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RESUMEN El síndrome de Sézary constituye la fase leucémica de la micosis fungoide caracterizado por eritrodermia, adenopatías superficiales y células atípicas en sangre. Predomina en los hombres con una proporción 2/1 respecto a las mujeres, y en las edades entre los 60 y 70 años de edad. La enfermedad es de difícil tratamiento, con un pronóstico reservado por su baja supervivencia. Por ser infrecuente y su posible similitud con otras dermatosis, se presenta un caso con antecedentes de psoriasis vulgar con 5 años de evolución, que hacía aproximadamente 6 meses, se encontraba sin mejoría en brote de agudización a pesar de los tratamientos indicados (AU).
ABSTRACT Sezary syndrome is the leukemic part of the fungoid mycosis, characterized by erythroderma, surface adenopathies and atypical cells in blood. It predominates in men with a 2/1 proportion in respect to women, and in ages ranging from 60 to 70 years. It is a difficult treated disease, with a reserved prognosis because of the low survival. Due to its infrequency and possible similarity to other dermatosis, it is presented a case with antecedents of vulgar psoriasis of 5 years evolution, without improvement for around 6 months, in acute outbreak in spite of the indicated treatments (AU).
Assuntos
Humanos , Masculino , Idoso , Psoríase/complicações , Psoríase/tratamento farmacológico , Neoplasias Cutâneas , Síndrome de Sézary/complicações , Síndrome de Sézary/diagnóstico , Síndrome de Sézary/etiologia , Síndrome de Sézary/mortalidade , Síndrome de Sézary/patologia , Síndrome de Sézary/epidemiologia , Exame Físico , Dermatopatias , Terapêutica , Atenção Secundária à Saúde , Biópsia/métodos , Micose Fungoide/complicações , Micose Fungoide/epidemiologia , Serviço Hospitalar de Oncologia , Testes Diagnósticos de RotinaRESUMO
El adenoma pleomórfico es una de las neoplasias más frecuentes que puede originarse en la glándula lagrimal, pero su origen en tejido ectópico subconjuntival, palpebral e intraocular ha sido escasamente reportado. Se presentó el caso de una paciente femenina de 60 años con tumor en órbita anterior de 4 meses de evolución, localizado por encima del párpado superior, dolorosa, firme, de 8 mm de superficie lisa, con Tomografía Axial Computarizada que informa proceso quístico V/S neoformativo. Se realizó biopsia excisional donde se encuentra nódulo tumoral bien delimitado de composición bifásica con abundante matriz cartilaginosa y mixoide, elementos mioepiteliales, epiteliales ductales y escamosos lo que establece el diagnóstico definitivo de adenoma pleomórfico. El tejido lagrimal ectópico constituye un dilema y una neoplasia originada en ellos constituye mayor problema aun. Los avances en la cirugía oftalmológica han permitido el diagnóstico y cirugía temprano de lesiones tumorales de esta localización para beneficio de los pacientes.
The pleomorphic adenoma is one of the most frequent neoplasia that could be originated in the tear gland, but its origin in subconjunctival, palpebral and intraocular tissue has been scarcely reported. We present the case of a female patient aged 60 years with a hard, painful tumor in anterior orbit of fourth months’ evolution, located over the higher eyelid, of 8 mm plain surface; the computerized axial tomography shows a neoformative cystic V/S process. We carried out scissional biopsy finding a well-delimitated, biphasic-composition tumoral nodule with large amount of cartilaginous and mixed, myoepithelial, ductal epithelial and squamous elements, helping to establish the definite diagnosis of pleomorphic adenoma. The ectopic lacrimal tissue is a dilemma and neoplasia originated in them is still a bigger problem. The advances in ophthalmologic surgery have allowed the early diagnosis and surgery of the tumoral lesions in this location for the patients’ sake.
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BACKGROUND: In order to prevent the spread of the hepatitis C virus (HCV) amongst Hispanic injection drug users (IDUs), we developed, validated, and implemented a multimedia educational intervention program. METHODS: A pre-post intervention study design was used to evaluate long-lasting knowledge and behavior changes in a group of 88 low-income Hispanic HIV-infected IDUs. Pre-intervention data was compared with data measured six months after the intervention. RESULTS: A significant increase in the awareness regarding HCV clinical manifestations, HCV risky behaviors, HCV prevention practices, and HIV/HCV co-infection synergisms was observed in the group six months post-intervention. CONCLUSION: Our study confirms the long-lasting benefits of multimedia based intervention programs for disseminating HCV prevention strategies in IDUs. Preventive educational approaches that use images, figures, and animations tools can be recommended to target and tailor interventions for vulnerable populations.
