RESUMO
Multiple myeloma, the second most common hematologic malignancy worldwide, is an aggressive disease with high morbidity and mortality rates. Although myeloma remains incurable, new treatments have improved patients' life expectancy and quality of life. However, as these therapies are administered for prolonged and often indefinite periods, their success depends on high treatment adherence and significant patient engagement. This study aimed to evaluate the impact of a novel digital educational strategy on treatment adherence, quality of life, and the development of complications in patients with newly diagnosed myeloma. To this end, a two-arm, randomized, prospective, double-blind study was conducted to compare the conventional educational approach alone or combined with the novel digital strategy. This strategy was based on some principles of the Persuasive Systems Design model and incorporated the educational recommendations of patients and caregivers. Compared to the control group that only received information through the conventional educational approach, patients randomized to the digital strategy showed significantly higher treatment adherence and quality of life, associated with increased functionality and rapid reincorporation into daily routines. The digital strategy empowered patients and caregivers to understand the disease and therapeutic options and helped patients recall treatment information and implement healthy lifestyle habits. These results support that patient-targeted educational strategies can positively influence treatment adherence and thus improve their quality of life.
Assuntos
Mieloma Múltiplo , Humanos , Mieloma Múltiplo/tratamento farmacológico , Qualidade de Vida , Estudos Prospectivos , Cooperação e Adesão ao Tratamento , Estilo de VidaRESUMO
A female patient in her 30s presented to the emergency department with a 10-day history of fever, weakness and diaphoresis. Subsequent investigations revealed a diagnosis of haemophagocytic syndrome, secondary to disseminated non-tuberculous mycobacterial infection affecting the bone marrow, lungs, lymph nodes and skin. The bone marrow culture confirmed the presence of Mycobacterium avium infection. The patient's haemophagocytic syndrome was managed using the HLH-2004 chemoimmunotherapy, and M. avium infection was treated with a combination of clarithromycin, ethambutol, rifampicin, ciprofloxacin and amikacin. Throughout her hospitalisation, the patient faced several serious complications arising from both the medications and the prolonged hospital stay (lasting 12 months). However, these complications were promptly identified and effectively managed through a multidisciplinary and comprehensive approach. This approach was crucial in achieving a favourable patient outcome and successful recovery.
Assuntos
Linfo-Histiocitose Hemofagocítica , Infecções por Mycobacterium não Tuberculosas , Infecções Oportunistas , Feminino , Humanos , Linfo-Histiocitose Hemofagocítica/complicações , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/complicações , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Amicacina , CiprofloxacinaRESUMO
Abstract Introduction: Among the sub-types of lymphoma, mantle cell lymphoma, or what was previously known as intermediate lymphocytic lymphoma, accounts for 3-10% of B-cell non-Hodgkin lymphomas. Treatment is directed according to the patient's classification, age, functional status and comorbidities, and is directly related to the ability to receive intensive treatment or transplantation. It is important to homogenize treatments to offer the best alternatives in the Colombian context, as there are different diagnostic and therapeutic options today, most of which are financed by the Colombian healthcare system. Objective: To structure a series of considerations for the diagnosis and treatment of MCL within the Colombian context. Methods: A formal, mixed (Delphi/nominal) expert consensus was developed. The options for each question were scored in two masked rounds and an open nominal session. The information was consolidated in Excel and analyzed using STATA 13. Results: 25 considerations were developed for the diagnosis and treatment of MCL. Twenty-two specialists participated: 16 hematologists and hematologist-oncologists, four hematopathologists, one radiation therapist and one nuclear medicine specialist from Bogotá, Medellín and Cali, with an average of 10.5 years' of practical experience and who were members of the Asociación Colombiana de Hematología y Oncología [Colombian Association of Hematology and Oncology]. Conclusions: The consensus established 26 considerations for the diagnosis and treatment of MCL, according to the Colombian context, aimed at healthcare professionals with a direct relationship with this disease. It is expected that clinical management will be homogenized by a consideration of this consensus and the referenced literature. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2606).
Resumen Introducción: Dentro de los subtipos de linfoma, el linfoma de células del manto o anteriormente denominado linfoma linfocítico intermedio corresponde a 3-10% de los linfoma no Hodgkin de células B. El tratamiento se enfoca según la clasificación del paciente, edad, estado funcional y comorbilidades, lo cual está directamente relacionado con la capacidad de recibir un tratamiento intensivo o trasplante. Es importante homogeneizar conductas con el fin de ofrecer las mejores alternativas bajo el contexto colombiano, pues actualmente existen diferentes opciones diagnósticas y terapéuticas, financiadas en su mayoría por el sistema de salud colombiano. Objetivo: Estructurar una serie de consideraciones para el diagnóstico y tratamiento para LCM, en el contexto colombiano. Métodos: Se llevó a cabo un consenso formal de expertos, tipo mixto (Delphi/ Nominal). Se calificaron las opciones de cada pregunta en dos rondas enmascaradas y una sesión abierta nominal. La información fue consolidada en Excel y analizada en STATA 13. Resultados: Se elaboraron 25 consideraciones para el diagnóstico y tratamiento de LCM. Participaron 22 médicos especialistas: 16 hematólogos y hemato-oncólogos, cuatro hemato-patólogos, un radioterapeuta y un especialista en medicina nuclear de Bogotá, Medellín y Cali, con experticia en la práctica de 10.5 años en promedio y quienes forman parte de la Asociación Colombiana de Hematología y Oncología. Conclusiones: El consenso definió 26 consideraciones para el diagnóstico y tratamiento de LCM, según el contexto colombiano, dirigidas a profesionales de la salud con relación directa a esta patología. Se espera homogeneizar las conductas clínicas teniendo en cuenta este consenso y la literatura referida. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2606).
