Valoración de la calidad de vida, el estado musculoesquelético y del dolor en pacientes recién diagnosticados de cáncer de colon / Assessment of quality of life, the musculoskeletal state and pain in recently diagnosed colon cancer patients

Objetivo: Determinar la calidad de vida, el estado musculoesquelético y el dolor en pacientes diagnosticados de cáncer de colon, previamente a cirugía. Material y métodos: Un total de 15 pacientes con cáncer de colon y 15 controles sanos formaban la muestra del estudio transversal. La calidad de vida se evaluó a través del cuestionario QLQ-C30. El resto de variables se valoró mediantes el test de McQuade, dinamometría de tronco, algometría para los umbrales de dolor a la presión y una escala visual analógica. Se realizó un análisis principal mediante la covarianza ANCOVA. Resultados: Se encontraron diferencias significativas en la calidad de vida entre pacientes diagnosticados con cáncer de colon y los controles sanos en la función física (p < 0,01), tareas (p < 0,01), función emocional (p = 0,046), fatiga (p < 0,01), dolor (p = 0,05), insomnio (p = 0,04), apetito (p = 0,01), diarrea (p = 0,01) y salud global (p < 0,01). Mediante las imágenes ecográficas se encontró una disminución del grosor de los músculos oblicuo interno (p = 0,02) y del transverso del abdomen (p = 0,02) entre ambos grupos de estudio. No hubo cambios significativos en el resto de variables estudiadas. Conclusiones: Los pacientes diagnosticados de cáncer de colon presentan, previamente a la cirugía, un deterioro de la calidad de vida y alteraciones musculoesqueléticas de la musculatura profunda estabilizadora del abdomen. Los grupos de estudio no presentan cambios significativos con relación al dolor

Objectives: To investigate the quality of life and musculskeletal state and pain in colorectal diagnosed cancer patients prior to the surgical intervention. Material and methods: A total of 15 patients with colorectal cancer and 15 healthy control patients made up this cross-sectional study. Quality of life was assessed with EORTC QLQ_C30 questionnaire. The remaining variables were measured with the McQuade test, digital dynamometer, algometry for pressure pain threshold and the Visual Analogue Scale. The main analysis was made using the ANCOVA. Results: Significant differences were found in quality of life among patients diagnosed with colon cancer and healthy controls in physical function (P < .01), role functioning (P < .01), emotional functioning (P = .046), fatigue (P < .01), pain (P = .05), insomnia (P = .04), appetite loss (P = .01), diarrhea (P = .01) and global health status (P < .01). Ultrasound imaging showed a decrease in the thickness of both muscles: internal oblique (P = .02) and transversus abdominis (P = .02) between the 2 study groups. There were no significant changes in the rest of the variables studied. Conclusions: The patients diagnosed with colorectal cancer show deterioration of quality of life and musculoskeletal disorders in the stabilizing muscles in the abdomen prior to the surgery. The study groups did not show significant changes related to pain

Linfangioma quístico retroperitoneal / Retroperitoneal cystic lymphangioma

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Glomerunefritis membranosa secundaria a tuberculosis / Membranous secondary Glumeronefritis to tuberculosis

La tuberculosis (TBC) es una enfermedad multisistémica causada por Mycobacterium tuberculosis, el riñón puede ser afectado en diversas formas, la glomerulonefritis ha sido descrita en forma ocasional, en estos casos el daño es producido por mecanismo inmunológico. Los linfocitos Thelper (Th) se diferencian funcionalmente en dos subtipos Th1 y Th2, que producen dos grupos distintos de citoquinas, las que determinan respuesta inmune diferente. La respuesta inmune en TBC es mediada por inmunidad celular a predominio del tipo Th1. Sin embargo los pacientes que desarrollan TBC extrapulmonar o TBC miliar, presentan una respuesta a predominio del tipo Th2. Presentamos dos pacientes con diagnóstico de TBC extrapulmonar (ganglionar, pleural), glomérulonefritis membranosa (sugerente de activación tipo Th2). Los pacientes con TBC con comprmiso renal en particular en presencia de proteinuria, deben ser mas ampliamente estudiados desde el punto de vista renal e inmunológico.

Risk of infection from needle reuse at a phlebotomy center.

OBJECTIVES: This study determined infection risk for HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) from needle reuse at a phlebotomy center that possibly exposed 3810 patients to infection. METHODS: We used a model for the risk of infection per blood draw, supplemented by subsequent testing results from 1699 patients. RESULTS: The highest risk of transmission was for HBV infection: 1.1 x 10(-6) in the best case and 1.2 x 10(-3) in the (unlikely) worst case. Subsequent testing yielded prevalence rates of 0.12%, 0.41%, and 0.88% for HIV, HBV, and HCV, respectively, lower than National Health and Nutrition Examination Survey III prevalence estimates. CONCLUSIONS: The infection risk was very low; few, if any, transmissions are likely to have occurred.

