Enfermos crónicos domiciliarios: valoración integral físico-cognitiva y caídas durante 3 años de seguimiento

ObjectiveTo assess the physical and cognitive capacity of chronically ill homebound patients, and the falls they suffered during three years of monitoring.DesignDescriptive, longitudinal study.Setting«Raval Nord» Health District, Barcelona.Patients and other participantsAll the 243 homebound chronic patients registered in the home care programme in May 1996 (67% women, average age 84).Measurements and main resultsAfter three years 16% had gone into an old people's home, 9% had moved house and 38% had died. The probability of not continuing in the programme after three years monitoring was related to less autonomy, presence of comorbidity, and worse cognitive capacity (p < 0.05). Of the 90 patients (37%) who remained active in May 1999, 41% showed disorders on the Short Portable Mental Status Questionnaire (SPMSQ), with a significant relationship to greater age, less autonomy and the presence of comorbidity. Numerous alterations in analysis (21.6%) and linked illnesses (18.9%) were found in the patients with cognitive deterioration. 42% of the patients active in May'99 had fallen during the monitoring period. 10% of the falls involved fractures. The number of falls was higher when there was visual-auditory loss, consumption of psychiatric drugs or absence of use of orthopaedic aids. There was also a greater probability of falls in patients who only had a part-time carer (p < 0.05).ConclusionsIt is important to assess the autonomy, cognitive capacity and comorbidity of homebound chronic patients when monitoring them. Likewise, cognitive disorders and falls must be properly weighed, as they are common in this class of patient

Enfermos crónicos domiciliarios y consumo de psicofármacos

ObjetivoValorar el consumo de psicofármacos en los pacientes crónicos domiciliarios.DiseñoEstudio longitudinal, descriptivo.EmplazamientoÁrea Básica de Salud Raval Nord de Barcelona.Pacientes u otros participantesTodos los 243 enfermos crónicos domiciliarios registrados en el programa de atención domiciliaria en mayo de 1996. A los 3 años un 16% ha ingresado en una residencia, un 9% se ha trasladado de domicilio, un 38% ha fallecido y un 37% permanecía activo.Mediciones y resultados principalesDe los 90 pacientes que seguían activos, un 40% había consumido algún psicofármaco en mayo de 1999. El 8% de los pacientes que refirió consumir psicofármacos lo hacía por automedicación. El grupo farmacológico más consumido entre los psicofármacos era las benzodiazepinas, en un 64%. El consumo de psicofármacos fue superior en el sexo femenino (45%) y en las personas que vivían solas o en estado de viudedad (50%). El porcentaje de pacientes con consumo de psicofármacos fue superior cuando había peor grado de autonomía según el índice de Katz (67%), déficit cognitivo en el Short Portable Mental Status Questionnaire (SPMSQ) de Pfeiffer (62%) y ante la presencia de comorbilidad (56%) (p < 0,01).ConclusionesExiste un elevado consumo de psicofármacos en los pacientes crónicos domiciliarios, especialmente cuando hay deterioro físico-cognitivo y presencia de comorbilidad.ObjectiveTo assess the consumption of psychiatric drugs by chronic homebound patients.DesignDescriptive, longitudinal study.SettingRaval Nord Health District, Barcelona.Patients and other participantsAll 243 chronically ill homebound patients registered on the home care programme in May 1996. After three years 16% had gone into a home, 9% had moved residence, 38% had died, and 37% remained active.Measurements and main resultsOf the 90 patients still active, 40% took some psychiatric drug in May 1999. 8% of the patients who said they had taken psychiatric drugs did so by self-medication. The most commonly consumed pharmocological group of the psychiatric drugs were benzodiazepines at 64%. Women took more psychiatric drugs (45%), as did persons living alone or who had been bereaved (50%). The proportion of patients taking psychiatric drugs was greater when there was worse autonomy according to the Katz index (67%), a cognitive deficit on the Short Portable Mental Status Questionnaire (SPMSQ) of Pfeiffer (62%), and in the presence of comorbidity (56%) (p < 0.01).ConclusionsThere is high consumption of psychiatric drugs by chronic homebound patients, especially when there is physical-cognitive deterioration and presence of comorbidity

Existem diferenças nas emoções percebidas pelos alunos do ensino médio de acordo com o sexo e o ano letivo nas sessões de expressão corporal?