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Infecções por HIV/complicações , Educação em Saúde/métodos , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hepatite C/prevenção & controle , Hispânico ou Latino , Multimídia , Adulto , Feminino , Infecções por HIV/etnologia , Hepatite C/etnologia , Humanos , Masculino , Pobreza , Avaliação de Programas e Projetos de Saúde , Porto Rico , Comportamento de Redução do Risco , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/etnologiaRESUMO
INTRODUCTION: With the introduction of highly active antiretroviral therapy, the hepatitis C virus (HCV) infection has become a primary health problem among individuals suffering from HIV/ AIDS in Puerto Rico, principally those who are injecting drug users (IDUs). A multimedia educational intervention, based on the Health Beliefs Model and Social Cognitive Theory was developed and implemented to reduce HCV-associated risk behaviors among IDUs. METHODS: A pre- and post- intervention study evaluated the knowledge and behavioral changes in a group of HIV-infected persons recruited from February 2006 through December 2008. RESULTS: A total of 110 participants were recruited: all were IDUs; 82% were men; 86.3% were HIV/HCV co-infected and 24.5% had active injected drugs in the month prior to recruitment. The group mean age was 42.2 +/- 9.2 years and mean educational level was 10th grade. Knowledge of HCV risk behaviors, perception of HCV susceptibility, and perception of disease severity increased after the intervention. Knowledge of HCV clinical manifestations and HIV co-infection complications and treatment also improved. In addition, HCV risk behaviors and injecting drug practice decreased significantly among IDUs. CONCLUSIONS: This new multimedia intervention captured and maintained the participants' attention and interest, facilitating their educational process. Thus, greater attention and interest leads to greater knowledge and prevention improvement.
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Infecções por HIV/epidemiologia , Hepatite C/epidemiologia , Hepatite C/prevenção & controle , Hispânico ou Latino , Comportamento de Redução do Risco , Adulto , Feminino , Infecções por HIV/etnologia , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Multimídia , Avaliação de Programas e Projetos de Saúde , Assunção de RiscosRESUMO
OBJECTIVES: We describe the changes in the socio demographic, risk behavior, immunological and clinical trends profiles of a cohort HIV patients followed at the Retrovirus Research Center, at baseline and study periods interval by periods intervals: 1992-1997, 1998-2003, and 2004-2008. METHODS: This is a cross-sectional study of a longitudinal cohort comprised of 4016 HIV/AIDS patients admitted to the RRC since January 1992. Data collected include socio-demographic variables; risk related variables; psychological variables; and clinical variable by periods of study. RESULTS. The most common AIDS defining conditions observed in patients were: Pneumocistis Cariini pneumonia (PCP), toxoplasmosis of brain (TP), and wasting syndrome (WS). Chronic conditions are more prevalent than AIDS-defining conditions in the cohort of patients. CONCLUSIONS: Understanding the socio demographic, HIV risk behavior profile; and the immunological and clinical trends among HIV patients is critical for redesigning services and programs oriented in HIV patient care.
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Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Assunção de Riscos , Adulto , Estudos de Coortes , Estudos Transversais , Demografia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Porto Rico/epidemiologia , Fatores Socioeconômicos , Fatores de TempoRESUMO
BACKGROUND: Adolescence is associated with risky behaviors related with social and developmental factors. Objectives were to describe social and developmental factors affecting Puerto Rican early adolescent by gender and type of school at study entry. METHODS: Cross-sectional study design. The study group was composed by 168 seventh grade adolescents from private and public schools. Descriptive and non-parametric comparisons were performed. RESULTS: Significance differences among proportions for gender by type of school were found in the following variables: self-esteem and HIV/AIDS attitudes in public school and peer pressure and sensation seeking in private school. DISCUSSION: Our study revealed that public school adolescents are characterized by males with higher self-esteem and less attitude for HIV/AIDS, while in private school the males has more peer pressure and seeking sensation than females. Future studies could analyze factors related with changes in developmental factors, this step is important to evaluate the effectiveness of ASUMA interventions.