Eukaryotic translation initiation factor 4GI is a cellular target for NS1 protein, a translational activator of influenza virus.

Influenza virus NS1 protein is an RNA-binding protein whose expression alters several posttranscriptional regulatory processes, like polyadenylation, splicing, and nucleocytoplasmic transport of cellular mRNAs. In addition, NS1 protein enhances the translational rate of viral, but not cellular, mRNAs. To characterize this effect, we looked for targets of NS1 influenza virus protein among cellular translation factors. We found that NS1 coimmunoprecipitates with eukaryotic initiation factor 4GI (eIF4GI), the large subunit of the cap-binding complex eIF4F, either in influenza virus-infected cells or in cells transfected with NS1 cDNA. Affinity chromatography studies using a purified His-NS1 protein-containing matrix showed that the fusion protein pulls down endogenous eIF4GI from COS-1 cells and labeled eIF4GI translated in vitro, but not the eIF4E subunit of the eIF4F factor. Similar in vitro binding experiments with eIF4GI deletion mutants indicated that the NS1-binding domain of eIF4GI is located between residues 157 and 550, in a region where no other component of the translational machinery is known to interact. Moreover, using overlay assays and pull-down experiments, we showed that NS1 and eIF4GI proteins interact directly, in an RNA-independent manner. Mapping of the eIF4GI-binding domain in the NS1 protein indicated that the first 113 N-terminal amino acids of the protein, but not the first 81, are sufficient to bind eIF4GI. The first of these mutants has been previously shown to act as a translational enhancer, while the second is defective in this activity. Collectively, these and previously published data suggest a model where NS1 recruits eIF4GI specifically to the 5' untranslated region (5' UTR) of the viral mRNA, allowing for the preferential translation of the influenza virus messengers.

HIV infection as a risk factor for shigellosis.

We investigated cases of shigellosis in San Francisco and Alameda Counties identified during 1996 by active laboratory surveillance to assess the role of HIV infection as a risk factor for shigellosis. Dramatically elevated rates of shigellosis in HIV-infected persons implicate HIV infection as an important risk factor for shigellosis in San Francisco.

The PA influenza virus polymerase subunit is a phosphorylated protein.

The induction of proteolysis by expression of the influenza virus PA polymerase subunit is the only biochemical activity ascribed to this protein. In the course of studying viral protein synthesis by two-dimensional gel electrophoresis, we observed the existence of several PA isoforms with different isoelectric points. These isoforms were also present when the PA gene was singly expressed in three different expression systems, indicating that a cellular activity is responsible for its post-translational modification. In vivo labelling with [32P]orthophosphate, followed by two-dimensional gel electrophoresis, clearly demonstrated the incorporation of phosphate into the PA molecule. Phosphoserine and phosphothreonine epitopes were present in PA, while phosphotyrosine residues were absent, as tested by immunoblotting with specific antibodies. These facts, as well as the presence of multiple consensus sites for casein kinase II (CKII) phosphorylation, prompted us to test the involvement of this kinase in PA covalent modification. PA protein purified by immunoprecipitation could be specifically labelled by the catalytic alpha subunit of human CKII, which was expressed and purified from bacteria. Collectively, these data demonstrate that the PA subunit of the influenza virus RNA polymerase is a phosphoprotein.

The N-terminal half of the influenza virus NS1 protein is sufficient for nuclear retention of mRNA and enhancement of viral mRNA translation.

A collection of C-terminal deletion mutants of the influenza A virus NS1 gene has been used to define the regions of the NS1 protein involved in its functionality. Immunofluorescence analyses showed that the NS1 protein sequences downstream from position 81 are not required for nuclear transport. The capacity of these mutants to bind RNA was studied by in vitro binding tests using a model vRNA probe. These experiments showed that the N-terminal 81 amino acids of NS1 protein are sufficient for RNA binding activity. The collection of mutants also served to map the NS1 sequences required for nuclear retention of mRNA and for stimulation of viral mRNA translation, using the NP gene as reporter. The results obtained indicated that the N-terminal 113 amino acids of NS1 protein are sufficient for nuclear retention of mRNA and stimulation of viral mRNA translation. The possibility that this region of the protein may be sufficient for virus viability is discussed in relation to the sequences of NS1 genes of field isolates and to the phenotype of known viral mutants affected in the NS1 gene.

Cryptosporidiosis among patients infected with human immunodeficiency virus. Factors related to symptomatic infection and survival.