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In March 2015, a patient in Colombia with HIV/AIDS was hospitalized for disseminated ulcers after milking cows that had vesicular lesions on their udders. Vaccinia virus was detected, and the case met criteria for progressive vaccinia acquired by zoonotic transmission. Adherence to an optimized antiretroviral regimen resulted in recovery.
Assuntos
Infecções por HIV , Vaccinia virus/isolamento & purificação , Vacínia/diagnóstico , Síndrome da Imunodeficiência Adquirida , Adulto , Animais , Terapia Antirretroviral de Alta Atividade , Antivirais/uso terapêutico , Colômbia , Humanos , Masculino , Vacínia/tratamento farmacológico , Vacínia/transmissão , Zoonoses/virologiaRESUMO
Multicentric Castleman's disease (MCD) is a known entity with characteristics of lymphoproliferative syndrome, characterized by cytokine activation. Its association with human immunodeficiency virus (HIV) is frequently described, as well as its positivity for human herpesvirus 8 (HHV-8). However, some negative patients for the latter (called idiopathic MCD), may have an aggressive spectrum of the disease (characterized by the presence of cytopenia, renal failure, anasarca and organomegaly), known as TAFRO syndrome (thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly). We present the case of a young patient recently diagnosed with HIV infection, in whom MCD was found, and with an aggressive course despite treatment, who met criteria for TAFRO syndrome despite HHV-8 positivity.
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Abstract Introduction: Coal worker's pneumoconiosis is caused by the inhalation of coal dust and its accumulation in the lungs after several years of exposure. Objective: To determine the prevalence of pneumoconiosis in underground mining workers exposed to coal dust in Cundinamarca, Colombia, and its association with their spirometry results and respiratory symptoms. Materials and methods: Cross-sectional study conducted on 215 workers who were administered a questionnaire on respiratory symptoms. For each worker a chest radiograph was taken according to the criteria of the International Labor Organization. Information on the workers' socio-demographic characteristics, smoking habits, and spirometry results was included. Results: The average age was 45.5 ± 9.4 years and the average length of employment was 21.7±10.0 years. Expectoration was the symptom most frequently reported (73.5%). Regarding spirometry results, a normal pattern was observed in 89.8% of the sample, while obstructive and restrictive patterns were found in 5.1% and 3.7% of the subjects, and 0.5% had a peripheral airways dysfunction pattern. The prevalence of pneumoconiosis was 42.33%. FEV1/FVC ratio (81.75 vs. 83.74, p=0.045) and FF25-75% (84.96 vs. 91.95, p<0.001) mean values were significantly lower in workers with pneumoconiosis. Conclusion: Pneumoconiosis was highly prevalent in the study population and its diagnosis was associated with spirometry results (FEV1/FVC and FEF25.75%); bearing in mind that currently there are not effective treatments for this disease, it is necessary to implement control and prevention strategies aimed at reducing occupational exposure to coal dust and, this way, prevent its occurrence.
Resumen Introducción. La neumoconiosis de los mineros de carbón resulta de la inhalación de polvo del carbón y se desarrolla después de varios años de exposición. Objetivo. Determinar la prevalencia de neumoconiosis y su relación con los resultados de espirometría y los síntomas respiratorios en trabajadores expuestos a polvo de carbón en Cundinamarca, Colombia. Materiales y métodos. Estudio de corte transversal realizado en 215 trabajadores a quienes se les aplicó un cuestionario sobre síntomas respiratorios y se les realizó radiografía de tórax según los criterios de la Organización Internacional del Trabajo. Se incluyó la información relativa a sus características sociodemográficas, hábitos de tabaquismo y resultados de espirometría. Resultados. El promedio de edad fue 45.5±9.4 años y el de experiencia laboral fue de 21.7±10.0 años. El síntoma más frecuente fue la expectoración (73.5%). En la espirometría, se observó patrón normal en el 89.8% de la población, obstructivo en el 5.1%, restrictivo en el 3.7% y de alteración de vías aéreas periféricas en el 0.5%. La prevalencia de neumoconiosis fue de 42.3%. Los valores promedio de FEV1/CVF (81.75 vs. 83.74, p=0.045) y FF25-75% (84.96 vs. 91.95, p<0.001) fueron menores significativamente en los mineros con neumoconiosis. Conclusión. La prevalencia de neumoconiosis fue muy alta en la población estudiada y su ocurrencia estuvo asociada a los resultados de la espirometría (FEV1/CFV y FEF25-75%); teniendo en cuenta que no hay tratamientos eficaces para esta enfermedad, es necesario implementar estrategias de control y prevención diseñadas para reducir la exposición laboral al polvo de carbón y, de esta forma, prevenir su aparición.