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Comportamento do Adolescente , Desenvolvimento do Adolescente , Psicologia do Adolescente , Comportamento Social , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Porto Rico , Fatores SexuaisRESUMO
Desde las primeras descripciones de Golden y Stout6, este grupo de lesiones mesenquimales se consideraron de origen muscular y recibieron nombres como leiomioma, leiomioma celular, leiomioma epitelioide, leiomioblastoma, leiomioma bizarro y leiomiosarcoma. No es, sin embargo, hasta la utilización de la inmunohistoquímica y la subsiguiente demostración de la ausencia de marcadores musculares y la presencia ocasional de marcadores neurales, que surge de la mano de Mazur y Clark3 el término de tumores del estroma. Actualmente se denominan GISTs a los tumores mesenquimales CD117.positivos, fusiformes o epitelioides, primarios del tracto gastrointestinal, epiplon, mesenterio y retroperitoneo10. Los GISTs aparecen en la pared del tubo digestivo: estómago (50-60 por ciento), intestino delgado (20-30 por ciento), intestino grueso (10 por ciento) y esófago (5 por ciento) y ocasionalmente en epiplon, mesenterio y retroperitoneo (5 por ciento). En nuestro trabajo se presenta a una paciente de 67 años de edad que fue ingresada en nuestro centro por presentar un cuadro de sangramiento digestivo alto, estudiada, y se comprobó una tumoración del fundus gástrico de 6 cm , se operó y los resultados definitivos de anatomía patológica arrojaron un Tumor del Estroma Gastrointestinal.
Since the first descriptions made by Golden and Stout, this group of mesenchymal lesions is considered of muscular origin and they were named as leiomyoma, cellular leiomyoma, epithelioid leiomyoma, leiomyoblastoma, bizarre leiomyoma and leiomyosarcoma. But Mazur and Clark created the term estromal tumor only after they began to use the inmunohistochemistry and subsequently showed the absence of muscular markers, and the occasional presence of neural markers. Nowadays, gastrointestinal estromal tumors are called the primary mesenchymal CD117.positive, fusiform or epithelioid tumors of the gastrointestinal tract, epiplon, mesenterio, and retroperitoneum. The gastrointestinal estromal tumors appear at the wall of the digestive tube: stomach (50-60 percent), small intestine (20-30 percent), large intestine (10 percent) and esophagus (5 percent), and occasionally in epiplon, mesenterio, and retroperineum (5 percent). In our work we present a 67 year-old patient, entered in our hospital for presenting high digestive bleeding. We studied the case, and found a 6 cm tumor of the gastric fundus. The tumor was operated and.
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Humanos , Feminino , Idoso , Endoscopia do Sistema Digestório/métodos , Hemorragia Gastrointestinal , Tumores do Estroma Gastrointestinal/cirurgia , Tumores do Estroma Gastrointestinal/patologia , Relatos de CasosRESUMO
Paciente masculino, blanco, de 30 años de edad, que acude al médico por presentar nódulo en región lateral derecha del cuello, se indica ultrasonido y biopsia aspirativa de la lesión. El primero informa imagen eco lúcida unilocular del lóbulo derecho del tiroides y la segunda compatible con quiste branquial, posteriormente se realiza intervención quirúrgica consistente en hemitiroidectomia derecha. El resultado de la biopsia (B-07-1513) fue el de quiste broncogénico intratiroideo. Se realiza revisión bibliográfica y solamente se encuentra reporte de tres casos de quiste broncogénico intratiroideo, por lo que decidimos realizar esta presentación.
A 30-years-old, white, male patient attended the hospital because he presented a nodule on the right side of the neck. An ultrasound and an aspirative byopsy of the lession were indicated. The first one showed a unilocular echolucid image of the right lobule of the thyroid and the second one, an image compatible with a bronchial chyst. Then, we carried out a surgical intervention: a right hemithyiroidectomy. The result of the biopsy (B-07_1513) was an intrathyroid bronchogenic chyst. We made a bibliographic review and found only three reports of intrathyroid bronchogenic chyst, thus deciding to present this case.
