Estrategias de afrontamiento utilizadas por los pacientes con tuberculosis de un centro de salud / Ways of coping used by patients with tuberculosis of a community center

Cuando una persona recibe el diagnóstico de una enfermedad crónica como la tuberculosis cambia la forma como se ve a sí misma y a su vida, ello afecta profundamente el autoconcepto, y la adaptación dependerá de una multiplicidad de factores, como la edad, el sexo, el estatus social, el apoyo, la educación, las creencias religiosas, los patrones de personalidad, la inteligencia, los estilos de afrontamiento, el equilibrio o control emocional, etc. Objetivo: identificar las estrategias de afrontamiento utilizadas por los pacientes con tuberculosis. Material y métodos: estudio descriptivo de corte transversal. Se realizó en el Centro de Salud ©Santa Rosa¯ de San Juan de Lurigancho. El cuestionario Brief Cope fue aplicado a 30 pacientes. Para su validación, fue sometido a juicio de expertos y a una prueba piloto. Resultados: el 86,6 por ciento de la población utiliza el afrontamiento activo, el 73,3 por ciento de la población siempre utiliza la aceptación y el 53,3 por ciento utiliza la autodistracción como medio de afrontamiento. Conclusiones: de la dimensión estrategias centradas en el problema, los pacientes que asisten a la ESN-PCT del Centro de Salud Santa Rosa utilizan, en mayor porcentaje, el afrontamiento activo.

When a patient is diagnosed with chronic tuberculosis, the way the person sees his or her life changes. Auto concept is affected and the adaptation will depend on multiple factors such as age, gender, social status, education, religious believes, personality, intelligence, ways of coping, self control, etc. Objetive: The aim of the project was to identify the ways of coping in patients with Tuberculosis. Material and Methods: A descriptive and cross-sectional research was conducted at ©Santa Rosa¯ community center in San Juan de Lurigancho. The ways of coping questionnaire was applied to a sample of 30 patients with tuberculosis. An expert review and pilot study were conducted to assess the credibility and validity of the instrument. Statistical analysis of the quantitative data was conducted. Results: The findings of the study revealed that 86.6 percent of the interviewers use active coping, 73.3 percent of the population always uses the acceptance and 53.3 percent use self-distraction as a means of confrontation. Conclusions. Patients who attend the ESN-PCT at ©Santa Rosa¯ community center mostly use problem focused ways of coping.

American Joint Committee on Cancer T category for eyelid sebaceous carcinoma correlates with nodal metastasis and survival.

PURPOSE: To determine whether T category of the American Joint Committee on Cancer (AJCC) TNM staging system for eyelid carcinoma, 7th edition, correlates with lymph node metastasis, distant metastasis, and survival in patients with sebaceous carcinoma of the eyelid. DESIGN: Retrospective, cohort study. PARTICIPANTS: Fifty consecutive patients treated by 1 author (BE) for eyelid sebaceous carcinoma between May 1999 and August 2010. METHODS: Each tumor was staged according to the AJCC 7th edition TNM criteria. The Kaplan-Meier method was used to determine associations between disease-specific survival and (1) T category at presentation, (2) lymph node metastasis, and (3) distant metastasis. MAIN OUTCOME MEASURES: T category at presentation, nodal metastasis, survival. RESULTS: The study included 37 women and 13 men (median age, 68.5 years; range, 44-86 years). Forty-four patients were white, 5 were Hispanic, and 1 was Asian. TNM designations were TXN0M0, 7 patients; T1N0M0, 4 patients; T2aN0M0, 12 patients; T2bN0M0, 11 patients; T2bN1M0, 2 patients; T2bN1M1, 1 patient; T3aN0M0, 2 patients; T3aN1M0, 5 patients; T3bN0M0, 1 patient; T3bN1M0, 1 patient; T3bN0M1, 2 patients; T4N0M0, 1 patient; and T4N0M1, 1 patient. T category at presentation was significantly associated with lymph node metastasis (P = 0.0079). No tumors with T category better than T2b or smaller than 9 mm in greatest dimension were associated with nodal metastasis. Five patients (10%) died of disease during follow-up. Their TNM designations were T2bN1M1, 1 patient; T3bN0M1, 2 patients; T4N0M0, 1 patient; and T4N0M1, 1 patient. No tumors smaller than 12 mm in greatest dimension were associated with distant metastasis or death. T category was significantly associated with disease-specific survival (P = 0.0009). Disease-specific survival was poorer among patients with T category of T3a or worse (P = 0.035). CONCLUSIONS: T category in the 7th edition of the AJCC TNM staging system for eyelid carcinoma correlates with outcomes in patients with sebaceous carcinoma of eyelid. On the basis of the present findings, it seems reasonable to recommend sentinel lymph node biopsy or at least strict regional lymph node surveillance for patients with eyelid sebaceous carcinoma with tumors of T category T2b or worse or 10 mm or more in greatest dimension.