RESUMO
In 2014, vaccinia virus (VACV) infections were identified among farmworkers in Caquetá Department, Colombia; additional cases were identified in Cundinamarca Department in 2015. VACV, an orthopoxvirus (OPXV) used in the smallpox vaccine, has caused sporadic bovine and human outbreaks in countries such as Brazil and India. In response to the emergence of this disease in Colombia, we surveyed and collected blood from 134 farmworkers and household members from 56 farms in Cundinamarca Department. We tested serum samples for OPXV antibodies and correlated risk factors with seropositivity by using multivariate analyses. Fifty-two percent of farmworkers had OPXV antibodies; this percentage decreased to 31% when we excluded persons who would have been eligible for smallpox vaccination. The major risk factors for seropositivity were municipality, age, smallpox vaccination scar, duration of time working on a farm, and animals having vaccinia-like lesions. This investigation provides evidence for possible emergence of VACV as a zoonosis in South America.
Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/virologia , Vaccinia virus , Vacínia/epidemiologia , Vacínia/virologia , Zoonoses/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Agricultura , Animais , Criança , Colômbia/epidemiologia , Feminino , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Masculino , Pessoa de Meia-Idade , Orthopoxvirus/imunologia , Fatores de Risco , Estudos Soroepidemiológicos , Vaccinia virus/imunologia , Adulto JovemAssuntos
Neoplasias do Sistema Nervoso Central/diagnóstico , Febre/patologia , Hematoma Subdural/diagnóstico , Leucemia Mielomonocítica Crônica/diagnóstico , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Sarcoma Mieloide/diagnóstico , Idoso de 80 Anos ou mais , Neoplasias do Sistema Nervoso Central/complicações , Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Evolução Fatal , Hematoma Subdural/complicações , Hematoma Subdural/diagnóstico por imagem , Humanos , Leucemia Mielomonocítica Crônica/complicações , Leucemia Mielomonocítica Crônica/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/complicações , Meningioma/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Sarcoma Mieloide/complicações , Sarcoma Mieloide/diagnóstico por imagem , Distúrbios da Fala/etiologiaRESUMO
CASE DESCRIPTION: An 82-years old Hispanic woman with a past medical history significant for pulmonary thromboembolism on oral anticoagulation, rheumatoid arthritis, and hypertension developed a new onset thrombocytopenia. CLINICAL FINDINGS: Small clonal B-cells populations (SCBP) also known as monoclonal B-cell lymphocytosis was found as part of the workup for an idiopathic thrombocytopenia and lead ultimately to the diagnosis of parotid primary follicular lymphoma coexisting with Warthin tumor involving the bone marrow in a small extent and oncocytic papilloma located in the maxillary sinus. TREATMENT AND OUTCOME: Patient was treated with Rituximab monotherapy with improvement on her platelet count. CLINICAL RELEVANCE: Although it is unclear the role of this clonal cells, they may work as a possible diagnostic tool for occult lymphomas. Further prospective studies are needed to confirm this possible association.
DESCRIPCIÓN DE CASO: Mujer hispana de 82 años con una historia médica significativa de tromboembolismo pulmonar en anticoagulación, artritis reumatoide e hipertensión, la cual desarrolló recientemente una trombocitopenia. HALLAZGOS CLÍNICOS: Una pequeña población de células B monoclonales también conocida como linfocitosis monoclonal de células B fue encontrado dentro del estudio de una trombocitopenia idiopática que conllevó al diagnóstico de un linfoma folicular primario de parótida coexistiendo con un tumor de Warthin y un papiloma oncocítico localizado en el seno maxilar. TRATAMIENTO Y RESULTADO: La paciente fue tratada con monoterapia de Rituximab con una mejoría en su conteo de plaquetas. RELEVANCIA CLÍNICA: Aunque el rol de las pequeñas poblaciones B monoclonales no está completamente dilucidado, podrían tener una aplicación como herramienta diagnóstica. Futuros estudios prospectivos son necesarios para confirmar esta posible asociación.
