Renal association clinical practice guideline in post-operative care in the kidney transplant recipient

These guidelines cover the care of patients from the period following kidney transplantation until the transplant is no longer working or the patient dies. During the early phase prevention of acute rejection and infection are the priority. After around 3-6 months, the priorities change to preservation of transplant function and avoiding the long-term complications of immunosuppressive medication (the medication used to suppress the immune system to prevent rejection). The topics discussed include organization of outpatient follow up, immunosuppressive medication, treatment of acute and chronic rejection, and prevention of complications. The potential complications discussed include heart disease, infection, cancer, bone disease and blood disorders. There is also a section on contraception and reproductive issues.Immediately after the introduction there is a statement of all the recommendations. These recommendations are written in a language that we think should be understandable by many patients, relatives, carers and other interested people. Consequently we have not reworded or restated them in this lay summary. They are graded 1 or 2 depending on the strength of the recommendation by the authors, and AD depending on the quality of the evidence that the recommendation is based on

Associação entre risco de disfagia e risco nutricional em idosos internados em hospital universitário de Brasília Association between risk of dysphagia and nutritional risk in elderly inpatients at a univesity hospital of Brasília, Brazil

OBJETIVOS: Investigar a associação entre o grau de risco de disfagia e o risco nutricional dos pacientes idosos internados na clínica médica do Hospital Universitário de Brasília. MÉTODOS: Estudo transversal, analítico, original, observacional, não-controlado, com amostra de conveniência e estratificada. Foram aplicados a Mini Avaliação Nutricional e o questionário de risco de disfagia em 49 pacientes idosos nas primeiras 48 horas após admissão na clínica médica, em setembro de 2006. RESULTADOS: A freqüência de idosos foi maior na faixa etária entre 60-74 anos 11meses (78%), com média de idade de 69 anos, sendo 41% mulheres e 59% homens. A proporção de risco de disfagia dos pacientes idosos foi de 69% e do estado nutricional inadequado de 71%, valor elevado principalmente entre as mulheres. Ambos os sexos se encontram em risco nutricional, masculino (20,5, Desvio-padrão - DP=5) e feminino (19, DP=6). O estudo mostrou que as mulheres apresentam uma tendência maior para risco de disfagia, porém os homens apresentam um quadro de maior gravidade (risco moderado). Foi encontrada uma correlação negativa moderada entre os valores de risco de disfagia e seus respectivos scores da Mini Avaliação Nutricional. CONCLUSÃO: Foi verificado neste estudo que os idosos apresentam dois agravantes de sua qualidade de vida: estado nutricional e disfagia, que podem ser agudizados na internação hospitalar.<br>OBJECTIVES: This study aimed to verify the association between the degree of risk of dysphagia and nutritional risk of elderly inpatients at the medical clinic of Brasília´s University Hospital. METHODS: This is a cross-sectional, analytic, original, observational, uncontrolled study with convenience and stratified sample. The Mini Nutritional Assessment and a questionnaire to assess risk of dysphagia were administered to 49 elderly patients within the first 48 hours after admission to the medical clinic, in September 2006. RESULTS: Most of the elderly inpatients aged from 60 to 74 years and 11 months (78%) with a mean age of 69 years; 41% were females and 59% were males. Sixty-nine percent of the elderly inpatients were at risk of dysphagia and 71% presented inadequate nutritional status, especially women. Both males (20.5, standard deviation= 5) and females (19, standard deviation= 6) were at nutritional risk. The study showed that women are more likely to develop dysphagia yet men presented a higher degree of risk (moderate risk). There is a moderate negative correlation between the values obtained for the risk of dysphagia and their respective Mini Nutritional Assessment scores. CONCLUSION: This study verified that two factors aggravate the quality of life of the elderly: their nutritional status and dysphagia. Both can worsen dramatically during hospitalization

Living with oropharyngeal dysphagia: effects of bolus modification on health-related quality of life—a systematic review

Purpose - Difficulty swallowing, oropharyngeal dysphagia, is widespread among many patient populations (such as stroke and cancer groups) and aged community-dwelling individuals. It is commonly managed with bolus modification: altering food (usually cutting, mashing or puréeing) or fluids (typically thickening) to make them easier or safer to swallow. Although this treatment is ubiquitous, anecdotal evidence suggests patients dislike this management, and this may affect compliance and well-being. This review aimed to examine the impact of bolus modification on health-related quality of life. Methods - A systematic review of the literature was conducted by speech pathologists with experience in oropharyngeal dysphagia. The literature search was completed with electronic databases, PubMed and Embase, and all available exclusion dates up to September 2012 were used. The search was limited to English-language publications which were full text and appeared in peer-reviewed journals. Results - Eight studies met the inclusion criteria. Generally, bolus modification was typically associated with worse quality of life. Modifications to foods appeared to be more detrimental than modifications to fluids, but this may be due to the increased severity of dysfunction that is implied by the necessity for significant alterations to foods. The number of studies retrieved was quite small. The diverse nature of methodologies, terminologies and assessment procedures found in the studies makes the results difficult to generalise. Conclusion - Overall, even though the severity of dysphagia may have been a confounding factor, the impact of bolus modification on health-related quality of life in patients with oropharyngeal dysphagia appears to be negative, with increased modification of food and fluids often correlating to a decreased quality of life. Further, associated disease factors, such as decreased life expectancy, may also have affected health-related quality of life. More research is needed

Seasonality and resource availability control bacterial and archaeal communities in soils of a temperate beech forest

It was hypothesized that seasonality and resource availability altered through tree girdling were major determinants of the phylogenetic composition of the archaeal and bacterial community in a temperate beech forest soil. During a 2-year field experiment, involving girdling of beech trees to intercept the transfer of easily available carbon (C) from the canopy to roots, members of the dominant phylogenetic microbial phyla residing in top soils under girdled versus untreated control trees were monitored at bimonthly intervals through 16S rRNA gene-based terminal restriction fragment length polymorphism profiling and quantitative PCR analysis. Effects on nitrifying and denitrifying groups were assessed by measuring the abundances of nirS and nosZ genes as well as bacterial and archaeal amoA genes. Seasonal dynamics displayed by key phylogenetic and nitrogen (N) cycling functional groups were found to be tightly coupled with seasonal alterations in labile C and N pools as well as with variation in soil temperature and soil moisture. In particular, archaea and acidobacteria were highly responsive to soil nutritional and soil climatic changes associated with seasonality, indicating their high metabolic versatility and capability to adapt to environmental changes. For these phyla, significant interrelations with soil chemical and microbial process data were found suggesting their potential, but poorly described contribution to nitrification or denitrification in temperate forest soils. In conclusion, our extensive approach allowed us to get novel insights into effects of seasonality and resource availability on the microbial community, in particular on hitherto poorly studied bacterial phyla and functional groups