Resumen: Introducción: Las emociones percibidas por los alumnos durante las sesiones de expresión corporal son determinantes para conseguir una mayor satisfacción y motivación durante la práctica. Por tanto, es importante analizar la influencia de la lógica interna en las actividades de expresión en los alumnos participantes. Objetivos: El objetivo de esta investigación fue analizar la influencia del sexo y el curso escolar en las emociones percibidas durante la realización de actividades de expresión corporal como situación motriz de expresión. Método: La muestra estuvo compuesta por 80 alumnos pertenecientes a un centro público de educación secundaria que participaron voluntariamente en esta investigación (sexo: chicos n=49, chicas n=31; curso académico: 1ª n=28, 2A n=30, 2B n=22). Se diseñaron 5 actividades, las cuales se realizaron en dos sesiones en semanas diferentes. Para analizar las emociones percibidas se les suministró la Escala Juegos Deportivos y Emociones (GES) modificada. Resultados y discusión: Se encuentran diferencias en las emociones rabia y tristeza en función del sexo siendo estas mayores en los hombres (p<.05) y en las emociones rabia, tristeza, miedo y vergüenza en función del curso escolar, reportando mayores valores en el curso donde los alumnos tenían menor edad (p<.05). Conclusiones: En conclusión, el sexo y la edad son dos factores a tener en cuenta en el diseño de las sesiones de expresión corporal debido a su influencia en las emociones percibidas por los alumnos.Abstract: Introduction: The emotions perceived by the students during the sessions of body expression are determinant to achieve a greater satisfaction and motivation in the practice. Therefore, it is important to analyse the internal logic influence in the emotions perceived by the participants in body expression sessions. Aim: The aim of this research was to analyse the sex and academic year influence on the emotions perceived during the performance of body expression activities as motor situation of expression. Methods: 80 public high-school students participated voluntarily in this research (sex: boys n=49, girls n=31, academic course: 1A n=28, 2A n=30, 2B n=22). Five activities were designed, which were performed in two sessions in different weeks. To analyze the perceived emotions, the modified Sports Games and Emotions (GES) Scale was used. Results & discussion: Differences are found in emotions according to sex and age. Rage and sadness were higher in men (p<.05), while, anger, sadness, fear and shame were higher in the youngest teenagers (p<.05). Conclusions: In conclusion, sex and age are two factors to take into account in the design of body expression sessions due to their influence on the emotions perceived by the students.Resumo: Introdução: As emoções percebidas pelos alunos durante as sessões de expressão corporal são determinantes para alcançar uma maior satisfação e motivação durante a prática. Portanto, é importante analisar a influência da lógica interna nas atividades de expressão dos alunos participantes. Objetivos: O objetivo desta pesquisa foi analisar a influência do sexo e do ano escolar sobre as emoções percebidas durante a realização de atividades de expressão corporal como situação motora de expressão. Método: A amostra foi constituída por 80 estudantes pertencentes a uma escola pública de ensino médio que participaram voluntariamente da pesquisa (sexo: meninos n=49, meninas n=31, ano acadêmico: 1A n=28, 2A n=30, 2B n=22). Cinco atividades foram planejadas, que foram realizadas em duas sessões em diferentes semanas. Para analisar as emoções percebidas, foi fornecida a escala modificada Sports Games and Emotions (GES). Resultados e discussão: Diferenças são encontradas nas emoções de raiva e tristeza dependendo do sexo, sendo mais velhas nos homens (p<.05) e nas emoções raiva, tristeza, medo e vergonha, dependendo do ano letivo, relatando valores mais elevados em o curso onde os alunos eram mais jovens (p<.05). Conclusões: Conclui-se que o sexo e a idade são dois fatores a considerar no desenho das sessões de expressão corporal, devido a sua influência nas emoções percebidas pelos estudantes

Thrombopoietin Receptor Agonists for Severe Thrombocytopenia after Allogeneic Stem Cell Transplantation : Experience of the Spanish Group of Hematopoietic Stem Cell Transplant