Assuntos
Linfócitos B/patologia , Medula Óssea/patologia , Linfocitose/patologia , Linfoma/patologia , Neoplasias Primárias Desconhecidas/patologia , Neoplasias Parotídeas/patologia , Trombocitopenia/patologia , Idoso de 80 Anos ou mais , Medula Óssea/diagnóstico por imagem , Células Clonais/patologia , Feminino , Humanos , Linfocitose/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Neoplasias Primárias Desconhecidas/diagnóstico por imagem , Neoplasias Parotídeas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Trombocitopenia/diagnóstico por imagemRESUMO
Case Description: An 82-years old Hispanic woman with a past medical history significant for pulmonary thromboembolism on oral anticoagulation, rheumatoid arthritis, and hypertension developed a new onset thrombocytopenia. Clinical Findings: Small clonal B-cells populations (SCBP) also known as monoclonal B-cell lymphocytosis was found as part of the workup for an idiopathic thrombocytopenia and lead ultimately to the diagnosis of parotid primary follicular lymphoma coexisting with Warthin tumor involving the bone marrow in a small extent and oncocytic papilloma located in the maxillary sinus. Treatment and Outcome: Patient was treated with Rituximab monotherapy with improvement on her platelet count. Clinical relevance: Although it is unclear the role of this clonal cells, they may work as a possible diagnostic tool for occult lymphomas. Further prospective studies are needed to confirm this possible association.
Descripción de caso: Mujer hispana de 82 años con una historia médica significativa de tromboembolismo pulmonar en anticoagulación, artritis reumatoide e hipertensión, la cual desarrolló recientemente una trombocitopenia. Hallazgos clínicos: Una pequeña población de células B monoclonales también conocida como linfocitosis monoclonal de células B fue encontrado dentro del estudio de una trombocitopenia idiopática que conllevó al diagnóstico de un linfoma folicular primario de parótida coexistiendo con un tumor de Warthin y un papiloma oncocítico localizado en el seno maxilar. Tratamiento y resultado: La paciente fue tratada con monoterapia de Rituximab con una mejoría en su conteo de plaquetas. Relevancia clínica: Aunque el rol de las pequeñas poblaciones B monoclonales no está completamente dilucidado, podrían tener una aplicación como herramienta diagnóstica. Futuros estudios prospectivos son necesarios para confirmar esta posible asociación.
Assuntos
Idoso de 80 Anos ou mais , Feminino , Humanos , Trombocitopenia/patologia , Medula Óssea/patologia , Neoplasias Primárias Desconhecidas/patologia , Neoplasias Parotídeas/patologia , Linfócitos B/patologia , Linfocitose/patologia , Linfoma/patologia , Trombocitopenia/diagnóstico por imagem , Medula Óssea/diagnóstico por imagem , Neoplasias Primárias Desconhecidas/diagnóstico por imagem , Neoplasias Parotídeas/diagnóstico por imagem , Células Clonais/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Linfocitose/diagnóstico por imagem , Linfoma/diagnóstico por imagemAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/genética , Neoplasias do Sistema Nervoso Central/diagnóstico , Raios gama/uso terapêutico , Plasmócitos/patologia , Linfoma Plasmablástico/diagnóstico , Adulto , Neoplasias do Sistema Nervoso Central/patologia , Neoplasias do Sistema Nervoso Central/terapia , Lobo Frontal/efeitos dos fármacos , Lobo Frontal/patologia , Lobo Frontal/efeitos da radiação , Expressão Gênica , HIV , Herpesvirus Humano 4 , Humanos , Masculino , Linfoma Plasmablástico/patologia , Linfoma Plasmablástico/terapia , Proteínas Proto-Oncogênicas c-myc/genética , Proteína Supressora de Tumor p53/genéticaRESUMO
BACKGROUND: In the past decade, several studies have focused on the treatment needs of female inmates with substance abuse problems. An important finding has been that these women are more likely to report histories of sexual, physical, and emotional abuse-at rates varying from 77% to 90%. The trauma resulting from this kind of abuse is a key contributing factor in behavioral problems in adolescence and subsequent delinquency, substance abuse, and criminality in adulthood. METHODS: This was a retrospective clinical study. A convenience sample of 112 women who entered the program's treatment groups consecutively for one year form part of the study. Information on traumatic events was obtained using some questions from the Initial Trauma Review. It explores whether the participant experienced physical abuse, sexual abuse, disasters, automobile accidents, or witnessed violence under the age of 18. It also examines experiences as an adult, including sexual and physical abuse, attacks by others who are not intimate partners, and abuse by authorities. RESULTS: Revictimization in sexual abuse was found in 78.1% of participants. Significant differences were identified between women who had experienced a traumatic sexual event from a person five years their senior before the age of 18 and then suffered from sexual violence as an adult, and women who had never undergone either of these events (x(2) = 11.3, df 112/1, p = <.001). In physical abuse, the figure was 82.17%. Differences were observed between women who were revictimized through physical abuse before and after the age of 18 (x(2) = 5.91, df 112/1, p = <.01), and those who had not experienced any kind of revictimization. Significant differences were found between women who had suffered a traumatic sexual event as a child and subsequently physical violence from their parents, and women who had not undergone either of these events (x(2) = 3.48, df 112/1, p = <.05). CONCLUSIONS: Investment in treatment in these areas during the prison sentence and after release may contribute to preventing these women from become repeat offenders. Creating sources of work and halfway houses that continue the program to prevent relapses into substance use can help defend the human rights of this group of women and achieve social justice.