Histologic features of conjunctival melanoma predictive of metastasis and death (an American Ophthalmological thesis).

PURPOSE: In conjunctival melanoma, tumor thickness and nonlimbal location are associated with poor prognosis. However, other established high-risk features for cutaneous melanoma, including ulceration, mitotic figures, epithelioid cell type, and lymphovascular invasion, have not previously been studied extensively for their prognostic value in conjunctival melanoma. We examined the hypothesis that these features also predict regional nodal metastasis and death in conjunctival melanoma. METHODS: The medical records of 44 of 46 consecutive conjunctival melanoma patients treated between June 2003 and December 2009 were retrospectively reviewed; tumor tissue was not available for the two excluded patients. Demographic and clinicopathologic features, including tumor location, tumor thickness, ulceration, mitotic rate, histology, lymphovascular invasion, and microsatellitosis, were reviewed. Outcome measures included regional nodal metastasis, distant metastasis, and death. RESULTS: Twenty-six women and 18 men had a median age of 62 years. Regional nodal metastasis occurred in 7 patients (16%) and distant metastasis in 9 (20%). Median follow-up was 40 months. At last follow-up, 10 patients (23%) had died of disease. Tumor thickness>2.0 mm, ulceration, and mitotic figure>1/mm2 predicted regional nodal metastasis and death from disease. In addition to these three histologic features, vascular invasion, epithelioid cell type, and microsatellitosis significantly predicted death from disease. Tumor location (bulbar vs nonbulbar) was not correlated with regional nodal metastasis or death. CONCLUSIONS: In conjunctival melanoma, as in cutaneous melanoma, thicker tumor, ulceration, and higher mitotic rate are correlated with regional nodal metastasis. In addition, lymphovascular invasion, epithelioid cell type, and microsatellitosis are correlated with melanoma-related death.

[Psychosocial adjustment in colorectal cancer patients undergoing chemotherapy or chemoradiotherapy].

BACKGROUND: Psychosocial adaptation is a measurement that represents the patient's adjustment to those changes involved in their illness. We undertook this study to search for individual characteristics and clinical aspects associated with successful psychosocial adjustment in patients with colorectal cancer (CRC) undergoing (CT) chemotherapy or chemoradiotherapy (CRT). METHODS: Seventy-five patients with CRC treated with CT or CRT in a cancer center were included. Psychosocial Adjustment to Illness Scale Self-Reporting (PAIS-SR) questionnaire was used as a measurement of psychosocial adjustment. RESULTS: Psychosocial adaptation was successful in 18 patients (24%) and unsuccessful in 57 patients (76%). Young patients, married patients and males showed lower psychosocial adaptation to disease. This is associated with the decrease in sexual relations, economic resources and psychological symptoms. Patients complained that they were unsatisfied due to the lack of disease and treatment information offered by the heath care team. CONCLUSIONS: In the process of adaptation, clinical features such as tumor location and treatment scheme are considered basic, as well as age, education, marital status. Areas such as sexuality, interpersonal and family relationships, economic status and emotional state of patients affected by the disease and treatments provide a deep complexity in the study of the psychosocial adaptation process in patients with CRC.

Manejo clínico de pacientes con tos persistente en el municipio Las Tunas / Clinical Management of Patients with Chronic Cough in the Municipality of Las Tunas