Persistent thrombocytopenia is a common complication after allogeneic hematopoietic stem cell transplantation (allo-SCT). Romiplostim and eltrombopag are the currently available thrombopoietin receptor agonists (TPO-RAs), and some studies with very small numbers of cases have reported their potential efficacy in the allo-SCT setting. The present retrospective study evaluated the safety and efficacy of TPO-RAs in 86 patients with persistent thrombocytopenia after allo-HSCT. Sixteen patients (19%) had isolated thrombocytopenia (PT), and 71 (82%) had secondary failure of platelet recovery (SFPR). TPO-RA therapy was started at a median of 127 days (range, 27 to 1177 days) after allo-SCT. The median initial and maximum administered doses were 50 mg/day (range, 25 to 150 mg/day) and 75 mg/day (range, 25 to 150 mg/day), respectively, for eltrombopag and 1 µg/kg (range, 1 to 7 µg/kg) and 5 µg/kg (range, 1 to 10 µg/kg), respectively, for romiplostin. The median platelet count before initiation of TPO-RA therapy was 14,000/µL (range, 1000 to 57,000/µL). Platelet recovery to ≥50,000/µL without transfusion support was achieved in 72% of patients at a median time of 66 days (range, 2 to 247 days). Eighty-one percent of the patients had a decreased number of megakaryocytes before treatment, showing a slower response to therapy (P =.011). The median duration of treatment was 62 days (range, 7 to 700 days). Grade 3-4 adverse events (hepatic and asthenia) were observed in only 2% of the patients. At last follow-up, 81% of patients had discontinued TPO-RAs and maintained response, and 71% were alive. To our knowledge, this is the largest series analyzing the use of TPO-RAs after allo-SCT reported to date. Our results support the efficacy and safety in this new setting. Further prospective trials are needed to increase the level of evidence and to identify predictors of response

Defects in memory B-cell and plasma cell subsets expressing different immunoglobulin-subclasses in patients with CVID and immunoglobulin subclass deficiencies

Background: Predominantly antibody deficiencies (PADs) are the most prevalent primary immunodeficiencies, but their B-cell defects and underlying genetic alterations remain largely unknown. Objective: We investigated patients with PADs for the distribution of 41 blood B-cell and plasma cell (PC) subsets, including subsets defined by expression of distinct immunoglobulin heavy chain subclasses. Methods: Blood samples from 139 patients with PADs, 61 patients with common variable immunodeficiency (CVID), 68 patients with selective IgA deficiency (IgAdef), 10 patients with IgG subclass deficiency with IgA deficiency, and 223 age matched control subjects were studied by using flow cytometry with EuroFlow immunoglobulin isotype staining. Patients were classified according to their B-cell and PC immune profile, and the obtained patient clusters were correlated with clinical manifestations of PADs. Results: Decreased counts of blood PCs, memory B cells (MB Cs), or both expressing distinct IgA and IgG subclasses were identified in all patients with PADs. In patients with IgAdef, B-cell defects were mainly restricted to surface membrane (sm)IgA(+) PCs and MBCs, with 2 clear subgroups showing strongly decreased numbers of smIgA(+) PCs with mild versus severe smIgA(+) MBC defects and higher frequencies of nonrespiratory tract infections, autoimmunity, and affected family members. Patients with IgG subclass deficiency with IgA deficiency and those with CVID showed defects in both smIgA(+) and smIgG(+) MBCs and PCs. Reduced numbers of switched PCs were systematically found in patients with CVID (absent in 98%), with 6 different defective MBC (and clinical) profiles: (1) profound decrease in MBC numbers; (2) defective CD27(+) MBCs with almost normal IgG(3)(+) MBCs; (3) absence of switched MBCs; and (4) presence of both unswitched and switched MBCs without and; (5) with IgG(2)(+) MBCs; and (6) with IgA(1)(+) MBCs. Conclusion: Distinct PAD defective B-cell patterns were identified that are associated with unique clinical profiles

Evaluación del ISTH-BAT en los trastornos plaquetarios congénitos: correlación clínica, laboratorio y molecular

CO-153 Introducción: Los trastornos plaquetarios congénitos (TPC) son un grupo heterogéneo de enfermedades raras, que se clasifican en trombocitopenias hereditarias (THs) y en trombocitopatías hereditarias (TFPs). Su identificación inicial y su diagnóstico final son complejos. Éste, se basa en la la historia clínica, la exploración física, pruebas de laboratorio fenotípicas y la confirmación de la alteración molecular subyacente. Por otra parte, la valoración de la clínica hemorrágica suele ser subjetiva, por lo que la Sociedad Internacional de Trombosis y Hemostasia (ISTH) recomienda la utilización de escalas de sangrado (bleeding assessment tools, BAT). Los objetivos de nuestros estudios fueron a) evaluar la clínica hemorrágica con el ISTH-BAT en pacientes diagnosticados de TPC, b) su comparación entre THs y TFPs y c) su relación con las pruebas funcionales y moleculares. Métodos: Estudio retrospectivo de 138 pacientes con TPC incluidos en el proyecto nacional “Caracterización funcional y molecular de los TPC” de la SETH. La clínica hemorrágica se evaluó mediante el ISTHBAT, obteniendo un score de sangrado (BS). El diagnóstico fenotípico se realizó mediante hemograma y frotis de sangre periférica, la función plaquetaria mediante agregometría de transmisión de luz (LTA) y citometría de flujo (CMF) y el diagnóstico molecular mediante secuenciación ..

