Translation, cultural adaptation and validation of the Systemic Lupus Erythematosus Activity Questionnaire (SLAQ) in a cohort of Italian systemic lupus erythematosus patients.

Introduction The Systemic Lupus Erythematosus Activity Questionnaire (SLAQ) is a patient-reported instrument for the assessment of disease activity in systemic lupus erythematosus (SLE). The aims of the present study are translation, cultural adaptation and validation of an Italian version: the SLAQit. Methods The process of translation and cultural adaptation followed published guidelines. SLAQit was pretested in a group of 35 SLE patients to evaluate acceptability, comprehension and feasibility. Internal consistency, test-retest validity and external validity were tested on consecutive SLE patients attending the clinic. Results In total, 135 SLE patients were enrolled in this study. The pilot test provided a 99.9% response rate and demonstrated feasibility and comprehensibility of the questionnaire. A good internal consistency was found among the three components of the score (SLAQ score, numerical rating scale (NRS), patient global assessment question (PGA); α = 0.79). SLAQit showed very high reliability (test-retest α > 0.8). NRS and PGA showed a strong positive correlation with both Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) ( p = 0.002 and p < 0.001, respectively) and European Consensus Lupus Measurement (ECLAM) scores ( p = 0.01 and p < 0.001, respectively), while the SLAQ score did not. A significant agreement was observed between the physician's intention to treat and both the NRS and PGA scores, while no significant association was reported with the SLAQ score. Conclusions SLAQit was demonstrated to be a reliable and valid instrument for self-assessment of disease activity in SLE patients.

Long-term function and survival of elderly donor kidneys transplanted into young adults.

BACKGROUND: Traditionally, elderly donor kidneys have not been widely accepted for transplantation on the assumption of inferior performance. However, the United Network for Organ Sharing reports an increase in the number of elderly donors from less than 2% in 1982 to 24% in 1995. This trend is commensurate with the increase of older dialysis patients and an overall increase in the elderly population in the United States (1). Optimal utilization of these kidneys is essential to overcome the acute organ shortage. METHODS: In this study, we transplanted 25 kidneys from elderly donors (ages 56-72 years) into young adult recipients (ages 20-50 years) (group 1) over a 4-year period. We compared the results with matched recipients of young adult donor kidneys (group 2) with regard to long-term kidney function and graft survival. A pretransplant biopsy of elderly donor kidneys was carried out and a frozen section report was obtained. Only those kidneys showing glomerulosclerosis of less than 20% were accepted for transplantation. All cadaveric kidneys were preserved in University of Wisconsin solution. RESULTS: Pretransplant biopsies of elderly donor kidneys showed structural deficits, which included glomerulosclerosis in 85%, arteriolar and/or mesangial thickening in 75%, and interstitial lymphocyte infiltration in 30%. The mean serum creatinine was 2.4+/-0.74, 2.2+/-0.56, and 2.9+/-0.76 mg/100 ml in group 1 and 1.5+/-0.55, 2.3+/-2.24, and 1.7+/-0.62 in group 2 at 1, 3, and 5 years, respectively. The patient survival was 92%, 92%, and 88% in group 1, and 100%, 100%, and 100% in group 2 at 1, 3, and 5 years, respectively. The graft survival was 80%, 64%, and 56% in group 1 and 100%, 96%, and 88% in group 2 at similar time intervals. The differences in the serum creatinine and graft survival between the two groups were statistically significant (P < 0.05). CONCLUSIONS: Most of the elderly donor kidneys with structural deficits transplanted into young adults provided suboptimal function and inferior long-term graft survival. To maximize the utilization and optimize the survival of elderly donor kidneys, we propose transplantation of these kidneys into age-matched recipients with similar physiological requirements as those of donors, with regard to kidney function.

Interpretation of pediatric x-ray films by emergency department pediatricians.

This study compared the interpretation of pediatric roentgenograms by emergency department pediatricians and radiologists. Data were available from 532 of 600 children who had 564 radiographic studies during a six-week period: 217 examinations of the chest, 200 of the extremities, 74 of the skull, 35 of the abdomen, and 38 of miscellaneous structures. The emergency department pediatricians and the radiologists were in agreement in 91.1% of the cases. Among the 50 of 564 (8.9%) discordant studies, only seven (1.2%) required changes in therapy. The results attest to the accuracy of emergency department pediatricians in interpreting the usual types of films ordered in their department. However, this group specifically erred in the identification of subtle fractures and the detection of abnormalities incidental to the primary purpose for which the film was obtained. Future educational programs should address these areas of deficiency.

Life-threatening complications of varicella.

We reviewed the records of 96 children hospitalized with varicella from July 1, 1975 to June 30, 1980. Eighty-one were immunologically normal and 15 were immunocompromised on the basis of neoplasia, immunosuppressive therapy, or genetic disease. These children experienced 106 complications including viral dissemination-encephalitis (44), bacterial infection (25), Reye's syndrome (17), unusual cutaneous lesions (eight), drug overdose (five), diabetic ketoacidosis (two), neonatal infection (two), dehydration (two), and exacerbation of preexisting nephrosis (one). The length of hospitalization varied from one to 38 days with a median of five days. There were ten varicella pneumonia (one), of neonatal varicella (one), and of a ruptured mycotic aneurysm secondary to septicemia (one). This review demonstrates (1) a substantial occurrence of life-threatening complications of varicella in childhood, and (2) a need for prospective epidemiologic data on the incidence of complications to determine the scope and extent of varicella vaccination.