Se describen las causas que obligaron a los pacientes con tos persistente a acudir a las consultas de Neumología de las diferentes áreas de salud del municipio Las Tunas. La muestra estuvo integrada por 943 casos en el período de enero de 2004 a diciembre de 2005. Se evaluaron la edad, el sexo, la vía de llegada a la consulta, los síntomas clínicos, la forma de aparición de la tos y el diagnóstico definitivo de los casos. El 72,4 por ciento de los pacientes acudió a la consulta de forma espontánea y sólo el 27,6 por ciento fueron remitidos por su médico de asistencia. Los síntomas más frecuentes fueron la tos (100 por ciento), la disnea (42,1 por ciento), la fiebre (28,3 por ciento) y la expectoración (23,4 por ciento). En el 52,1 por ciento de los pacientes predominó la tos crónica, el 28,3 por ciento tuvo la forma aguda y el 19,6 por ciento - la subaguda; esta diferenciación permitió establecer una metodología diagnóstica adecuada del 100 por ciento de los casos como: asma (31,4 por ciento), hiperreactividad bronquial post infecciosa (26,6 por ciento), enfermedad rinosinusal (19 por ciento), bronquiectasias (9,3 por ciento), EPOC (3,5 por ciento), faringitis crónica (2,1 por ciento), TB pulmonar (0,6 por ciento), uso de IECA (Inhibidores de la Enzima Convertidota de Angiotensina) (1,3 por ciento), carcinoma broncogénico (1,3 por ciento)(AU)

The causes that made patients with chronic cough visit the Pneumology consultation in Las Tunas municipality are described. 943 patients were included from January 2004 to December 2005. Age, sex, way followed to see the physicians, clinical symptoms, way coughing appeared and definitive diagnosis of cases were evaluated. 72,4 per cent of the patients went to the doctors spontaneously and the rest through family doctors´ referral. The principal symptoms were: cough (100 per cent), dyspnea (42,1 per cent), fever (28,3 per cent) and expectoration (23,4 per cent). Chronic cough was predominant in 52,1 per cent of the cases, followed by the acute (28,3 per cent) and subacute ways (19,6 per cent). This differentiation made it possible to establish a proper methodological diagnosis of the 100 per cent of the cases: asthma (31,4 per cent), bronchial hyperactivity (26,6 per cent), postnasal drip syndrome (19 per cent), bronchiectasis (9,3 per cent), COPD (3,5 per cent), chronic pharingitis (2,1 per cent), pulmonary tuberculosis (0,6 per cent), use of converter angiotensin enzyme (1,3 per cent) and lung cancer (1,3 per cent)(AU)

Centralización del diagnóstico de la tuberculosis pulmonar: impacto de su aplicación sobre el programa de control en el municipio Las Tunas / Pulmonary Tuberculosis Diagnosis Centralization: Impact of its Application upon the Control Program in Las Tunas municipality

Con el objetivo de evaluar el impacto de un nuevo sistema de organización de los servicios de salud para el diagnóstico de la tuberculosis pulmonar, se estableció una estrategia de intervención, donde se aplicó la centralización del diagnóstico en dos de los 5 laboratorios existentes en las áreas de salud del municipio de Las Tunas, entre los períodos comprendidos de abril a septiembre de 2004 y de octubre de 2004 a septiembre de 2005. Se compararon los resultados con el período enero a diciembre de 2003. Se emplearon las variables: calidad de la muestra de esputo, número de casos de tuberculosis pulmonar BAAR positivos diagnosticados por microscopía, rendimiento del diagnóstico, tiempo de demora del diagnóstico, índice de muestras no útiles contaminadas y costos operacionales. Se obtuvo un aumento del rendimiento de diagnóstico de casos de 0,4 a 1,5 por cada 100 láminas. Se redujo el número de muestras no útiles para diagnóstico de 10 por ciento a 0,13 por ciento. El 68 por ciento de los casos diagnosticados correspondieron al grupo de los ancianos. Se lograron reducir los costos unitarios de la baciloscopía y el cultivo. Se demostró la efectividad de la centralización como método para el diagnóstico de la tuberculosis pulmonar. Se recomienda la generalización de este método a todos los municipios del país(AU)

In order to evaluate the impact of a new organizational system in health service for the diagnosis of pulmonary tuberculosis , an intervention strategy is established in which the centralization of the diagnosis is applied in two of five microbiology laboratories belonging to Las Tunas municipality in the following periods: April to September of 2004 and October 2004 to September 2005. A comparison of the results with January to December of 2003 period was done. The principal variables were: sputum sample quality, number of cases of positive pulmonary tuberculosis sputum, diagnosed by microscopy, diagnosis rating, time to achieve a positive diagnosis, non useful contaminating sample ratings, and operational costs. The principal results showed an increasing efficiency in diagnostic cases ,from 0,4 to 1,5 per 100 sheets; the number of non useful samples for diagnosis was reduced from 10 to 0,13 per cent 68 per cent of the cases belong to the elderly group. Unitary cost of culture and sputum smear were reduced. The effectiveness of centralization as a diagnosis method was demonstrated. The generalization of this method to all municipalities of our country is recommended(AU)

