ABSTRACT
INTRODUCTION: Transplantation is a process with several psychosocial challenges. Regarding the case of xenotransplantation, the perceived similarity between humans and pigs may be stressful. Adjustment disorders have been reported among transplantation recipients. We sought to assess the psychosocial aspects of xenotransplantation among porcine islet-cell recipients and their efforts to adapt themselves to this condition. MATERIAL AND METHODS: Ten insulin-dependent diabetes mellitus patients aged 14.58 +/- 7.93 who received porcine islet-cells were included. The bioartificial steel/fibrous tissue chamber method was used. All patients and their relatives were interviewed about their expectations, overall functioning, and experiences. The quality of life, enjoyment, and satisfaction scale and the hospital anxiety and depression scales were used. A 1-year follow-up was done. RESULTS: Their motivation was centered on autonomy; there were no troubles regarding the graft origin. Xenotransplantation was perceived with pragmatism, seeing pigs as an unlimited resource. The patients with best outcomes also had the greatest improvements in several quality of life areas (QOL) while the medium responders had fewer QOL improvements. The nonresponders experienced mainly frustration. Parents' concerns were not related to their children's health but to their recently gained autonomy. CONCLUSIONS: In addition to enthusiasm, the perception of animals as an unlimited source of organs may affect patient compliance; in this group, xenotransplantation was seen as using as a long-lasting drug, with chamber walls considered as a physical, immunologic, and, in certain manner, a psychological barrier.
Subject(s)
Diabetes Mellitus, Type 1/surgery , Islets of Langerhans Transplantation/psychology , Transplantation, Heterologous/psychology , Adolescent , Animals , Anxiety , Depression , Humans , Interviews as Topic , Islets of Langerhans Transplantation/methods , Motivation , Parents/psychology , Patient Satisfaction , Personal Autonomy , Swine , Transplantation, Heterologous/methodsABSTRACT
BACKGROUND: Among the kidney transplantation candidates, regardless if they already have a living related donor (LRD) or if they are waiting for a cadaveric donor (CD), the transplantation process is highly stressful, and the stress intensity is proportioned to the waiting time for surgery. The patients waiting for a CD have no certainty about receiving a kidney in time for surviving, or, when the patient's relatives refused the donation, they may feel rejected by their family. In chronic diseases, psychiatric comorbidity affects the disease evolution, dampering the treatment efficacy, leading to long-term hospitalizations and a more severe emotional stress. OBJECTIVE: To calculate the difference of anxiety and depression levels between LRD and CD patients. METHODS: The Hospital Anxiety and Depression scale (HAD) was applied to the kidney transplantation candidates who attended their first psychiatric evaluation along a year, they were grouped according to their kind of donor (LRD= 31, CD= 12). Statistical analysis was performed by means of Fisher and Mann-Whitney tests. RESULTS: 33.33% of the LRD patients were anxious (6.60+/- 2.65 points) and 40% were depressed (5.9+/- 3.29); 75% of the CD patients were anxious (p= 0.005) (10.17+/- 2.48, p< 0.001) and 90% were depressed (p= 0.088) (12.0+/- 9.33, p= 0.005). CONCLUSIONS: The CD patients have a greater risk for anxiety and more severe depressive disorders than the LRD patients. Comparing this sample against 100 patients with chronic diseases, we found no differences with CD patients, but they have a higher risk for anxiety and depression than LRD patients, this may suggest that the last mentioned patients may overestimate the prognosis of their disease.