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Sobreviventes Adultos de Maus-Tratos Infantis/estatística & dados numéricos , Mulheres Maltratadas/estatística & dados numéricos , Vítimas de Crime/estatística & dados numéricos , Prisioneiros/estatística & dados numéricos , Delitos Sexuais/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Fatores Etários , Idade de Início , Mulheres Maltratadas/psicologia , Vítimas de Crime/psicologia , Feminino , Humanos , México/epidemiologia , Prisioneiros/psicologia , Estudos Retrospectivos , Delitos Sexuais/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
Introducción. Del 60 al 80 % de los pacientes con leucemia linfoblástica aguda de precursores B presentan alteraciones genéticas que influyen en el pronóstico de la enfermedad y en la biología del tumor. Objetivo. Analizar distintas alteraciones genéticas en leucemia linfoblástica aguda de precursores B en niños, y su relación con el inmunofenotipo y con la tasa de proliferación, en comparación con precursores B normales. Materiales y métodos. En 44 pacientes se evaluó, por citometría de flujo, el inmunofenotipo, el contenido de ADN y la proliferación, y por RT-PCR, las traslocaciones t(9;22), t(12;21), t(4;11) y t(1;19). Mediante un análisis jerarquizado de conglomerados se identificaron los patrones inmunofenotípicos de expresión asociados a las traslocaciones, tomando como referencia precursores B normales. Resultados. La cuantificación del ADN mostró que el 21 % de los casos de leucemia linfoblástica aguda de precursores B eran hiperdiploides de índice alto y, el 47,7 %, hiperdiploides de índice bajo. La presencia de hiperdiploidía se asoció con mayor proliferación tumoral y con inmunofenotipos aberrantes, que incluyeron expresión anormal de CD10, TdT, CD38 y CD45 y un mayor tamaño de los linfoblastos. La presencia de t(9;22) y t(12;21) discrimina células normales de células tumorales con aberraciones en la expresión de CD19, CD20, CD13, CD33, CD38, CD34 y CD45. Conclusiones. El perfil de aberraciones fenotípicas detectado en conjunto con anormalidades en la proliferación tumoral, se asocia de forma significativa con hiperdiploidiía de ADN y discrimina de forma clara linfoblastos con t(9;22) y t(12;21) de los precursores B normales. La identificación de estos parámetros será de gran utilidad como herramienta para la clasificación y seguimiento de los pacientes.
Introduction: Between 60 and 80% of patients with B-cell acute lymphoblastic leukemia show genetic abnormalities which influence the prognosis of the disease and the biology of the tumor. Objective: To analyze different genetic abnormalities in acute B lymphoblastic leukemia in children, its relationship with the immunophenotype and the proliferative rate compared with normal B cell precursors. Materials and methods: We assessed immunophenotype, DNA content and proliferative rate in 44 samples by flow cytometry, and translocations t(9;22), t(12;21), t(4;11), and t(1;19) by RT-PCR. Using a hierarchical cluster analysis, we identified some immunophenotypic patterns associated to genetic abnormalities when compared with normal B cell precursors. Results: DNA quantification showed that 21% of the cases had high hyperdiploidy and 47.7% has low hyperdiploidy. The presence of hyperdiploidy was associated with increased tumor proliferation and aberrant immunophenotypes, including abnormal expression of CD10, TdT, CD38, and CD45 and an increased size of the lymphoblasts. The presence of t(9;22) and t(12;21) discriminates normal cells from tumor cells with aberrant immunophenotype in the expression of CD19, CD22, CD13, CD33, CD38, CD34, and CD45. Conclusions: The aberrant immunophenotype profile detected in neoplastic cells along with abnormalities in the proliferative rate were significantly associated with DNA hyperdiploidy and clearly distinguished lymphoblasts with t(9;22) and t(12;21) from normal B cell precursors. The identification of these parameters is useful as a tool for classification and monitoring of these patients.
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Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Linfócitos B/classificação , Leucemia de Células B/genética , Leucemia de Células B/imunologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/imunologia , Proliferação de Células , DNA de Neoplasias/análise , Diploide , ImunofenotipagemRESUMO
Introduction Anorexia nervosa is a suffering entity from eating disorders and family has a relevant role in this disorders; a severe family dysfunction is a risk factor and an important maintainer factor. On the other hand, the family's participation in treatment increases the possibility of success. The aim of this paper is to contribute with the analysis of the form on which the subjects, who suffer from anorexia nervosa and their parents, coexist with their suffering, and share their story. Materials and methods It is a qualitative research study that pretends to know about the family's experiences. The informants where selected according to a theoretical non probabilistic sample. Depth interviews were used and the material was analyzed through a narrative analysis by thematic axis according to Kolher Riessman model. Results The presented family is formed by three members, mother, father and daughter, with anorexia nervosa. Presenting excessively restrictive behaviors oscillating between control and impulsivity. The mother turns her into her confident and the father is too strict and demanding. Concerning the treatment, it lasted approximately three years on impasse, the patient did not show any evolution. Discussion The four evolution moments of the suffering had several points of view according to each of the informants, in literature, the mother and daughter's symbiotic relationship and the peripheral relationship established with the father are mentioned, change was achieved in the family alliances and the change in the nature of their bonds was facilitated. Conclusions These findings are an initial step to know the experiences of each of the family members during the treatment and the expectations they have towards the remission of the suffering.
