Quality of Life (QoL) assessment in a cohort of patients with Phenylketonuria

Background: Phenylketonuria (PKU) is a chronic inborn error of amino acid metabolism that requires lifelong follow-up and intervention, which may represent strains on Quality of Life (QoL). This observational study evaluated QoL in a cohort of PKU patients, using updated and detailed instruments. Methods: 22 patients with mild PKU respondent to BH4 and 21 patients with classical PKU treated with diet were recruited in this study. Adult patients completed WHOQOL questionnaire-100 (WHOQOL-100) and pediatric patients the Pediatric QoL inventory (PedsQL™). Psychiatric and mood disorders were also evaluated using TAD or BDI and STAI-Y inventories. A multivariable linear regression model was fitted to investigate the predictors of QoL, including age, sex, treatment type, length of current treatment, educational level and employment status (only for adults) as covariates. Results were presented as regression coefficients with 95% confidence interval. Results: Global QoL scores were within normal range both in patients with mild and classical disease but global QoL scores were significantly higher in patients with mild PKU under BH4 treatment as compared to those affected by classical disease who were under diet regimen. Furthermore, QoL significantly increased in long treated PKU patients. Among adult patients, QoL scores were significantly lower in males, in patients with lower education and in those employed or unemployed as compared to students (baseline). Conclusions: Both diet and medical treatment based upon BH4 seem to be associated with higher QoL in the long run. However, patients with mild PKU can rely on BH4 to achieve a higher Phe tolerance and a better compliance to therapy due to diet relaxation/avoidance. Some specific categories of patients with a lower QoL should be investigated more in depth, engaging with those at risk of lower treatment compliance. The questionnaires employed in the present study seemed to be able to effectively detect criticalities in QoL assessment and represent an advance from previous inventories employed in the past. A series of secondary diaryl and dialkyl nitrosamines have been synthesised and tested as substrates and/or inhibitors of highly purified acetyl-cholinesterase from Torpedo fuscomaculata. None were found to act as substrate, but many could selectively inhibit the enzyme. Kinetic analysis has shown that all the nitrosamines act as reversible competitive inhibitors with respect to the substrate, acetylthiocholine chloride; with time they act as irreversible covalent inhibitors. Scatchard analysis indicates that aliphatic nitrosamines have a weaker affinity for the enzyme compared to the aromatic and heterocyclic nitrosamines. In all cases the number of binding sites was four. Pseudo first-order kinetics are observed with the rate constant being proportional to the concentration of the nitrosamine and the order of reaction being equal to one. © 1994 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.