobbies and work.Conclusion:This study elucidated the common behaviors of patients with RA, the impact of RA on their psychological state and daily and social life, and the required support. The psychological condition and daily and social life also had a great influence on medical behavior. Therefore, psychosocial support and establishment of trust between healthcare professionals and patients are crucial. In addition, improving patients’ self-management skills including self-efficacy and empowerment is also necessary. As patients with RA often feel anxious in various situations and expect nurses’ support, nurses should listen to patients, pay attention to their concerns and anxieties, and show a solution-oriented attitude. In order for patients to feel at ease in their Patient Journey, nurses should sail with them while maintaining a patient-centered perspective.Disclosure of Interests:None declared

scholarly journals Beyond ‘Juggling’ and ‘Flexibility’: Classed and Gendered Experiences of Combining Employment and Motherhood

2006 ◽  
Vol 11 (2) ◽  
pp. 94-106 ◽  
Author(s):  
Jo Armstrong
Keyword(s):  
Case Studies ◽  
Family Life ◽  
Work And Family ◽  
Work Life ◽  
Gender Inequalities ◽  
Illustrative Case ◽  
Life Balance ◽  
Interview Research ◽  
And Gender ◽  
The Uk

This paper proposes that there is a need to push beyond the popular discourses of ‘flexibility’ and ‘work-life balance’. Developing a feminist-Bourdieuian approach and drawing on three illustrative case studies from my interview research with 27 mothers in the UK, I show the importance of maintaining a focus on class and gender inequalities. In the first part of the paper the concepts of capitals, dependencies and habitus which shaped, and were shaped by, this interview research are discussed. An analysis of three women's accounts of their experiences across work and family life is then used to illustrate that although these women all used terms such as ‘flexibility’ and ‘juggling’ in describing their work, the experience of that work was crucially influenced by their histories and current positioning. Tracing each of these women's trajectories from school, attention is focused on the influence of differential access to capitals and relations of dependency in the emergence of their dispositions toward work. Overall, the paper points to the significance of examining the classed and gendered dimensions of women's experiences of employment and motherhood.

scholarly journals Tolvaptan in the Management of Acute Euvolemic Hyponatremia After Transsphenoidal Surgery: A Retrospective Single-Center Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Rita Indirli ◽  
Júlia Ferreira de Carvalho ◽  
Arianna Cremaschi ◽  
Beatrice Mantovani ◽  
Elisa Sala ◽  
...  
Keyword(s):  
Side Effects ◽  
Hospital Stay ◽  
Hypertonic Saline ◽  
Transsphenoidal Surgery ◽  
Length Of Hospital Stay ◽  
Treatment Modalities ◽  
Fluid Restriction ◽  
Close Monitoring ◽  
Osmotic Demyelination ◽  
Sodium Correction

IntroductionSyndrome of inappropriate antidiuresis (SIAD) can be a complication of hypothalamus-pituitary surgery. The use of tolvaptan in this setting is not well established, hence the primary aim of this study was to assess the sodium correction rates attained with tolvaptan compared with standard treatments (fluid restriction and/or hypertonic saline). Furthermore, we compared the length of hospital stay in the two treatment groups and investigated the occurrence of overcorrection and side effects including osmotic demyelination syndrome.MethodsWe retrospectively reviewed 308 transsphenoidal surgical procedures performed between 2011 and 2019 at our hospital. We selected adult patients who developed post-operative SIAD and recorded sodium monitoring, treatment modalities and outcomes. Correction rates were adjusted based on pre-treatment sodium levels.ResultsTwenty-nine patients (9.4%) developed post-operative SIAD. Tolvaptan was administered to 14 patients (median dose 15 mg). Standard treatments were employed in 14 subjects (fluid restriction n=11, hypertonic saline n=1, fluid restriction and hypertonic saline n=2). Tolvaptan yielded higher adjusted sodium correction rates (12.0 mmolL-1/24h and 13.4 mmolL-1/48h) than standard treatments (1.8 mmolL-1/24h, p<0.001, and 4.5 mmolL-1/48h, p=0.004, vs. tolvaptan). The correction rate exceeded 10 mmolL-1/24h or 18 mmolL-1/48h in 9/14 and 2/14 patients treated with tolvaptan, respectively, and in no patient who received standard treatments. No side effects including osmotic demyelination occurred. Tolvaptan was associated with a shorter hospital stay (11vs.15 days, p=0.01).ConclusionsTolvaptan is more effective than fluid restriction (with or without hypertonic saline) and allows for a shortened hospital stay in patients with SIAD after transsphenoidal surgery. However, its dose and duration should be carefully tailored, and close monitoring is recommended to allow prompt detection of overcorrection.

