[Olmesartan-associated enteropathy: attention to an emerging iatrogenic phenomenon]. / Enteropatía asociada a olmesartán: atención a un fenómeno iatrogénico emergente.

Olmesartan is an angiotensin II type 1 receptor blocker commonly used in the treatment of hypertension. Several cases of sprue-like enteropathy associated with the use of this drug have been described which, even with important signs and limitations for the patient, present a full recovery after discontinuing the use of olmesartan. The case of a 64 year-old patient is presented, diagnosed with hypertension, under treatment with olmesartan-amlodipine, with chronic diarrhoea and villous atrophy on intestinal biopsies without diagnostic criteria for celiac disease and with complete remission after suspending discontinuing the use of olmesartan. Based on the clinical features presented by the case reported, the clinical and anatomopathological findings are described as well as the evolution of drug-induced enteropathy.

Quality of life assessment in a living donor kidney transplantation program: evaluation of recipients and donors.

BACKGROUND: Quality of life (QOL) in donors before and after living kidney donor transplantation (LKDT) has been an important concern. Investigation of these issues in related recipients is not as common. Since 2002, a protocol of psychosocial evaluation for donors and recipients was included in the living kidney donation program. We sought to evaluate QOL in donors and recipients, before and after transplantation, and to compare the 2 groups. METHODS: Before and after transplantation, 35 recipients and 45 donors completed a Sociodemographic Questionnaire and Short-Form 36 Health Survey Questionnaire (SF-36). The Wilcoxon test, Mann-Whitney test, and logistic regression were applied. RESULTS: Before transplantation, recipients had lower QOL values than donors for all dimensions (P < .05), with the exception of Mental Health. After transplantation, they had higher values (P < .05) for every dimension on the SF-36. Among donors, there were no significant changes. Physical function and social function were considered poorer by donors versus recipients (P < .05). CONCLUSIONS: In this LKDT program, more females were donors and fewer were recipients. Most of donors were siblings. All donors were related (the Portuguese law pertaining to unrelated donation was enacted in 2007). QOL was significantly poorer among recipients before surgery. After surgery, QOL significantly improved in recipients and was not poorer in donors. LKDT improved recipients' lives and did not affect donors' negatively.

Perceptions in living kidney donation: what protagonists think and feel.

BACKGROUND: Although donor perceptions of donation have been evaluated in several programs, evaluation of associated recipients has not been as frequent. PURPOSE: Our aim was to evaluate and compare after transplantation, donor and recipient perceptions of donation. METHODS: After transplantation 35 recipients and 45 donors completed a sociodemographic and a donation perception questionnaire. We applied the Fisher test to descriptive (absolute and relative frequency) data. RESULTS: 57.8% of donors were female and 62.9% of recipients male. 53.3% of donors were siblings, 44.5% parents, and 2.2% a daughter. Most recipients (71.9%) thought that the donation was the donors' initiative and 21.9% that it was suggested by medical team. 96.4% responded that it was the donor's wish that determined their decision; 51.4% had serious or some doubts about accepting the option, but for 48.6% it was an easy decision. Among the donors, 88.9% decided by themselves and 8.9% were asked for donation. For 91.1%, their wish was the main reason of the decision, but 8.9% felt a moral obligation; 77.8% thought it was an easy decision, and 17.8% hesitated a little 84.4% were not worried about their future health. CONCLUSIONS: Altruistic motivations were predominant in both groups. Most recipients thought that the motivation for donation was self-determined, a finding that agreed with donor perceptions. Perceptions about the quality of and changes in emotional relationship were the same in both groups. Donors and recipients referred to the donation process as positive, but there were some negative emotions and perceptions.

Depression and anxiety in living kidney donation: evaluation of donors and recipients.

