ABSTRACT
Objetivo. Estudiar las variables asociadas al cumplimiento del tratamiento antidepresivo en un sector de la población peruana y comparar lo hallado con lo reportado en la lietratura mundial. Método. Se incluyeron 133 pacientes de consulta externa, vistos entre marzo y junio de 1999, correspondientes a los siguientes establecimientos de salud: Instituto Nacional de Salud Mental "Honorio Delgado-Hideyo Noguchi", Hospital Hipólito Unanue, Hospital María Auxiliadora y Clínica Ricardo Palma. Resultados. Las variables que se asociaron significativamente con cumplimiento del tratamiento fueron: psicoterapia complementaria (p<0.001), número de consultas (p<0.001), explicación clara por parte del médico de cómo debía tomar la medicación (p<0.001), creencia de que el medicamento ayuda o es beneficioso (p<0.001), repuesta al tratamiento (p=0.002), considerar que la medicación es necesaria para su tratamiento (p=0.003), buen trato por parte del médico (p=0.007), confianza en el médico tratante (p=0.01) cefalea (P=0.026) e insomnio (p=0.041); por otro lado, los factores que se asociaron significativamente al incumplimiento fueron: problemas para cubrir el costo de la medicación (p<0.001), temor a hacerse dependiente de la medicación (p=0.003), considerar que es suficinete tomar la medicación sólo hasta sentirse bien (p=0.044) y dolor abdominal (p=0.03). Los pacientes incumplidores consideraron que el costo de la medicación era la principal causa por la que habían dejado el tratamiento. Conclusiones. Las variables asociadas al cumplimiento del tratamiento son similares a las encontradas en otros estudios, destacando las relacionadas con la información que el paciente recibe, la relación médico-paciente y el costo del fármaco.
Subject(s)
Humans , Male , Female , Depression/therapy , PsychotherapySubject(s)
Antibodies, Anticardiolipin/blood , Pyoderma Gangrenosum/immunology , Aged , Humans , Male , Pyoderma Gangrenosum/bloodABSTRACT
The eradication of a high-response Factor VIII inhibitor in patients with severe hemophilia A is extremely rare even with prolonged immunosuppressive therapy. This report presents a patient with severe hemophilia A, in whom the disappearance of such an inhibitor coincided with the development of the acquired immunodeficiency syndrome (AIDS). Laboratory studies demonstrated a marked decrease in helper T-cells and marked depression of cell-mediated immunity by in vivo and in vitro testing. In addition, humoral immune responses were abnormal. Thus, anamnestic antibody formation to different antigens was absent and in vitro pokeweed mitogen-induced immunoglobulin synthesis by the patient's B-cells was markedly impaired even in the presence of normal T-cells. These findings indicate that the disappearance of the Factor VIII inhibitor and the lack of an anamnestic antibody response to infused Factor VIII observed in this patient may be secondary to a humoral immunodeficiency associated with AIDS.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Factor VIII/antagonists & inhibitors , Hemophilia A/blood , Acquired Immunodeficiency Syndrome/immunology , Adult , Antibody Formation , Hemophilia A/complications , Hemophilia A/immunology , Humans , MaleABSTRACT
We report seven cases of atypical cutaneous fibrous histiocytoma, which appears to be a variant of cutaneous fibrous histiocytoma (dermatofibroma). These patients are all middle-aged women (mean, 39 years old) with small nodules occurring on the trunk and limbs. The lesions are characterized by marked focal cellular atypia, the absence of mitoses, and xanthomatous changes in both mononuclear and giant cells--all found within a small dermal nodule (approximately 1 cm) separated from an acanthotic epidermis by a Grenz zone. Their benign nature is demonstrated by the absence of recurrence, even after 9 years follow-up time.
Subject(s)
Histiocytoma, Benign Fibrous/pathology , Skin Neoplasms/pathology , Adult , Female , Fibroma/pathology , Follow-Up Studies , Humans , Middle AgedABSTRACT
A case of epidermotropic cutaneous toxoplasmosis is reported. The patient, a 53-year-old man with chronic myelogenous leukemia in blast crisis, received a bone marrow allograft but continued to have severe pancytopenia. Numerous diffuse, palpable, purpuric nodules appeared 21 days after the transplant. Organisms were found within the epidermal keratinocytes--both singularly and in cysts. Dermal and neural infiltration was also present. Toxoplasma gondii was identified on the basis of the ultrastructural features of the parasite. Possible sources of infection include reactivation of a previous latent infection, transmission through a bone marrow allograft, or nosocomial acquisition.