Subject(s)
Anxiety/diagnosis , Depression/diagnosis , Kidney Transplantation/psychology , Adult , Anxiety/etiology , Cadaver , Depression/etiology , Female , Humans , Living Donors , Male , Stress, Psychological/etiology , Time FactorsABSTRACT
Introducción: Entre los candidatos a trasplante renal, independientemente de que dispongan un donador vivo relacionado (DVR) o esperen un donador cadavérico (DC), el proceso del trasplante produce un estrés intenso, el cual es proporcional al tiempo de espera para la cirugía. Quienes esperan DC no tienen la certeza de obtener un órgano a tiempo para sobrevivir, o bien, cuando sus parientes se niegan a donar, los enfermos sienten ser rechazados por su familia. En enfermedades crónicas, la comorbilidad psiquiátrica afecta la evolución del padecimiento y reduce la eficacia del tratamiento, llevando a internamientos largos y a un mayor desgaste emocional. Objetivo: Determinar la diferencia de niveles de ansiedad y depresión en pacientes de DC en comparación a los pacientes con DVR. Metodología: Se aplicó la escala hospitalaria de ansiedad y depresión (HAD) a los candidatos a trasplante renal que acudieron a su primer consulta psiquiátrica a lo largo de un año, agrupándose de acuerdo al donador que disponen (DVR= 31, DC= 12). El análisis estadístico se realizó mediante las pruebas de Fisher y de Mann-Whitney. Resultados: El 33,33 por ciento de los pacientes con DVR presentaron ansiedad (6,60ñ 2,65 puntos) y 40 por ciento depresión (5,9ñ 3,29); el 75 por ciento de los pacientes de DC mostraron ansiedad (p= 0,005) (10,17ñ 2,48, p< 0,001) y 90 por ciento depresión (p= 0,088) (12,0ñ 9,33, p= 0,005). Conclusiones: Los pacientes de DC tienen mayor riesgo de padecer ansiedad que los enfermos con DVR y sufren cuadros depresivos más severos. Comparando esta muestra contra 100 enfermos crónicos, no encontramos diferencias con los pacientes de DC, pero sí tienen mayor riesgo de ansiedad y depresión que los pacientes con DVR, lo cual indicaría que estos últimos enfermos pudieran tener ideas sobrevaloradas sobre la evolución de su enfermedad (AU)
Subject(s)
Adult , Male , Female , Humans , Stress, Psychological , Time Factors , Kidney Transplantation , Living Donors , Anxiety , Cadaver , DepressionABSTRACT
BACKGROUND: Pulmonary tuberculosis (PTB) develops by a complex combination of environmental factors with genetic susceptibility. In this context, an association between human leukocyte antigens (HLAs) and tuberculosis has been examined in several populations, but results have been controversial. DESIGN AND MEASUREMENTS: A prospective evaluation of class II HLA genotypes was completed by the polymerase chain reaction (PCR) sequence-specific primer technique and PCR sequence-specific oligonucleotide hybridization in a Mexican population. SETTING: This study was conducted at the Clinical Service of Tuberculosis and the Department of Immunology, National Institute of Respiratory Diseases, Mexico City, Mexico. PATIENTS: Four groups were examined: 95 healthy subjects; 50 nonimmunosuppressed PTB patients; 15 HIV-infected patients (stage IVc in the Centers for Disease Control and Prevention [CDC] classification system for AIDS) with PTB; and 37 HIV-infected patients in the asymptomatic stage (CDC stage II). RESULTS: The frequencies of alleles DQA1*0101 (odds ratio [OR], 6.18; 95% confidence interval [CI], 2.38 to 16.08), DQB1*0501 (OR, 6.16; 95% CI, 2.44 to 17.71), and DRB1*1501 (OR, 7.92; 95% CI, 2.71 to 23.14) were significantly increased in nonimmunosuppressed patients with PTB when compared with healthy subjects. By contrast, frequencies of allele DQB1*0402 and antigens DR4 and DR8 were significantly decreased in patients with PTB. Additionally, a significantly higher frequency of the DRB1*1101 allele was found in HIV-positive subjects (OR, 6.67; 95% CI, 2.13 to 20.83). CONCLUSION: The genetic influence associated with the HLA system appears to have an important role in the development of PTB, although this susceptibility may not be relevant in patients with severe immunodeficiency diseases such as AIDS.