Hydralazine-induced liver injury: a review and discussion

2021 ◽  
Vol 14 (8) ◽  
pp. e243278 ◽  
Author(s):  
Meeta Bhardwaj ◽  
Nakul Jay Bhardwaj ◽  
Kendra Cueto ◽  
T Colin Killeen
Keyword(s):  
Side Effects ◽  
Liver Injury ◽  
Antihypertensive Agent ◽  
Adverse Reactions ◽  
Liver Enzymes ◽  
Injury Pattern ◽  
Hypertension Management ◽  
Close Monitoring ◽  
Hepatocellular Injury ◽  
Specific Symptoms

Hydralazine is a commonly prescribed antihypertensive agent. Some of its labelled adverse reactions include lupus-like syndrome, tachycardia, headache and fever. Despite its well-known side effects, little is known about hydralazine’s hepatotoxic effects. We report the case of a 54-year-old female patient who was started on hydralazine for hypertension management but later presented with hydralazine-induced liver injury. Her initial presentation consisted of non-specific symptoms and a hepatocellular injury pattern. Liver biopsy revealed hepatic steatosis. Three weeks after discontinuation of hydralazine, the patient’s liver enzymes normalised, and her symptoms resolved. Few studies have examined the incidence and mechanism by which hydralazine induces a liver injury pattern. With this case, we review the literature, the pathogenesis involved and the eventual management of hydralazine-induced liver injury. We propose close monitoring of liver enzymes for patients on hydralazine throughout their treatment course.

Transplantation

2019 ◽  
pp. 399-414
Author(s):  
Gavin Spickett
Keyword(s):  
Gene Therapy ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Organ Transplantation ◽  
Cell Transplantation ◽  
Graft Failure ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Graft Vs Host Disease ◽  
The Subject

This chapter covers the indications, methods, immunological considerations, and monitoring of various types of transplantation. Covering stem cell transplantation, gene therapy, graft vs host disease, graft failure, and solid organ transplantation, the chapter provides an immunological overview of the subject.

Acute pain in the elderly

2011 ◽  
Author(s):  
Adrian Wagg ◽  
Shashi Gadgil
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Acute Pain ◽  
Health Care Professionals ◽  
The Elderly ◽  
World Health ◽  
Close Monitoring ◽  
Who Analgesic Ladder ◽  
Co Morbidity ◽  
Pain In The Elderly

Physiological changes that occur with age affect the pharmacokinetics and pharmacodynamics of drugs used in acute pain management. Elderly patients are often reluctant to complain of pain and seek treatment and may sometimes be unable to express pain due to impaired cognition or language. Evidence suggests the elderly as a group that receive inadequate analgesia and are often in pain. Health care professionals are often reluctant to administer sufficient analgesia due to fear of encouraging addiction or inducing side effects. The approach to pain management in this group should follow the World Health Organization (WHO) analgesic ladder with close monitoring for potential side effects and with escalation of treatment till sufficient analgesia is achieved. Choice of drugs and the route of administration should be tailored to the individual patient and should consider the nature of their pain and any disability or co-morbidity that will affect their response to the chosen agent. Non-steroidal anti-inflammatory drugs (NSAIDs) should be used with extreme caution, monitoring for potential gastrointestinal (GI) and renal side effects and long-term use should be avoided if possible. Opioids are effective analgesics and should not be denied to the elderly but their use should be monitored carefully and side effects such as nausea and constipation anticipated and treated.

A Preliminary Report on the Use of Clomipramine in General Practice

1975 ◽  
Vol 20 (1_suppl) ◽  
pp. 67-71 ◽  
Author(s):  
L. W. Wootton ◽  
R. I. Bailey
Keyword(s):  
General Practice ◽  
Side Effects ◽  
Combined Treatment ◽  
Clinical Situation ◽  
Illustrative Case ◽  
Case Histories ◽  
Drug Induced ◽  
Practice Population ◽  
History Of ◽  
Continue Therapy

The use of clomipramine in a large suburban general practice is reviewed. Three hundred and fifty patients have been treated to date out of a total practice population of twenty-one thousand. It is argued that phobic anxiety states are much commoner than is normally supposed and that they are usually associated with a history of separation or rejection in childhood. A combined treatment regime is employed for one month thereafter clomipramine alone is used. Side-effects may initially present a problem although they may not all be truly drug induced. Some patients use side-effects to manipulate the clinical situation. However proper interpretative management of side effects can assist the clinicians in persuading patients to continue therapy. Some impressive results have been obtained with clomipramine therapy. Illustrative case histories are provided.

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