Epstein-Barr virus associated colitis in kidney transplant patients: a case series

BACKGROUND

Gastrointestinal complications are common in kidney transplant (KT) patients and can be a consequence of the chronic use of immunosuppression. The differential diagnosis of colitis in KT patients includes intolerance to immunosuppressive agents, namely mycophenolate mofetil, de novo inflammatory bowel disease (IBD) and opportunistic infections. Epstein-Barr virus (EBV) infection may cause post-transplant colitis or trigger de novo IBD, although is seldom thought as the causative pathogen.

OBJECTIVES

To describe clinical characteristics, endoscopic and histological findings, treatment and outcome of three patients that developed EBV associated colitis following kidney transplantation.

METHODS

We retrospectively analyzed three patients with EBV associated colitis; clinical data including transplantation, gastrointestinal symptoms, endoscopy findings, and follow-up data was obtained.

RESULTS

We present a case series of three patients with EBV colitis following KT, with an average age at clinical presentation of 59 years and elapsed time since the KT ranging from five to 22 years. Clinical manifestations included bloody diarrhoea, abdominal pain, weight loss and/or fever. Cytomegalovirus colitis, mycophenolate mofetil-related colitis, lymphoproliferative disease and graft versus host disease were excluded. One patient had a prior diagnosis of IBD. Two of the three patients had an unfavourable outcome with death despite reduction and/or switching of immunosuppressants, optimal medical treatment (including antiviral and intravenous immunoglobulin therapies) and salvage surgical therapy.

CONCLUSION

A multidisciplinary approach is necessary to allow an expeditious diagnosis of a rare entity such as EBV associated colitis in KT. Long-term surveillance of these patients and the development of effective and safe therapies is essential.

Hand-Foot-Mouth Disease in an Adult

Hand-foot-mouth syndrome is a common childhood illness. Although occurrence in adults is rare, its incidence has been increasing. In such cases, it usually presents with atypical symptoms. The authors present the case of a 33-year-old male patient who presented with constitutional symptoms, feverish sensation, and macular palmoplantar rash associated with oral and oropharynx ulcers. The epidemiological history revealed exposure to two cohabitants (children) with a recent diagnosis of hand-foot-mouth disease (HFMD).

[The Portuguese version of the 20-item Toronto Alexithymia Scale -- I. Linguistic adaptation, semantic validation, and reliability study]

BACKGROUND

The Toronto Alexithymia Scale, namely in its revised version (TAS-20), is nowadays widely used and certainly the most well validated measure of alexithymia; allowing to recognize three distinct aspects of the construct.

OBJECTIVE

The aim of the present study is to assess reliability and validity of a Portuguese translation; proceeding in this first part, to the semantic validation and confirmatory structural analysis of the questionnaire, as well as to the analysis of the internal coherence of this structure, and of its reliability in what concerns time stability. Just to later examine validity related aspects as described in a second paper.

METHODS

Fist of all translation and substantiation were properly made as described according with commonly used procedures. Thus resulting in a questionnaire subsequently applied to three distinct populations: university students (N = 468), outpatients attending a routine general practice consultation (N = 50), and patients with inflammatory bowel disease (N = 74).

RESULTS

Despite some traceable instability while replicating the original model, confirmatory factorial analysis somehow allowed disclosing the three originally described factors. Nevertheless also resulted some differences susceptible to later being discerned among the factors in what concerns their internal coherence: the questionnaire as a whole is highly reliable, and the same goes for factor 1, in any of the studied samples; less steady results among different groups were found regarding factors 2 and 3. However the test-retest stability brought to evidence, in any of the considered groups, an excellent reliability in all aspects: global score and integrating factors.

CONCLUSION

With these sound psychometric properties of the instrument under scrutiny, the observed cross-cultural variations result as minor, while also considering the aimed comparability in the context of a vast amount of alexithymia studies carried out all over the world.

Relationships between alexithymia, emotional control, and quality of life in patients with inflammatory bowel disease

BACKGROUND

Although the constructs of alexithymia and emotional control have been associated with physical health, the relationship between these constructs is unclear and their influence on health-related quality of life has not been investigated previously. This study examined the relationships between alexithymia, emotional control, and quality of life in 74 patients with inflammatory bowel disease (IBD).

METHODS

The subjects completed the 20-item Toronto Alexithymia Scale (TAS-20), the Emotional Expression and Control Scale (EEC), and the Inflammatory Bowel Disease Questionnaire (IBDQ) for assessing quality of life.

RESULTS

The TAS-20 correlated negatively and significantly with the IBDQ global score and with subscales assessing bowel symptoms, systemic symptoms, and emotional functioning; the emotional control subscale of the EEC correlated positively and significantly with these measures. Although the TAS-20 correlated significantly and negatively with the emotional control subscale, alexithymia and quality of life scores were unrelated to subscales of the EEC assessing tendencies to either hold back or express emotions. A hierarchical stepwise multiple regression analysis revealed that alexithymia and, to a lesser extent, emotional control play a role in predicting quality of life in patients with IBD.

CONCLUSIONS

Alexithymia and emotional control are negatively related constructs and each construct has an independent influence on the subjective health status of patients with IBD.

[Expectations of control in the context of personality. More about the factorial structure of Levenson's IPC scale]

The goal of this study was to review some of the psychometric properties concerning the IPC scale as well as to confirm the locus of control structure as proposed by Levenson. Having that in mind we reviewed some previous studies on this subject, and tried to work out what went wrong when reports couldn't make a clear cut between social and chance factors within the external dimension of the proposed construct. The sample was formed by a homogeneous group drawn from a population of university students. This allowed for comparisons with similar studies. The innovation here resides in the analytical approach proposed, which should account for the oblique factors determined by the two alleged existent clusters for the external locus of control. It did, thus corroborating the original invariants proposed. The study also reinforces the conviction previously noted that questions 3, 4, and 10 should be ignored or even suppressed, eventually leading ulterior studies to report through standard transformation of the raw scores.