Bladder cancer index: cross-cultural adaptation into Spanish and psychometric evaluation

BACKGROUND: The Bladder Cancer Index (BCI) is so far the only instrument applicable across all bladder cancer patients, independent of tumor infiltration or treatment applied. We developed a Spanish version of the BCI, and assessed its acceptability and metric properties. METHODS: For the adaptation into Spanish we used the forward and back-translation method, expert panels, and cognitive debriefing patient interviews. For the assessment of metric properties we used data from 197 bladder cancer patients from a multi-center prospective study. The Spanish BCI and the SF-36 Health Survey were self-administered before and 12 months after treatment. Reliability was estimated by Cronbach's alpha. Construct validity was assessed through the multi-trait multi-method matrix. The magnitude of change was quantified by effect sizes to assess responsiveness. RESULTS: Reliability coefficients ranged 0.75-0.97. The validity analysis confirmed moderate associations between the BCI function and bother subscales for urinary (r = 0.61) and bowel (r = 0.53) domains; conceptual independence among all BCI domains (r ≤ 0.3); and low correlation coefficients with the SF-36 scores, ranging 0.14-0.48. Among patients reporting global improvement at follow-up, pre-post treatment changes were statistically significant for the urinary domain and urinary bother subscale, with effect sizes of 0.38 and 0.53. CONCLUSIONS: The Spanish BCI is well accepted, reliable, valid, responsive, and similar in performance compared to the original instrument. These findings support its use, both in Spanish and international studies, as a valuable and comprehensive tool for assessing quality of life across a wide range of bladder cancer patients

Defects in memory B-cell and plasma cell subsets expressing different immunoglobulin-subclasses in patients with CVID and immunoglobulin subclass deficiencies

Background: Predominantly antibody deficiencies (PADs) are the most prevalent primary immunodeficiencies, but their B-cell defects and underlying genetic alterations remain largely unknown. Objective: We investigated patients with PADs for the distribution of 41 blood B-cell and plasma cell (PC) subsets, including subsets defined by expression of distinct immunoglobulin heavy chain subclasses. Methods: Blood samples from 139 patients with PADs, 61 patients with common variable immunodeficiency (CVID), 68 patients with selective IgA deficiency (IgAdef), 10 patients with IgG subclass deficiency with IgA deficiency, and 223 agematched control subjects were studied by using flow cytometry with EuroFlow immunoglobulin isotype staining. Patients were classified according to their B-cell and PC immune profile, and the obtained patient clusters were correlated with clinical manifestations of PADs. Results: Decreased counts of blood PCs, memory B cells (MBCs), or both expressing distinct IgA and IgG subclasses were identified in all patients with PADs. In patients with IgAdef, B-cell defects were mainly restricted to surface membrane (sm)IgA1 PCs and MBCs, with 2 clear subgroups showing strongly decreased numbers of smIgA1 PCs with mild versus severe smIgA1 MBC defects and higher frequencies of nonrespiratory tract infections, autoimmunity, and affected family members. Patients with IgG subclass deficiency with IgA deficiency and those with CVID showed defects in both smIgA1 and smIgG1 MBCs and PCs. Reduced numbers of switched PCs were systematically found in patients with CVID (absent in 98%), with 6 different defective MBC (and clinical) profiles: (1) profound decrease in MBC numbers; (2) defective CD271 MBCs with almost normal IgG3 1 MBCs; (3) absence of switched MBCs; and (4) presence of both unswitched and switched MBCs without and; (5) with IgG2 1 MBCs; and (6) with IgA

Coagulation disorder and persistent microhematuria in a 17-year-old male patient

We report the case of a 17-year-old male patient with constant alteration of the prothrombin time and episodes of self-limited macrohematuria. After several studies we found out a deficiency of Factor X levels, whereas all other coagulation factors levels were normal. We continued with the study of the hematuria with urine and blood analysis, imaging tests and viral serologies, which finally made it possible to rule out any other primary or secondary glomerulopathies and to focus on IgA nephropathy as the most likely diagnosis. In this release we explain in detail the diagnostic tests performed. We have also reviewed the two entities separately and together, in search of a genetic disease which associates both pathologie