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Humanos , Masculino , Adulto , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide , Cisto Broncogênico/cirurgia , Tireoidectomia/métodosRESUMO
INTRODUCTION: The stage of a malignant tumor defines how advanced the malignant process is at the time of diagnosis. In many clinical scenarios it is an indirect measurement of the efficacy of screening interventions used for early detection. We have evaluated changes in the tumor-node-metastasis (TNM) stage of colorectal cancer across a 15-year period. METHODS: This was a retrospective study in which all patients who underwent colorectal cancer surgery at the HIMA San Pablo Medical Center in 1988-1990 (period 1) and 2002-2004 (period 2) had their pathological report examined. The TNM stage for all patients was examined by using standard criteria. RESULTS: A total of 285 patients were evaluated: 108 in period 1 and 177 in period 2. The number of patients > 71 years of age who underwent colon surgery increased (33% vs 46%). An increase in patients with stage one colon cancer was observed in period 2 (30% vs 10%) with a corresponding decrease in stage 2 and 3 (59% vs 83%). CONCLUSION: The pathologic and demographic profile of patients with colorectal cancer has changed over 15 years. Patients with colon cancer are younger and have an earlier stage of disease with a decrease in lymph node involvement. Patients with rectal cancer were older and more likely to be men.
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Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Idoso , Distribuição de Qui-Quadrado , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Porto Rico/epidemiologia , Estudos RetrospectivosRESUMO
INTRODUCTION: One of the factors that influences HIV risk behavior among early adolescents is their HIV/AIDS knowledge. The objectives of this study were 1) to describe the sociodemographic features and HIV/AIDS knowledge among Puerto Rican early adolescents participating in the ASUMA (A Supportive Model for HIV Risk Reduction in Early Adolescents) project; and 2) to assess changes in the knowledge of HIV/AIDS within the intervention and nonintervention groups after the first year of the study. METHODS: This is a prospective cohort study of 173 early adolescents after 12 months of participation in the ASUMA project. The setting of the study was four junior high schools. Baseline and follow-up self-administered questionnaires were issued to the entire study group. The first workshop was developed directed to increase HIV/AIDS knowledge and decrease vulnerability in the group assigned to the intervention. Descriptive and inferential analyses were performed. RESULTS: 47% of adolescents were cases and 52.6% controls. Most adolescents were 12 years old; 50.3% were boys and 49.7% were girls; 78.6% believe that they could have a good conversation with their parents; and 26.3% reported alcohol use at any time in their lives. A significant increase in HIV/AIDS knowledge was found among adolescents from the intervention group (P < .001), while a nonsignificant increase was found among control adolescents. CONCLUSIONS: An increase in HIV/AIDS knowledge was observed among adolescents who participated in the first year of the ASUMA project. This study illustrates the importance of the creation of culturally appropriate instruments and interventions to reduce HIV infection in adolescents.
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Síndrome da Imunodeficiência Adquirida/prevenção & controle , Síndrome da Imunodeficiência Adquirida/psicologia , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Síndrome da Imunodeficiência Adquirida/epidemiologia , Adolescente , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Projetos Piloto , Estudos Prospectivos , Porto Rico/epidemiologia , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Hepatitis C (HCV) and HIV coinfection has emerged as a major health problem in Puerto Rico, particularly among injection drug users (IDUs). We developed and implemented a multimedia educational intervention for HIV-infected IDUs, based on the Health Belief Model and social cognitive theory. METHODS: To evaluate the program's acceptability, a group of 42 participants completed a written questionnaire immediately after each intervention component. RESULTS: Participants were 85% male, the mean age was 41.6 years (standard deviation 9.2 years), and mean educational level was ninth grade. More than 73% of respondents reported that the computer-based program was very easy to operate. More than 83% agreed that the audio and video tools highly facilitated their learning process, and > 71% agreed that the sessions were long enough. Additionally, they reported a high incremental increase in perceived knowledge regarding HIV/HCV co-infection, HCV infection risk behaviors, HCV complications, HCV preventive measures, and HCV diagnosis and therapy. Most of the participants favored the dissemination of this intervention. CONCLUSIONS: The study found a very good acceptability and feasibility of the computerized intervention in the study group. This new technology that includes audiovisual tools in its design kept the participants' attention and interest, while increasing HIV/HCV co-infection knowledge. Subsequent studies will evaluate the efficacy of this intervention, investigating changes in knowledge and risk behaviors among HIV-infected persons.