Utilidad de la radiología en el diagnóstico de la tuberculosis pulmonar baar negativa / Negative baciloscopic pulmonary tuberculosis: usefulness of radiological criteria

Se realizó un estudio de intervención sobre la utilidad de las radiografías en el diagnóstico de la tuberculosis pulmonar BAAR negativa (TbP BAAR-) de casos evaluados por la Comisión Provincial para la TbP BAAR-, desde el 1ro de abril de 2004 al 30 de septiembre de 2005. El universo de estudio estuvo constituido por todos los enfermos consultados por la comisión, 35 en el 2004 y 55 en el 2005, y la muestra por los 18 casos diagnosticados como TbP BAAR- en ese período. Los pacientes evaluados eran acompañados por sus respectivos médicos de asistencia, quienes presentaban el caso ante la comisión con los estudios radiográficos correspondientes. Se encontró un predominio del sexo masculino con 11 casos; los mayores de 65 años fueron los más afectados, con 10 pacientes (55,6por ciento). Las formas radiológicas predominantes fueron la exudativa (5 pacientes), la bronconeumónica, cavitaria y opacitaria (4 casos). La evolución de las lesiones mostraron dos pacientes con categoría de excelente (resolución total), siete con buena evolución y el resto evolucionó de forma regular (resolución parcial más 70 y menos 90 por ciento). No hubo ningún caso considerado de mala evolución (resolución parcial menos 70 por ciento)(AU)

The usefulness of radiological criteria in the diagnosis of Negative Baciloscopic Pulmonary Tuberculosis was prospectively studied from April 2004 to September 2005 at the Provincial Tuberculosis Committee in Las Tunas Province. All the patients seen at the committee were evaluated, although 18 diagnostic cases were included only on the investigation. All the patients went to the committee conducted by their physicians, with their radiographic studies done. The male sex predominated with 11 cases. The elderly (10 cases) were the most affected . The radiological manifestations were exudations (5 cases), follow ed by the bronconeumonic, the cavitary and the opacity, with 4 cases respectively 2 patients ended the treatment with excellent radiological resolution; 7 with good radiological course and the others with normal course. No case had bad course (partial resolution minus 70 per cent)(AU)

Diagnóstico de la Tuberculosis Pulmonar con baciloscopía negativa en la provincia Las Tunas / Negative baciloscopic diagnosisis of pulmonary tuberculosis: Las Tunas province

Se realizó un estudio descriptivo sobre el trabajo realizado por la comisión provincial en el manejo del paciente sintomático respiratorio para el diagnóstico de la tuberculosis pulmonar con baciloscopía negativa, desde el 1ro de enero de 2004 al 31 de diciembre de 2005. El universo de estudio estuvo constituido por todos los enfermos consultados por la comisión, 35 en el 2004 y 55 en el 2005 para un total de 90 pacientes. Todos los casos fueron presentados por sus médicos de asistencia ante la comisión, donde se les llenó un cuestionario con los datos necesarios para su adecuado seguimiento y diagnóstico. Predominó el sexo masculino con 51 casos y el grupo de edad de mayores a 55 años (49 por ciento). El 82 por ciento de los pacientes provino de la atención primaria de salud, 18 casos fueron enviados desde las consultas especializadas de Neumología, el resto de instituciones hospitalarias de la provincia. La tercera parte de los pacientes fue diagnosticada como tuberculosa y correspondió a 18 casos en forma clínico radiológica (20 por ciento). Se realizaron, además, un total de 60 diagnósticos de otras afecciones con el predominio de las bronquiectasias con 12 casos, el asma y la enfermedad pulmonar obstructiva crónica con 11(AU)

A descriptive study about the symptomatic respiratory patient due to Negative Baciloscopic Pulmonary Tuberculosis (NBPTb) in the followup of the Provincial Committee for evaluation was performed, between January 2004 and December 2005. All the patients seen at the committee were evaluated, although only 35 attended in 2004 and 55 in 2005 were included in the investigation. The male sex was the predominant gender with 51 cases, as well as patients older than 55 years (49 per cent). 82 per cent of the patients were referred from the Primary Care Service; 18 cases were first evaluated by neumologist physicians, before been referred to the committe, and the others were evaluated by Secondary Care Units. Pulmonary Tuberculosis was present in the third part of the patients, and 18 of them belong to the clinic - radiologic pulmonary tuberculosis form. 60 other diagnosis were carried out, with a predominance of bronchiectasis (12 cases), asthma and chronic obstructive pulmonary diesea (11 cases)(AU)