Antecedentes La anorexia nervosa es un padecimiento de la conducta alimentaria en el que se ha observado que la familia desempeña un papel relevante, ya que una grave disfunción familiar puede ser un factor de riesgo y mantener la sintomatología. La participación de la familia en el tratamiento incrementa la posibilidad de éxito. La presente investigación pretende contribuir con un análisis de la forma en la que los propios sujetos que padecen anorexia nervosa y sus padres, conviven con el padecimiento y narran su historia. Material y métodos Se llevó a cabo un estudio cualitativo y un análisis de narrativa por ejes temáticos de acuerdo al modelo de Kolher Riessman. Los informantes se eligieron de acuerdo a un muestreo teórico no probabilístico y se realizaron entrevistas a profundidad focalizadas. Se eligió a una familia para este reporte. Resultados La familia analizada estuvo conformada por tres miembros: la madre, el padre y la hija con anorexia nervosa, presentándose conductas excesivamente rígidas que oscilan entre el control y la impulsividad. La paciente funciona como confidente de la madre, en tanto que el padre se muestra rígido y exigente. El tratamiento duró tres años aproximadamente en impasse ya que la paciente no mostró ninguna evolución. Discusión En los cuatro momentos de la evolución del padecimiento se observó que cada uno de los participantes tenía diferentes puntos de vista. En la bibliografía se menciona la relación simbiótica de la hija con la madre y la relación periférica establecida con el padre, en la información obtenida en este caso se confirma esa estructura. Conclusiones Estos hallazgos son un primer paso para conocer las experiencias de cada uno de los integrantes de la familia durante el inicio de la enfermedad, el tratamiento, la recaída y las expectativas que se tienen en cuanto a la remisión del padecimiento.
RESUMO
INTRODUCTION: Between 60 and 80% of patients with B-cell acute lymphoblastic leukemia show genetic abnormalities which influence the prognosis of the disease and the biology of the tumor. OBJECTIVE: To analyze different genetic abnormalities in acute B lymphoblastic leukemia in children, its relationship with the immunophenotype and the proliferative rate compared with normal B cell precursors. MATERIALS AND METHODS: We assessed immunophenotype, DNA content and proliferative rate in 44 samples by flow cytometry, and translocations t(9;22), t(12;21), t(4;11), and t(1;19) by RT-PCR. Using a hierarchical cluster analysis, we identified some immunophenotypic patterns associated to genetic abnormalities when compared with normal B cell precursors. RESULTS: DNA quantification showed that 21% of the cases had high hyperdiploidy and 47.7% has low hyperdiploidy. The presence of hyperdiploidy was associated with increased tumor proliferation and aberrant immunophenotypes, including abnormal expression of CD10, TdT, CD38, and CD45 and an increased size of the lymphoblasts. The presence of t(9;22) and t(12;21) discriminates normal cells from tumor cells with aberrant immunophenotype in the expression of CD19, CD22, CD13, CD33, CD38, CD34, and CD45. CONCLUSIONS: The aberrant immunophenotype profile detected in neoplastic cells along with abnormalities in the proliferative rate were significantly associated with DNA hyperdiploidy and clearly distinguished lymphoblasts with t(9;22) and t(12;21) from normal B cell precursors. The identification of these parameters is useful as a tool for classification and monitoring of these patients.
Assuntos
Linfócitos B/classificação , Leucemia de Células B/genética , Leucemia de Células B/imunologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/imunologia , Adolescente , Proliferação de Células , Criança , Pré-Escolar , DNA de Neoplasias/análise , Diploide , Feminino , Humanos , Imunofenotipagem , Lactente , MasculinoRESUMO
OBJECTIVE: To present an ethnographic description of the treatment of patients with excessive alcohol consumption in an emergency room, how they are evaluated by doctors, and the various contextual aspects surrounding this condition. MATERIAL AND METHODS: The ethnographic work was carried out over a period of two months, with researchers working 24 hours a day, seven days a week from January 9 to March 15, 2002 in the emergency room (ER) at General Hospital, Mexico City. RESULTS: Patients that had consumed alcohol and were admitted to the ER had to wait longer than others to be treated for their intoxication to wear off and for their sometimes aggressive attitude to become calm. The rejection of the alcoholized patients was expressed through scolding to persuade alcohol-dependent patients or those that abused alcohol to reduce their consumption. CONCLUSION: The theoretical and methodological approach of the ethnographic observation enables reflection on the social and cultural mechanisms related to this health problem.
