Impairment of patient-reported outcomes among patients with non-alcoholic fatty liver disease: a registry-based study.

BACKGROUND: Patients with non-alcoholic fatty liver disease (NAFLD) and more advanced fibrosis tend to have more impairment in their health-related quality of life and other patient-reported outcomes (PROs). AIM: To assess the association of PROs with select non-invasive tests (NITs) for fibrosis including FAST, Agile 3+ and Agile 4 scores METHODS: We enrolled patients with an established diagnosis of NAFLD who were seen in a tertiary care clinic into the NAFLD/NASH Registry. The FAST, Agile 3+ and Agile 4 scores were calculated using liver stiffness measurements by transient elastography and laboratory parameters. PROs were assessed using FACIT-F, CLDQ-NASH and WPAI instruments (total of 17 domain and summary scores). RESULTS: There were 1509 patients with NAFLD (mean age: 49 ± 11 years, 50% men, 41% employed, 30% advanced fibrosis and 20% cirrhosis). The mean FAST, Agile 3+ and Agile 4 scores were 0.39 ± 0.26, 0.35 ± 0.31 and 0.12 ± 0.23, respectively. Subjects with lower FAST, Agile 3+ and Agile 4 scores had the highest scores in select domains of FACIT-F, CLDQ-NASH and WPAI (p < 0.05 in comparison to subjects with elevated or high-risk NIT scores). Correlations with continuous NITs were significantly negative for Emotional and Functional well-being (FACIT-F), Activity/energy, Systemic symptoms, Worry and total scores (CLDQ-NASH), and Activity of WPAI (p < 0.05); the strongest was for Worry (CLDQ-NASH) with FAST (R = -0.17, p < 0.0001). The PRO scores of patients with NAFLD were lower than those of matched patients with chronic hepatitis B (p < 0.05 for 9/17 domain and summary scores). CONCLUSION: Patients with NAFLD and high FAST, Agile 3+ or Agile 4 scores experience impairment of health-related quality of life.

Determination of Senior Nursing Students' Mathematical Perception Skills and Pediatric Medication Calculation Performance.

AIM: Math skills in the health field are often used to calculate drug dosage and liquid quantity, body mass and cost analysis. The aim of this research is to determine the senior nursing students' mathematical perception skills and pediatric medication calculation performance. METHOD: The population of this descriptive cross-sectional research is composed of 103 nursing students in attending a state university in Izmir, Turkey. Of the 103 nursing students, 97 who answered all the questions comprised the study sample. All the participants took one-month training in the pediatric clinics during the last year of their education. The data were collected using the "Personal Information Form and Mathematics Perception, Information and Pediatric Drug Calculator Skills Survey" developed by the researchers by reviewing the literature. RESULTS: The mean age of the study participants was 22.24±0.89. Of them, 76.3% were female, 23.7% completed their Pediatric Internship Training in the pediatric inpatient units or the Pediatric Intensive Care Unit (PICU), 68% thought that their basic mathematics knowledge was adequate, and %30 stated that their dosage calculation, solution preparation and drug preparation skills were insufficient. In addition, the rate of the correct answers they gave to the questions on percentages, fractions and conversions was low. CONCLUSION: In the drug application process; not only practical skills, but also the theoretical knowledge should be considered. A nurse's responsibility does not end once he/she administers medication. Being careful throughout the entire process is one of the nurse's legal and ethical responsibilities. In this study, the students' drug calculation skills were inadequate.

Response of antioxidant system of tilapia (Oreochromis niloticus) following exposure to chromium and copper in differing hardness.

Tilapias (Oreochromis niloticus) were exposed to copper or chromium in soft water (SW) (~80 mg CaCO3/L, conductivity 1.77 mS/cm) or hard water (HW) (~320 mg CaCO3/L, conductivity 5.80 mS/cm) using 2 exposure protocols (20 µM for 48 h and 10 µM for 144 h). Following the exposures, antioxidant enzyme activities [superoxide dismutase (SOD); catalase (CAT); glutathione peroxidase; glutathione reductase; and glutathione S-transferase (GST)] and glutathione (GSH) levels were measured in the liver of fish. SOD and CAT activities of control fish kept in SW were significantly lower than control fish kept in HW. However, the other antioxidant indices (glutathione metabolism) of both control fish were unaffected from water hardness. Acute metal exposures did not alter the glutathione metabolism, whereas SOD activity in SW and CAT activity in both waters changed significantly. In subchronic duration, Cu exposure caused significant decreases in measured parameters, except for GST activity and GSH level. Similarly, GST activity and GSH level were unaffected from Cr exposure. This study showed that SOD and CAT were the most sensitive antioxidant indices, and that glutathione metabolism, in general, was not altered following metal exposures in different waters.

The effect of 25-hydroxyvitamin D3 on the immune system.

AIM: To examine the effect of 25-OH vitamin D3 on the immune system in patients with nutritional rickets. METHODS: Fifty-three patients were included in our study between April 2002 and March 2004. Diagnosis of rickets was based on clinical, biochemical and radiological examinations. Cell surface markers (CD), complement factors (C), and immunoglobulin (Ig) levels were determined to find out any relationship between rickets and immune system deficiency. RESULTS: Among the causes of admission to hospital, fever (66%) and coughing (62.2%) were the most frequent. Pneumonia was accompanied by rickets in 47.1% of the cases. Plasma CD4 levels before the treatment were higher than those in the post-treatment period, whereas CD20 and CD56 levels were lower. CONCLUSION: B cell and natural killer cell reduction which occur because of vitamin D deficiency may contribute to the development of pneumonia and other infections in patients with nutritional rickets.