The authors reviewed the medical records of 194 human immunodeficiency virus (HIV)-positive patients newly diagnosed with cryptosporidiosis and all 3,564 patients with newly diagnosed acquired immunodeficiency syndrome (AIDS) at San Francisco General Hospital for the period 1986-1992. The study was designed to address three questions: 1) How do AIDS patients who present with cryptosporidiosis differ from other patients with AIDS? 2) What factors are associated with survival among AIDS patients with newly diagnosed cryptosporidiosis? 3) Does a diagnosis of cryptosporidiosis impact survival after AIDS diagnosis? A total of 194 cases of cryptosporidiosis among HIV-infected patients were identified during the study period. Of the 194 patients, 109 (56%) had no prior diagnosis of AIDS. These 109 patients represented 3.1% of the 3,564 newly diagnosed cases of AIDS in the same period. Among the 134 patients with CD4 T-lymphocyte counts performed within 3 months of Cryptosporidium diagnosis, 34 (25%) had CD4 counts greater than 209 cells/ml. In a multivariate conditional logistic regression model, the incidence of Cryptosporidium was related to ethnicity (for blacks vs. whites, matched odds ratio (OR) = 0.15, 95% confidence interval (CI) 0.03-0.73), CD4 count (for a CD4 count of < or = 53 cells/ml vs. > 53 cells/ml, matched OR = 12.60, 95% CI 4.01-39.61), and age (for a 10-year increase, matched OR = 0.51, 95% CI 0.27-0.98). Two factors measured at the time of Cryptosporidium diagnosis were identified as being independently associated with survival (p < 0.001) in the proportional hazards model: CD4 count < or = 53 cells/ml versus > 53 cells/ml (relative hazard = 6.18, 95% CI 2.99-12.76) and hematocrit < or 37% versus > 37% (relative hazard = 2.27, 95% CI 1.22-4.22). The median durations of survival in the four subgroups of Cryptosporidium-infected patients defined by these two variables differed significantly from each other (range, 204-1,119 days). Cryptosporidiosis as an initial AIDS-defining diagnosis was associated with an elevated relative hazard of death in comparison with other AIDS-defining diagnoses (relative hazard = 2.01, 95% CI 1.38-2.93). These data identify the groups of HIV-infected individuals at risk for presentation with symptomatic Cryptosporidium infection; the distinct survival patterns among subgroups of those patients already infected with this parasite; and the survival of AIDS patients with newly diagnosed cryptosporidiosis relative to patients with other AIDS-defining conditions. Such information is necessary for the design of prospective studies, the development of prophylactic strategies, the evaluation of candidate therapies, and the provision of prognostic information to patients.

Outcome for hospitalized patients with fever and neutropenia who are infected with the human immunodeficiency virus.

We conducted a retrospective cohort study to evaluate the occurrence of bacteremia and associated mortality among hospitalized patients who were seropositive for the human immunodeficiency virus (HIV) and who developed fever and neutropenia following antineoplastic chemotherapy or for other reasons. Review of medical records revealed 224 episodes in 142 patients. Of these episodes, 57% occurred following antineoplastic chemotherapy, and 43% occurred under other circumstances. Members of the chemotherapy group had significantly less-advanced HIV disease, a lower mean absolute-neutrophil-count nadir, and a shorter duration of hospitalization. There was no difference between the two groups in the frequency of bacteremia or mortality due to all causes when they were compared by multivariate analysis. Statistically significant univariate and multivariate predictors of bacteremia included sepsis syndrome and concurrent infection. Predictors of mortality included sepsis syndrome, concurrent infection, bacteremia, and antimicrobial therapy. This study suggests that the cause of neutropenia in HIV-seropositive patients is not a predictor of the outcome of fever and neutropenic episodes. Instead, clinical presentation and concomitant illnesses have a greater impact on outcome for a patient.

[The attitudes of primary care professionals on mental patients and psychiatric care]. / Opiniones de los profesionales de atención primaria sobre los enfermos mentales y la asistencia psiquiátrica.

AIM: To describe the views of different primary care professionals regarding mental illness, psychiatric patients and mental health care. DESIGN: Crossover survey. SITE. Primary care centres in a health zone. PARTICIPANTS: All the primary care centre professionals and social service base teams. Out of 66 possible subjects, 61 answered the questionnaire. MEASUREMENTS AND RESULTS: A questionnaire composed by ourselves about peoples' opinions was given. The chi 2 test was then used to analyse the questionnaire, both item by item and by means of the distribution of frequencies and comparisons. On some items differences between Health Professionals and social service staff occurred. But there were no differences between doctors and nursing staff, nor between men and women (level of importance: 0.50). For 91% of those surveyed, mental health is an illness like any other. 87% believe psychiatry is a science; and 77% that psychiatry is related to the rest of medicine. 48% believe that the majority of mental disturbances are untreatable. 80% affirm that psychiatric admissions should be into special hospitals. CONCLUSION: The authors highlight the need to overcome the discrepancy between positive attitudes on the theoretical side and a reluctance to integrate those attitudes into practice.