Assuntos
Intoxicação Alcoólica/etnologia , Adulto , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , MéxicoRESUMO
OBJECTIVE:To present an ethnographic description of the treatment of patients with excessive alcohol consumption in an emergency room, how they are evaluated by doctors, and the various contextual aspects surrounding this condition. MATERIAL AND METHODS: The ethnographic work was carried out over a period of two months, with researchers working 24 hours a day, seven days a week from January 9 to March 15, 2002 in the emergency room (ER) at General Hospital, Mexico City. RESULTS: Patients that had consumed alcohol and were admitted to the ER had to wait longer than others to be treated for their intoxication to wear off and for their sometimes aggressive attitude to become calm. The rejection of the alcoholized patients was expressed through scolding to persuade alcohol-dependent patients or those that abused alcohol to reduce their consumption. CONCLUSION: The theoretical and methodological approach of the ethnographic observation enables reflection on the social and cultural mechanisms related to this health problem.
OBJETIVO: Presentar una descripción etnográfica en un servicio de urgencias (su) sobre la atención de los pacientes con consumo excesivo de alcohol, las formas de la valoración de los médicos y los diferentes aspectos contextuales que enmarcan esta condición. MATERIAL Y MÉTODOS: El trabajo etnográfico se realizó durante dos meses, trabajando las 24 horas, los siete días de la semana, del 9 enero al 15 de marzo de 2002, en el servicio de urgencias de un Hospital General de la Ciudad de México. RESULTADOS: Al paciente que había consumido alcohol y que ingresaba al SU se le hacía esperar más, para que se tranquilizara y a su vez disminuyera la intoxicación. A través de regaños se trató de sugerirle al paciente con dependencia o abuso de alcohol que redujera su consumo. CONCLUSIÓN: El abordaje teórico y metodológico de la observación etnográfica permite hacer una reflexión sobre los mecanismos sociales y culturales, enmarcados en las problemáticas de salud.
Assuntos
Adulto , Feminino , Humanos , Masculino , Intoxicação Alcoólica/etnologia , Serviço Hospitalar de Emergência , MéxicoRESUMO
En el presente documento se conceptualiza la intervención desde diferentes acepciones, siendo el sentido psicosocial de la intervención, la opción de sus autores. Los avances conceptuales sobre intervención psicosocial reflexionan sobre los planes de desarrollo municipales colombianos, en contextos y escenarios en los cuales intervienen los diferentes profesionales funcionarios expertos en el diseño de políticas, en el desarrollo de programas y proyectos dirigidos a la juventud agrópolis en municipios. Este documento se acoge también al saber interdisciplinario, al reconocimiento de las redes sociales, a la importancia de la cotidianidad y de los proyectos de vida, lo mismo que al lenguaje como generador de realidades a través de acuerdos de significación. La conceptualización mencionada está respaldada por una investigación en curso con jóvenes que viven en algunos municipios del Departamento de Cundinamarca (Colombia).La pretensión de esta investigación es trabajar con los funcionarios sobre la concepción que tienen de juventud, es de tipo cualitativo con carácter interventivo, reconociendo al sujeto que se encuentra en este periodo del ciclo vital como alguien con recursos o potencialidades. Finalmente se enuncian en este artículo las categorías que orientan la investigación en cuestión, propias de su orientación construccionista y que se relacionan directamente con el concepto de intervención.
