Quality of life among dialysis patients: Predictive analysis of illness intrusiveness and spiritual beliefs.

Objective: To investigate the predicting effect of illness intrusiveness and spiritual belief determining dialysis patients' quality of life. METHODS: The correlational study was conducted from September 2018 to July 2019 in Rawalpindi and Islamabad, Pakistan, and comprised adult patients of either gender experiencing dialysis issues for one year at the Pakistan Institute of Medical Sciences, the Pakistan Kidney Patients Association, the Islamabad Dialysis and Nephro Care Centre, the Bahria International Hospital and the Shifa Hospital Kidney Centre. Data was collected using the Illness Intrusiveness Scale, the Daily Spiritual Experience Scale, the World Health Organisation Quality of Life Scale, and a demographic sheet. Data was analysed using SPSS 23. RESULTS: Out of 200 patients, 116(58%) were males and 84(42%) were females. Female patients had higher mean values for illness intrusiveness value 62.08±14.47, spiritual belief 33.45±14.75 psychological health 18.00±3.88 and environmental health 25.15±4.93. Male dialysis patients had higher mean values for physical health 19.11±7.51 and social relationship 10.50±2.45. Illness intrusiveness was a significant negative predictor of physical health (p<0.000), psychological health (p<0.001), social relationship (p<0.000) and environmental health (p<0.05). Spiritual belief was a significant positive predictor of physical health (p<0.01), psychological health (p<0.001), social relationship (p<0.05) and environmental health (p<0.05). Conclusion: High level of illness intrusiveness in dialysis patients tended to decrease life quality. Those having a higher level of spiritual belief tended to develop a better approach to life quality.

Kikuchi's disease: an unusual presentation and a therapeutic challenge.

Kikuchi's disease, or necrotizing histiocytic lymphadenitis, is a rare disease that presents predominantly in young women in their 20s and 30s from the Far East. Our case depicts an African-American male, in his sixth decade of life, presenting with Kikuchi's disease, making our case unusual. The clinical presentation, together with laboratory and pathological tests described here, specifically the utilization of immunohistochemistry, aid in establishing a diagnosis. We advocate the use of steroids as symptomatic therapy and provide a novel and successful therapeutic regimen. We do not recommend antibiotic therapy until an infectious etiology is confirmed.

Nucleosome effects on mesangial cell matrix and proliferation: a possible role in early lupus nephritis.

BACKGROUND: Oligonucleosomes (ON) have been demonstrated in the circulation and biopsies of lupus nephritis patients. Their presence as immune complexes is an early and persistent finding in lupus nephritis as are changes in mesangial matrix. Since ON competitively bind to glomerular mesangial cells (MC) in a receptor-like fashion, the purpose of our study was to investigate what effects ON have on MC matrix and proliferation. METHODS: Rat and mouse MCs grown with ON or DNA for 1 week were dissociated from their matrices with Triton-X and their proteins were determined. MC collagen production, using collagenase sensitive 3H-proline incorporation, was measured after 48-hour incubation with ON and DNA. Similar experiments using 10-fold excess DNA were done to assess its blocking effect on ON induced collagen synthesis. ON interaction with matrix was evaluated by incubated 125I-ON with MC matrix grown with ON or media alone for 1 week. RESULTS: MCs stimulated by ON but not DNA significantly increased total matrix protein, total collagen and specifically, collagen type I synthesis. DNA inhibited ON-stimulated collagen synthesis. MC matrix incubated with ON binds 3 times more 125I-ON than matrix generated in media alone. Histone, a major component of nucleosomes, significantly increased 3H-thymidine incorporation. CONCLUSIONS: Oligonucleosomes, both qualitatively and quantitatively, influence mesangial cell function. These findings for the first time suggest ON to be pathogenic independent of their IC construct. DNA inhibition of ON induced mesangial matrix changes suggests participation of the ON/DNA receptor. Increased production of collagen type I may contribute to glomerulosclerosis.