Đorđe Pojatić

Background: Nearly 10% of all community-acquired pneumonias are caused by Chlamydia pneumoniae. This is a Gram-negative intracellular coccus that poses a significant challenge for routine diagnostics due to its poor growth in tissue culture and non-specific clinical presentations. Case Report: This study presents the case of a 61-year-old man whose initial disease manifestation included a non-specific upper respiratory tract infection and reactive pericarditis. A diagnostic work-up of the etiology of pericarditis, with stepwise exclusion of other causative agents, led to confirmation of a possible chronic, recurrent C. pneumoniae infection, with good clinical and laboratory responses to azithromycin across multiple hospitalizations. However, upon initiation of prolonged doxycycline therapy, the disease course was complicated by the development of Guillain–Barré syndrome. With appropriate treatment, the neurological deficit regressed, with near-complete resolution of the syndrome’s clinical picture. Discussion and Conclusions: The development of reactive pericarditis and the patient’s neurological symptoms stemmed from an immune response to bacterial antigens that resemble antigens of the central nervous system and the pericardium. Prolonged doxycycline therapy, together with symptomatic management of the neurological condition and concomitant pericarditis, represents good clinical practice and is one potential management approach for patients with similar presentations.

Background/Objectives: Ego defense mechanisms are subconscious processes that help individuals cope with stressors from both external and internal realities. They are divided into three levels based on their adaptive function. Patients undergoing chronic hemodialysis are those who have been treated with this method for longer than three months. Only a few studies have examined the defense mechanisms in hemodialysis patients. Our study aimed to examine the association between ego defense mechanisms and alexithymia, depression, and sleep disorders, as well as clinical and biochemical variables, in a group of 170 hemodialysis patients. Methods: We used the Defense Style Questionnaire-40, the Toronto Alexithymia Scale-26, the Pittsburgh Sleep Quality Index, and the Hamilton Depression Inventory as our analyses methods. Clinical and biochemical variables, along with interdialytic weight gain, were measured before the hemodialysis session. Results: There was a positive correlation between the affect displacement and dissociation with leukocyte levels (Spearman’s rho = 0.192, p = 0.02; rho = 0.165, p = 0.04), and between autistic fantasy and phosphorus levels (rho = −0.163, p = 0.04). Depressive HD patients had higher levels of somatization, affect displacement, and splitting compared to the HD patients without depression (Man–Whitney U test, p = 0.005, p = 0.022, p = 0.045). There were higher levels of immature defense mechanisms in the group of patients with alexithymia than in the group without alexithymia (Mann–Whitney U test, p < 0.001). Conclusions: The immature defense mechanisms were our research model’s strongest predictive factor of alexithymia (OR = 1.87, 95% CI 1.27 to 2.75).

Alexithymia, or the inability to distinguish between bodily feelings and emotions, has been linked to poor sleep quality in some studies. Rare studies examined the associations between electrolyte phosphorus in patients on hemodialysis and their sleep quality, daytime sleepiness, and alexithymia with inflammatory factors. Hemodialysis is a treatment method for terminal renal patients that involves the diffusion of unwanted metabolic products through the dialyzer membrane. Our study aimed to examine whether there was a difference in phosphorus levels, inflammatory factors, and daytime sleepiness according to the hemodialysis patients’ levels of alexithymia. The study involved 170 HD patients that had been treated with chronic dialysis for more than three months. Prior to the hemodialysis procedure, laboratory findings were sampled. Respondents completed the Pittsburgh Sleep Quality Index, the Toronto Alexithymia Scale 26, and the Epworth Sleepiness Scale, and were questioned about depression. The results showed that alexithymic HD patients exhibited significantly higher leukocyte counts, lower predialysis phosphorus values, and more pronounced daily sleepiness than the alexithymia-free group (Mann–Whitney U test, p = 0.02, p = 0.005, and p < 0.001, respectively). We concluded that alexithymia was an independent predictor of high daytime sleepiness in HD patients (OR = 1.05, 95% CI 1.02 to 1.09).

Alexithymia is a construct defined as the inability to differentiate between emotional experiences and bodily sensations. According to existing knowledge, alexithymia may have a major effect on the process of treatment and the outcome of the hemodialysis disease. The objective of this literature review was to determine the significance that alexithymia has for compliance and variables of clinical and mental health in the population of hemodialysis patients. For the above purpose, bibliographic databases “MEDLINE” and “Web of Science” were searched. The matrix method was used in analysis of articles. Searching both databases resulted in 248 articles. After applying exclusion and inclusion criteria, we included results of 13 articles in the literature review. The results of the search are findings regarding the prevalence and correlation of alexithymia with variables of clinical and mental health in hemodialysis patients. Alexithymia is significantly more common in the population of hemodialysis patients, and it has a negative effect on their mental and somatic health. Alexithymia levels in hemodialysis patients are more pronounced in cases where there is a greater number of comorbidities. Alexithymia is the predictor of high mortality rate in the population of hemodialysis patients, independent of other comorbidities.

Introduction: Patients undergoing chronic hemodialysis treatment (HD patients) experience sleep quality deterioration, which is associated with lower quality of life and represents an independent predictor of mortality in HD patients. Recently, the number of research papers aimed at assessing sleep quality in HD patients has been increased, due to the fact that it is such an important factor. Thus, this study aimed to identify the main factors related with low sleep quality in HD patients by reviewing scientific literature. Materials and methods: A search based on key words was performed in the MEDLINE database and selected scientific papers were analyzed by using the matrix method. The initial search retrieved 472 scientific articles to which certain inclusion and exclusion criteria were applied, combined with a critical analysis, resulting in the selection of a total of 48 papers. Factors related with low sleep quality in HD patients were grouped in three sub-groups, while sociodemographic and clinical characteristics showed significant impact on low sleep quality in HD patients. Results: It has also been proven that low sleep quality is correlated with biochemical variables such as inflammation factors, low albumin levels and other factors, whereas knowledge concerning factors involved in hemodialysis also contributes to the efforts of medical staff aimed at improving HD patients' quality of sleep. Conclusion: Etiology of sleep quality deterioration in HD patients is manifold, and significantly affected by psychosocial, biochemical and clinical factors.