Assuntos
Humanos , Adolescente , Colômbia , Teoria da Construção Pessoal , Terapia Psicanalítica , Psicologia , População Rural , Idioma , Terapia da RealidadeRESUMO
En el presente documento se conceptualiza la intervención desde diferentes acepciones, siendo el sentido psicosocial de la intervención, la opción de sus autores. Los avances conceptuales sobre intervención psicosocial reflexionan sobre los planes de desarrollo municipales colombianos, en contextos y escenarios en los cuales intervienen los diferentes profesionales funcionarios expertos en el diseño de políticas, en el desarrollo de programas y proyectos dirigidos a la juventud agrópolis en municipios. Este documento se acoge también al saber interdisciplinario, al reconocimiento de las redes sociales, a la importancia de la cotidianidad y de los proyectos de vida, lo mismo que al lenguaje como generador de realidades a través de acuerdos de significación. La conceptualización mencionada está respaldada por una investigación en curso con jóvenes que viven en algunos municipios del Departamento de Cundinamarca (Colombia).La pretensión de esta investigación es trabajar con los funcionarios sobre la concepción que tienen de juventud, es de tipo cualitativo con carácter interventivo, reconociendo al sujeto que se encuentra en este periodo del ciclo vital como alguien con recursos o potencialidades. Finalmente se enuncian en este artículo las categorías que orientan la investigación en cuestión, propias de su orientación construccionista y que se relacionan directamente con el concepto de intervención.(AU)
Assuntos
Adolescente , Humanos , Psicologia , Terapia Psicanalítica , Teoria da Construção Pessoal , População Rural , Colômbia , Terapia da Realidade , IdiomaRESUMO
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Abstract: Introduction. Social support has been useful as a key axis for different approaches on how positive human relations and social networks help the individual to achieve states of relative well-being and overcome stressful events which they have to cope with in their lives. This is particularly important in the case of imprisoned women, who generally lack social support, since many of them are abandoned by their relatives and friends with the consequent impact that this has on their physical and emotional well-being. Support from family and friends during imprisonment can imply an enormous difference in the living conditions of imprisoned women. It has been proved that the social support individuals receive through their social networks is a key factor for their well-being, specially at times of stress, transition or crisis, and protects them from the emergence of physical and psychic disorders. For these reasons, the objective of this article is to identify the main sources of social support in convicted women at two penitentiary centers in Mexico City and to determine whether the presence or absence of social support has an impact on their physical and mental well-being. Method. This is a descriptive field study carried out at two women's prisons in Mexico City: The East Preventive Center for Women and the Tepepan Center of Social Readjustment for Women. The type of sampling was non-probabilistic and selected by convenience. The final sample comprised of a total of 212 women. This study included current and lifetime female abusers of alcohol, tobacco and drugs, aged between 18 and 65, who could read and write. The exclusion criteria used were having a psychiatric disorder or a physical disability that would prevent them from completing the interview. The instrument used for compiling the information was a semi-structured interview consisting of 62 pages on various areas from the lives of female prisoners. The following sections of the questionnaire were analyzed for this article: a) sociodemographic characteristics, b) social networks, c) depression, and d) perception of physical and emotional health. The procedure followed to gather information on the female prisoners began with the establishment of an agreement with the General Administration of Prevention and Social Readjustment of the Federal District. Through this agreement, the mental health team, comprising psychiatrists, psychologists and anthropologists -previously trained in the use of a structured interview-, were granted access to the correctional facility. The interviews were carried out after the women had given their informed consent and told of the objectives of the study. The interviews lasted two hours on average, although on some occasions they took up to four sessions of two hours. The field work lasted two years. Results. Socio-demographic profile: The majority of the interviewees were under 40 years old (84%). They had low schooling (with only 41% having completed elementary school), were unmarried (48.6%), and most of them did not live either with a partner or an offspring (40.5%). A total of 58.6% had left home when they were young and nearly 40% lived on the streets. Before being admitted to the institution, they had been shopkeepers (29.5%), employees (21.9%), housewives (13.8%), manual workers(7.1%) and informal workers (5.7%). Contact with relatives and friends in the past month: A high number of the women in prison reported not having received any visits during the past month, with only a small percentage receiving daily visits. Almost 60% of the women declared not receiving any visits from significant figures, such as their partners or children. Frequency of visits and perception of physical and mental health: A third of the women rated their physical and mental health as not so good. When frequency of visits was linked to the women's perception of health, it was found that women, who had not received any visits over the past month, tended to evaluate their physical health more negatively (bad-mediocre) than those who received visits (43.5% versus 38.5%). A similar percentage was observed in the evaluation of their mental health (47.8% versus 45.3%). Frequency of visits and depression: When relating the frequency of visits to the presence and/or absence of depression, it was found that women who had not received visits during the past month experienced more depressive episodes (72.7% versus 61.1%). Nevertheless, these differences were not significant. Discussion. One of the most outstanding aspects observed in this study was the high level of abandonment suffered by the inmates, which confirms findings from other studies about women being abandoned by their loved ones more often than men after commiting a crime. The study found that in terms of accessibility, the physical location of penitentiary centers, is not a factor that fully explains the abandonment suffered by these women, since most of the inmates' relatives and friends live in the same city and even in the same neighborhood where the penitentiary center is located. A high presence of present depressive episodes was also observed in female prisoners, both among those who reported receiving visits and those who did not. A possible answer here is that imprisonment itself is a highly stressful event for those undergoing it and the support received from relatives and friends is not enough to offset the effects of confinement. Conclusions. The results of this study indicate there is a certain positive association between the social support female prisoners received from relatives and friends and their physical and mental well-being. Nevertheless, this cannot be considered a causal relationship, a conclusion which agrees with other reports regarding the positive influence of social support on prisoners' well-being. However, it is also suggested that this is a complex relation that must be investigated more in depth, since this support does not necessarily has the same effect on all individuals. One of the main recommendations deriving from these results is the need to make prisoners' relatives aware of the importance of promoting and maintaining a continuous and permanent contact with them, since this type of support usually brings about an enormous benefit for their physical and emotional well-being. It is also necessary for penitentiary institutions to reconsider the suspension of visits as a means of punishment and control, since this entails a series of negative consequences for the internal population and the institution itself.