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Instrução por Computador , Infecções por HIV/complicações , Hepatite C/prevenção & controle , Multimídia , Adulto , Distribuição de Qui-Quadrado , Estudos de Viabilidade , Feminino , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Hepatite C/epidemiologia , Humanos , Masculino , Porto Rico/epidemiologia , Porto Rico/etnologia , Inquéritos e QuestionáriosRESUMO
Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co-infection is an important and frequent scenario, predominantly in injecting drug users (IDUs). The present study evaluated morbidity and mortality variation in HIV-infected patients with and without HCV co-infection. Co-infection prevalence was determined in 356 HIV-infected persons. Their clinical manifestations, laboratory findings, risk factors, HIV therapies, and mortality rates were evaluated. The prevalence of HCV was 54% in the overall group and 81% in IDUs, with a predominance of HCV genotype 1. Mortality rates were similar in patients with and without co-infection; however, co-infected patients had significantly higher liver damage as a cause of mortality when compared with those who were not co-infected. The high prevalence of HCV and an emerging mortality from liver diseases showed the significance of this co-infection in the HIV epidemic. Primary and secondary prevention are necessary to reduce the expanding impact of HCV infection in HIV patients.
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Infecções por HIV/mortalidade , Hepatite C/mortalidade , Abuso de Substâncias por Via Intravenosa , Adulto , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Comorbidade , Feminino , HIV/isolamento & purificação , Infecções por HIV/sangue , Infecções por HIV/prevenção & controle , Hepacivirus/isolamento & purificação , Hepatite C/sangue , Hepatite C/prevenção & controle , Humanos , Masculino , Prevalência , Porto Rico/epidemiologia , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
The HIV epidemic is a significant global health care issue. With increasing knowledge and improved therapeutics the natural history of the infection has been modified. In this paper we aim to present the general socio-demographic profile and the clinical and therapeutic spectrum of patients with HIV infection who have visited the Bayamón Health Care facilities over the last 12 years and who are part of the Retrovirus Research Center (RRC). The objectives of the study are: 1) describe changes in the demographic, risk factors and clinical stage of patients with HIV infection initially seen in our center; 2) assess changing trends from the clinical and immunological perspective across time; 3) describe mortality risk of patients particularly after the introduction of antiretroviral therapy (ART). This is a cross-sectional study of 3,569 patients admitted to the RRC at the Universidad Central del Caribe between years 1992 through 2005. The variables studied were demographic, risk factors exposure, HIV status at baseline, clinical and immunological parameters, ART and the mortality risk. Chi square with Cramer's coefficient, Kaplan Meier and Cox proportional hazard ratio analysis were performed. The study revealed that individuals presenting at our health care facilities are older and that the proportion of females has increased. The risk factor profile shows increase in heterosexual contact with the disease. The study found that patients treated with ART had significantly lower mortality risk than those without ART. Patients who arrive to RRC with AIDS and Intravenous Drug Users (IDU) had a higher mortality risk than participants with HIV. The analysis of the trends showed changes in the demographic and clinical profile of patients across the years. HIV/AIDS prevention programs and policies need to be continued in Puerto Rico in order to better control the spread of the epidemic.
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Infecções por HIV/epidemiologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico/epidemiologiaRESUMO
INTRODUCTION: As of May 2003, 17% of all reported AIDS cases in Puerto Rico had occurred among those 20-29 years of age. These individuals were likely initially infected with HIV in adolescence. The objectives of this study are to describe and compare the prevalence of the sociodemographic, risk-behavior, and substance-use profile among patients infected with HIV during their adolescence (early) and compare them with patients infected at an older age (non-early). METHODS: This is a cross-sectional study of 3151 HIV/AIDS patients admitted to the retrovirus research center of our institution between 1992 and 2002. The variables we studied include the presence or absence of early infection, sociodemographic variables, risk-behavior variables, and substance-use variables. An early-infected patient was defined as a patient with HIV/AIDS that reported his or her first positive HIV test result before the age of 21 years. Descriptive and differential analyses were performed. RESULTS: Five percent of our patients were early-infected (157/3151). A significantly higher proportion (P < or = .05) among the early-infected patients as compared to the older group was females, required inpatient hospital care at the time of study entry, and had less than a 12th-grade education. In the interview a significantly higher proportion had antisocial behavior, had been in prison at some point in their life, and had used crack-cocaine. CONCLUSIONS: The early HIV-infected patients showed a different sociodemographic, risk-behavior, and substance-use profile. Knowledge of the specific characteristics of early HIV-infected patients could be used to develop primary prevention programs directed toward reducing HIV infection among young Puerto Ricans.