BACKGROUND: Psychosocial status of donors before and after living kidney donor transplantation has been an important concern. Investigations of psychosocial issues in related recipients are not frequent. AIM: The aims of this study were to evaluate and compare psychopathologic dimensions in donors and recipients before and after transplantation. METHODS: Thirty-five recipients and 45 donors completed a psychosocial evaluation before and after transplantation. We applied Pearson chi-square, McNemar, Fisher, Wilcoxon, and Mann-Whitney tests as well as linear and logistic regression statistical methods. RESULTS: Before transplantation 100% of the recipients presented total anxiety, compared with 64.4% of donors, with higher anxiety levels in all dimensions (P < .001). Also, 38.7% of recipients and 16.3% of donors had moderate/serious depression (P = .029). Men showed higher levels of cognitive anxiety before transplantation (odds ratio [OR] = 4.3; P = .008). After versus before transplantation central nervous system and cognitive anxiety had diminished in recipients (P = .031; P = .035, respectively); there were higher levels of cognitive anxiety than among the donors (P = .007). Depression showed no significant changes in recipients or donors; the differences were no longer significant. There were less severely depressed recipients but an increase among severely depressed donors. Male recipients and donors showed greater cognitive anxiety (P = .02; P = .04, respectively) at both times. Female recipients presented with more severe depression (P = .036). CONCLUSIONS: Anxiety is an important symptom. Surgery had a positive impact to lower anxiety in recipients. Most protagonists displayed little or no depression; it was more prevalent among recipients. Donors and recipients maintained some psychopathologic symptoms after surgery. We defined vulnerable groups among these cohorts.

Impact assessment in living kidney donation: psychosocial aspects in the donor.

BACKGROUND: Living donor kidney transplantation has a positive influence on graft survival and recipient quality of life (QoL). We assessed the psychosocial impact of donation to the donor. METHODS: Before and after the procedure 32 living kidney donors (mean age 41 years) completed the Zung Self-Rating Anxiety and Depression Scales; a Sociodemographic, Short-Form 36 Health Survey (SF-36), and a Donation Perceptions Questionnaire. RESULTS: Living kidney donors were siblings (62.5%), parents (34.4%), or a daughter (3.1%). Transplantation was not successful in two cases: one recipient death and one graft failure. No significant changes were observed in donor QoL except for the SF-36 social functioning subscale that showed significant improvement after donation (P = .038). A reduction in depression symptom frequency was verified after donation (from 65.6% to 46.9%). There was an almost significant decrease in depression scores (P = .077), which was in fact was significant when one considered only successful transplants (P = .021). There was no significant variation in anxiety scores among donors. Time since transplantation was inversely correlated with overall anxiety (r = .443, P = .011), and with somatic anxiety subscales (r = .357, P = .045). For most donors, the decision to donate was easy and spontaneous. Nearly all donors would donate again and strongly encourage others to donate. CONCLUSIONS: Except for the social functioning scale that improved, no significant changes were observed in QoL of living kidney donors after the procedure. Depression scores significantly decreased after donation, but anxiety scores remained stable. Donors, who were mostly siblings, showed positive perceptions about donation, did not regret their decision, and strongly recommend it to others.

Teaching undergraduates about familial breast cancer: comparison of a computer assisted learning (CAL) package with a traditional tutorial approach.

We have developed a computer assisted learning package for teaching clinical medical students about familial breast cancer. It explains the principles of genetic predisposition to breast cancer, the association with other cancers, the principles of family history taking and confirmation, risk assessment and possible interventions. Clinical medical students were randomised to either conventional teaching or CAL, 48 students attended the evaluation session. Students randomised to conventional teaching received a 20 min mini-lecture, those randomised to CAL completed the package with technical, but not academic support available. At the end of the intervention both groups of students completed a short written assessment of acceptability and knowledge and understanding of breast cancer genetics. There was no significant difference between the CAL and mini-lecture groups in terms of marks or acceptability. Thus CAL appears to be an acceptable and effective method of teaching clinical medical students about familial breast cancer. Although time consuming to develop, CAL can be used in a variety of settings to increase curriculum flexibility. Methods of motivating students to complete the CAL, and of providing educational support are being explored.

Digital video for networked CAL delivery.

Digital moving images (AVI format), were integrated into a specific computer-assisted learning (CAL) application, providing a highly visual and interactive self-learning tool in an area of the medical curriculum which is difficult to teach by traditional methods. This paper outlines the process used to obtain the digital video using relatively inexpensive equipment and the subsequent delivery over a university network without resorting to major upgrading of the network specifications.