Combined therapy versus usual care for the treatment of depression in oncologic patients: a randomized controlled trial.

OBJECTIVE: To compare narrative therapy (NT) plus escitalopram versus escitalopram plus usual care on quality of life and depressive symptomatology of depressed patients with oncologic disease. METHODS: A total of 72 subjects (mean age 54.6 years), predominantly female with non-metastatic breast, lung and colon cancer and depressive disorder (DSM-IV-TR) were randomized to receive treatment with NT plus escitalopram (n=39) or escitalopram (10-20 mg QD) plus usual care (n=33). Main endpoints were improvement in dimensions of quality of life measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30 and reduction of depressive symptoms using the Hospital Anxiety and Depression Scale at weeks 12 and 24. RESULTS: The combined therapy group showed significantly greater improvement in all the functioning dimensions (p<0.01), pain scale (p=0.02), global health (p=0.02), and global quality of life (p=0.007) at weeks 12 and 24. There were no statistically significant differences in depressive symptomatology between the groups. From week 12 to week 24 study retention was higher in the combined treatment group (p=0.01). CONCLUSIONS: Brief NT in combination with escitalopram was superior to usual care and escitalopram in improving functioning dimensions of quality life.

Factores familiares y sociales asociados al bienestar emocional en adolescentes diabéticos

Hemos realizado un estudio transversal en el que han participado 55 adolescentes diabéticos y sus familias. Se analizan las relaciones existentes entre factores sociodemográficos, características generales de la familia, apoyo específico a la enfermedad, bienestar del adolescente y control metabólico. El sexo y la cohesión familiar son los factores que con más fuerza predicen el bienestar del adolescente diabético. El apoyo específico a la enfermedad tanto por parte de la familia como de los amigos es también un importante factor asociado al bienestar. No se encuentra ninguna asociación entre las variables estudiadas y el control metabólico. Los resultados nos llevan a la conclusión de que, en los adolescentes estudiados, el bienestar emocional depende de factores personales y de su entorno, y es independiente del buen control de su glucemia (AU)

[HIV myelopathy as the presenting symptom of acquired immunodeficiency syndrome]. / Mielopatía por VIH como síntoma inicial del síndrome de inmunodeficiencia adquirida.

INTRODUCTION: Spinal lesions in the acquired immunodeficiency syndrome (AIDS) occur in 22% of all neurological complications, although their occurrence as the first sign of the disease is very uncommon. First place amongst the myelopathies described as associated with HIV is taken by vacuolar myelopathy, followed by the myelites. CLINICAL CASE: We studied a 65 year old homosexual man who had previously been free of symptoms and signs of HIV infection. He was seen for progressive paraparesia which had begun some days previously, followed by altered sense of position and of vibration. Complementary tests showed that the patient was a carrier of HIV antibodies in high titre (P-24) with a high viral load of 907 x 1,000 copies RNA/ml. Testing with evoked potentials showed changes compatible with involvement of the sensory pathways of the spinal cord. After treatment with dexamethasone there was obvious improvement with partial recovery of his symptoms. CONCLUSIONS: The neurological condition described was compatible with vacuolar type myelopathy due to HIV, appearing in the initial stages of the illness and coinciding with a marked increase in the viraemia. Although necropsy is necessary for confirmation of the diagnosis, more and more evidence is being found on which to base clinical suspicion. We discuss various hypotheses regarding possible pathogenic mechanisms arising in these circumstances.

[Carcinomatosis of the choroid plexus: clinical case and necropsy findings]. / Carcinomatosis de plexos coroideos: caso clínco y hallazgos necrópsicos.

INTRODUCTION: Carcinomas of the choroid plexus are a rare malignant variety of papillary tumours which originate in the choroid plexus. Their occurrence in adults has been questioned because of the difficulty in differentiating them from the metastases of adenocarcinomas. CLINICAL CASE AND CONCLUSIONS: We present the case of a 57 year old man with a rapidly progressive illness characterized by disorientation, behaviour changes and amnesia, progressive deterioration of the level of consciousness until he was in deep coma and died (all within one month). There was no clinical evidence of the presence of a primary extra-cranial tumour. On magnetic resonance there was obliteration of the ventricular system with a protein material and thickening and increased marking of the ependyma walls, compatible with ventriculitis. Necropsy, limited to the skull, showed the presence of a malignant infiltrating tumour with papillary morphology, which affected the choroid plexuses of the whole ventricular system, infiltrated the adjacent nervous tissue and extended to the leptomeninges. These findings suggest a differential diagnosis between carcinoma of the choroid plexus and metastatic meningeal carcinoma.

Lymphocyte proliferation kinetics and genotoxic findings in a pilot study on individuals chronically exposed to arsenic in Mexico.

In the search for early biological markers to detect genetic damage, a pilot study on a hydroarsenicism-exposed group was designed. Blood and urine samples were taken from 11 individuals chronically exposed and from 13 individuals with lower exposure to the metal. Lymphocyte cultures for cytogenetic studies and HGPRT assay were done with coded peripheral blood samples, while arsenic levels and the "rec assay" in B. subtilis were determined in urine samples. The highly exposed group excreted greater amounts of As, nevertheless the rec assay showed negative results. An interesting finding is that the cell-cycle kinetics exhibited a significant difference between the groups studied, the average generation time (AGT) was longer in the highly exposed group. The percentages of chromosomal aberrations and the frequencies of sister-chromatid exchanges were similar in both populations, although complex aberrations were more frequent in the highly exposed group, which also showed a higher average variation frequency in the HGPRT assay, but the 2 latter observations were not statistically significant. The lag in lymphocyte proliferation could mean an impairment of the immune response due to arsenic exposure.

6-Thioguanine-resistant T-lymphocyte autoradiographic assay. Determination of variation frequencies in individuals suspected of radiation exposure.

We used the autoradiographic assay to assess human in vivo somatic cell gene mutation at the hypoxanthine guanine phosphoribosyl transferase (HGPRT) locus in T-lymphocytes. Cells able to incorporate tritiated thymidine in vitro in the presence of 6-thioguanine were enumerated in order to determine 6-thioguanine-resistance (TGr) variant frequencies in cryopreserved lymphocytes from 17 normal control individuals, from 3 persons suspected to have been exposed to 60Co in an accident in Cd. Juárez (Mexico), studied 24 months after the accident, and from 4 individuals who were in Kiev during the radiation accident in Chernobyl (U.S.S.R.); 2 of them were studied 1 month after the accident, and again 1 year after the first sampling, the other 2 were studied 13 months after the accident. The data obtained indicate that this assay may be useful in any laboratory of cytogenetics for human population monitoring and that its use following accidental exposure to ionizing radiation should be further evaluated.