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Infecções por HIV/epidemiologia , Assunção de Riscos , Classe Social , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Infecções por HIV/complicações , Humanos , Masculino , Porto Rico , Transtornos Relacionados ao Uso de Substâncias/complicaçõesRESUMO
OBJECTIVES: To compare the occurrence of AIDS as well as the sociodemographic and clinical profiles of AIDS patients in Puerto Rico before and after the introduction of highly active antiretroviral therapy (HAART) and the privatization of the island's public health care system. METHODS: We compared the incident AIDS cases for two three-year periods, 1992-1994 and 1998-2000, in four populations: (1) entire United States, (2) Puerto Rico, (3) Bayamón Health Region (located in north-central Puerto Rico, it includes 11 of the island's 78 municipalities), and (4) an HIV cohort enrolled at the Universidad Central del Caribe (UCC) School of Medicine. The UCC is located in Bayamón, Puerto Rico, within an academic medical complex that houses the teaching hospital (Ramón Ruíz Arnaú University Hospital), the ambulatory health care facilities (Immunology Clinics) for patients with HIV, and administrative buildings. This represents the major government-sponsored health care infrastructure within the Bayamón Health Region. RESULTS: Incident AIDS declined substantially between the two periods in each of the four populations studied. The 48.1% decline in Puerto Rico exceeded the 40.9% decline in the United States. The decline in Puerto Rico likely resulted from increased availability and implementation of HAART and the delivery of health care to HIV/AIDS patients in an integrated fashion within each regional ambulatory clinic. In spite of this improvement, the absolute number of patients with AIDS on the island remains high. Substantial resources for treatment and prevention are required. The proportion of new AIDS cases was lower among women, persons 40 years of age or older, the less educated, and those living alone. Injection drug use remains the predominant mode of transmission in Puerto Rico. CONCLUSIONS: Further gains in Puerto Rico's fight against AIDS will depend on the island's ability to reduce the transmission that occurs through injection drug use; the use of HAART on a larger number of vulnerable patients, particularly intravenous drug users; educational interventions to improve medication compliance in certain risk groups; and specific measures aimed at decreasing the rate of injection drug use.
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Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/epidemiologia , Terapia Antirretroviral de Alta Atividade , Reforma dos Serviços de Saúde , Adolescente , Adulto , Área Programática de Saúde , Feminino , Humanos , Incidência , Masculino , Porto Rico/epidemiologiaRESUMO
Objetivos. Comparar la frecuencia de casos de sida, así como las características sociodemográficas y clínicas de los pacientes de sida en Puerto Rico, antes y después de la introducción de la terapia antirretrovírica de gran actividad (TARGA) y la privatización del sistema de salud de la isla. Métodos. Comparamos los nuevos casos de sida durante dos períodos de tres años, 19921994 y 19982000, en cuatro poblaciones: 1) todos los Estados Unidos, 2) Puerto Rico, 3) la Región de Salud de Bayamón (que se sitúa en la parte norte del centro de Puerto Rico y contiene 11 de las 78 municipalidades de la isla) y una cohorte de pacientes infectados por el VIH y atendidos en la Escuela de Medicina de la Universidad Central del Caribe (UCC). La UCC está en Bayamón, Puerto Rico, dentro de un complejo médico universitario donde se encuentran el hospital escuela (Hospital Universitario Ramón Ruíz Arnaú), las clínicas ambulatorias (Clínicas de Inmunología) para pacientes infectados por el VIH y los edificios administrativos. Todo ello en conjunto representa la principal infraestructura de atención sanitaria de carácter público en la Región de Salud de Bayamón. Resultados. La frecuencia de nuevos casos de sida se redujo notablemente entre los dos períodos en cada una de las cuatro poblaciones estudiadas. La reducción de 48,1% observada en Puerto Rico superó a la de 40,9% observada en los Estados Unidos en general. La reducción en Puerto Rico obedeció probablemente a la mayor disponibilidad y aplicación de la TARGA y a la provisión de atención sanitaria de manera integrada a pacientes de sida o con infección por el VIH en cada clínica ambulatoria regional. A pesar de estas mejoras, sin embargo, el