La tos como síntoma y mecanismo de defensa: comentarios y recomendaciones para su manejo / Cough as a symptom and defense mechanism. Comments and recommendations for its management

La tos es uno de los síntomas más comunes en pacientes que solicitan atención médica, tanto a nivel primario como en las consultas de neumología; probablemente porque ésta es causante de profundos y adversos efectos sobre la calidad de vida del paciente. Se presenta un acercamiento al manejo de la tos en forma de recomendaciones y puntos claves. Con estas orientaciones que describimos es posible diagnosticar e, incluso, orientar terapias exitosas en la gran mayoría de los casos. Las causas de tos crónica pueden ser identificadas entre el 88 por ciento al 100 por ciento de los casos, y sus determinaciones conducen a terapias exitosas con un rango de éxito que va del 84 por ciento al 98 por ciento. Por su importancia clínica y epidemiológica para el diagnóstico de las enfermedades respiratorias y, en especial, de la tuberculosis, realizamos esta revisión actualizada del tema(AU)

Cough is one of the most common symptoms for which patients seek medical attention from primary healthcare physicians and pulmonologists, probably because cough can so profoundly and adversely affect the quality of patients lives. In this review, an approach to managing cough using recommendations and key points ways is presented. With a systematic approach based on the guidelines described, it should be possible to diagnose and treat cough successfully in most cases. The cause of chronic cough can be determined in 88 to 100 per cent of cases, and determination leads to specific therapies with success rates that range from 84 to 98 percent. Because of its clinical and epidemiological importance to diagnose respiratory diseases and tuberculosis this review of the theme is done(AU)

Risk factors of vertebral fractures in women with systemic lupus erythematosus.

The aim of the current study was to analyze the role of traditional and systemic lupus erythematosus (SLE)-related risk factors in the development of vertebral fractures. A cross-sectional study was performed in women with SLE attending a single center. A vertebral fracture was defined as a reduction of at least 20% of vertebral body height. Two hundred ten patients were studied, with median age of 43 years and median disease duration of 72 months. Osteopenia was present in 50.3% of patients and osteoporosis in 17.4%. At least one vertebral fracture was detected in 26.1%. Patients with vertebral fractures had a higher mean age (50 +/- 14 vs. 41 +/- 13.2 years, p = 0.001), disease damage (57.1% vs. 34.4%, p = 0.001), lower bone mineral density (BMD) at the total hip (0.902 +/- 0.160 vs. 982 +/- 0.137 g/cm(2), p = 0.002), and postmenopausal status (61.9% vs. 45.3%, p = 0.048). Stepwise logistic regression analysis revealed that only age (p = 0.001) and low BMD at the total hip (p = 0.007) remained as significant factors for the presence of vertebral fracture. The high prevalence of vertebral fractures in the relatively young population implies that more attention must be paid to detect and treat vertebral fractures.

Risks factors for low bone mineral density in pre-menopausal Mexican women with systemic lupus erythematosus.

The aim of this study was to determine the prevalence and risk factors for low bone mineral density (BMD) in women with systemic lupus erythematosus (SLE). A cross-sectional study was conducted among 100 pre-menopausal patients with SLE. Patients were evaluated using a questionnaire about the following variables: age, disease duration, disease activity, chronic disease damage, cumulative corticosteroid dose, and history of fracture. Lumbar spine and hip measurements of BMD were performed by dual absorptiometry. Univariate and multivariate statistical analyses were used to assess the relationship between risk factors and BMD. The mean age was 32.8 +/- 8.7 years, and the median duration of SLE was 73.2 +/- 65 months. The mean cumulative corticosteroid dose was 20.0 +/- 21.3 g. The mean BMD was 1.09 +/- .18 g/cm(2) in the lumbar spine and 1.0 +/- .14 g/cm(2) in the hip. Osteopenia was present in 40% of patients and osteoporosis in 5%. In the multiple regression analysis, low BMD in the lumbar spine was associated with chronic disease damage and low body mass index (BMI). Low BMD in the hip was associated with cumulative corticosteroid dose and low BMI. Chronic disease damage, low BMI, and cumulative corticosteroid dose are risks factors for low BMD in pre-menopausal SLE patients. Osteopenia was found in 40% of patients, while osteoporosis was found in only 5%.