número absoluto de pacientes de sida en la isla sigue siendo elevado. Hacen falta cuantiosos recursos para proporcionar tratamiento y aplicar medidas de prevención. La proporción de casos de sida nuevos fue menor entre las mujeres, las personas de 40 años de edad o mayores, las personas con menos escolaridad y las que vivían solas. El uso de drogas inyectadas sigue siendo la principal vía de transmisión en Puerto Rico. Conclusiones. En Puerto Rico, cualquier adelanto futuro en la lucha contra el sida dependerá de la capacidad de la isla para reducir la transmisión ocasionada por el uso de drogas inyectadas; de la administración de la TARGA a un gran número de pacientes vulnerables, especialmente a usuarios de drogas intravenosas; de intervenciones educativas para mejorar la observancia del tratamiento en ciertos grupos en riesgo; y de medidas orientadas a reducir la frecuencia del uso de drogas inyectadas
Objectives. To compare the occurrence of AIDS as well as the sociodemographic and clinical profiles of AIDS patients in Puerto Rico before and after the introduction of highly active antiretroviral therapy (HAART) and the privatization of the island's public health care system. Methods. We compared the incident AIDS cases for two three-year periods, 19921994 and 19982000, in four populations: (1) entire United States, (2) Puerto Rico, (3) Bayamón Health Region (located in north-central Puerto Rico, it includes 11 of the island's 78 municipalities), and (4) an HIV cohort enrolled at the Universidad Central del Caribe (UCC) School of Medicine. The UCC is located in Bayamón, Puerto Rico, within an academic medical complex that houses the teaching hospital (Ramón Ruíz Arnaú University Hospital), the ambulatory health care facilities (Immunology Clinics) for patients with HIV, and administrative buildings. This represents the major government-sponsored health care infrastructure within the Bayamón Health Region. Results. Incident AIDS declined substantially between the two periods in each of the four populations studied. The 48.1% decline in Puerto Rico exceeded the 40.9% decline in the United States. The decline in Puerto Rico likely resulted from increased availability and implementation of HAART and the delivery of health care to HIV/AIDS patients in an integrated fashion within each regional ambulatory clinic. In spite of this improvement, the absolute number of patients with AIDS on the island remains high. Substantial resources for treatment and prevention are required. The proportion of new AIDS cases was lower among women, persons 40 years of age or older, the less educated, and those living alone. Injection drug use remains the predominant mode of transmission in Puerto Rico. Conclusions. Further gains in Puerto Rico's fight against AIDS will depend on the island's ability to reduce the transmission that occurs through injection drug use; the use of HAART on a larger number of vulnerable patients, particularly intravenous drug users; educational interventions to improve medication compliance in certain risk groups; and specific measures aimed at decreasing the rate of injection drug use
Assuntos
Hispânico ou Latino , Terapia Antirretroviral de Alta Atividade , Síndrome da Imunodeficiência Adquirida , Porto RicoRESUMO
AIMS: To describe and assess the changing trends in socio-demographic, risk, clinical and immunological parameters in male intravenous drug users (IDU) with AIDS. DESIGN, SETTING AND PARTICIPANTS: Baseline description by year of entry of 610 male IDU with AIDS who entered into a cohort study in Bayamón, Puerto Rico, from 1992 to 2000. Study participants were evaluated at in-patient health-care facilities in the University Hospital Ramón Ruiz Arnau or in the ambulatory immunology clinic facilities. FINDINGS: The median age at which subjects entered the study and the proportion of patients with an educational level lower than a high school degree increased from 1992 to 2000. Upward trends were also observed in the practice of injecting non-prescription drugs during the last 12-month period, the practice of needle sharing and the use of a combination of heroin and cocaine ('speedballs'). Higher proportions of subjects were also diagnosed with wasting syndrome and bacterial pneumonia. The median CD4 count recorded at entry decreased over the course of the study. CONCLUSIONS: Puerto Rican male IDU diagnosed with AIDS are arriving at health-care facilities in the latest stages of the disease. Better and early interventions with different health care approaches need to be developed.
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/etnologia , Adulto , Distribuição por Idade , Contagem de Linfócito CD4 , Transtornos Relacionados ao Uso de Cocaína/complicações , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/etnologia , Estudos de Coortes , Escolaridade , Dependência de Heroína/complicações , Dependência de Heroína/epidemiologia , Dependência de Heroína/etnologia , Humanos , Masculino , Uso Comum de Agulhas e Seringas , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/etnologia , Prevalência , Porto Rico/epidemiologia , Porto Rico/etnologia , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/etnologia , Síndrome de Emaciação/complicações , Síndrome de Emaciação/epidemiologia , Síndrome de Emaciação/etnologiaRESUMO
This study presents information on AIDS patients in Puerto Rico, including their general sociodemographic profile, some risk-related parameters, characteristics of vulnerable groups, and elements of the clinical spectrum of the disease. Data were analyzed from the Puerto Rico AIDS Surveillance Program and available studies about the HIV/AIDS epidemic in Puerto Rico. A total of 23.089 AIDS cases were reported to the Puerto Rico AIDS Surveillance Program from January 1981 through February 1999. The HIV/AIDS epidemic has affected mostly males and females between the ages of 30 and 49, though cases have also been reported for other age groups. The cumulative proportion of persons with AIDS who are women has increased tremendously, from 11.4 pour cent for the 1981-1986 period to 21.6 pour cent for the entire 1981-1999 period. In Puerto Rico the category of injecting drug users (IDUs) accounts for the majority of the AIDS cases (52 pour cent), followed by heterosexual contact (22 pour cent), and men who have sex with men (17 pour cent). The three main diagnoses for AIDS on the island are wasting syndrome (30.7 pour cent); esophageal, bronchial, and lung candidiasis (29.4 pour cent); and Pneumocystis carinii pneumonia (26.8 pour cent). According to 1994 vital statistics for Puerto Rico, AIDS was the fourth-leading cause of death. The overall reported AIDS mortality rate was 42.0 per 100.000 persons, with the rate for males, 67.8, much higher than it was for females, 17.4. AIDS is the first cause of death among persons between 30 and 39 years old. Intense efforts are needed to better understand the epidemic in Puerto Rico and its biology, social and family impacts, and financial costs
Este estudio presenta información sobre los pacientes con sida en Puerto Rico, como su perfil sociodemográfico general, los factores de riesgo, las características de los grupos vulnerables y los elementos del espectro clínico de la enfermedad. Los datos analizados procedían del Programa de Vigilancia del sida en Puerto Rico y de estudios sobre la epidemia de VIH/sida en la isla. De enero de 1981 a febrero de 1999 se habían comunicado a dicho programa 23 089 casos de sida. La epidemia de VIH/ sida ha afectado sobre todo a varones y hembras de 30 a 49 años, aunque también se han descrito casos en otros grupos de edad. La proporción acumulada de pacientes del sexo femenino con sida ha aumentado enormemente, de 11,4% en el período 19811986 a 21,6% en el período 19811999. En Puerto Rico, el grupo de adictos a drogas por vía parenteral representa la mayoría de los casos de sida (52%), seguido de los heterosexuales (22%) y de los varones homosexuales (17%). Los tres diagnósticos de sida establecidos con mayor frecuencia en la isla son el síndrome consuntivo (30,7%), la candidiasis esofágica, bronquial y pulmonar (29,4%) y la neumonía por Pneumocystis carinii (26,8%). De acuerdo con las estadísticas demográficas de 1994 en Puerto Rico, el sida constituyó la cuarta causa de muerte. La tasa global de mortalidad por sida fue de 42,0 por 100 000 habitantes, siendo mucho más elevada en los hombres (67,8) que en las mujeres (17,4). El sida es la primera causa de muerte en personas de 30 a 39 años de edad. Serán necesarios grandes esfuerzos para comprender mejor la epidemia en Puerto Rico, su biología, su impacto social y familiar y sus costes financieros.