Información, ansiedad y depresión en pacientes sometidos a trasplante de progenitores hematopoyéticos (TPH) en un estudio de intervención psicológica / Information, anxiety and depression in patients submitted to bone marrow transplantation (BMT) in a study of psychological intervention

En el Servicio de Hematología del hospital Universitario Virgen de las Nieves de Granada se ha puesto en marcha un programa psicológico para pacientes candidatos a trasplante de progenitores hematopoyéticos (TPH). Con dicho programa se pretende favorecer la adaptación, amortiguar el impacto psicológico y el sufrimiento asociado. Se potencian los recursos para disminuir, en los posibles, los efectos negativos como son la ansiedad y la depresión, en base a las diferencias individuales, el nivel de información a cerca del proceso y a sus propios recursos de afrontamiento. El programa psicológico consiste en cuatro sesiones que incluyen. 1. Análisis y manejo de la información, 2. Habilidades de afrontamiento, 3. Manejo del estrés y 4. Preparación para el aislamiento a nivel familiar. Se midieron las variables de ansiedad, depresión con la Escala de Ansiedad y Depresión (HAD) y el nivel de información con una escala categorial diseñada específicamente para este estudio. Los momentos de medida se realizaron al diagnóstico, al ingreso en cámara de aislamiento, a los cien días, a los seis meses, al año y a los dos años después del trasplante. Se contemplan dos grupos principales; un grupo intervención, que recibe el programa de intervención psicológica y un grupo control al cual no se aplica el programa debido a la mecánica de ingreso. En este trabajo se muestra como los pacientes que reciben la intervención psicológica antes del trasplante, obtienen niveles menores en ansiedad y depresión, mostrando un nivel de información más elevado que los que no reciben dicha intervención. Se concluye con la importancia de la intervención psicológica especializada y adaptada en un proceso agresivo como es el trasplante de progenitores hematopoyéticos (AU)

At the department of Haematology on the University Hospital Virgen de las Nieves, Granada, it is applied a psychological program for patient bone marrow transplantation (BMT) candidates. With this program it is tried to favors the adjustment, to muffle the psychological impact and to determine the associated suffering. The resources are promoted to diminish the negative effects such as anxiety and depression, on the basis of the individual differences, the level of information to near the process and to it own resources of confrontation. The psychological program consist of four meetings which include: 1. Analysis and information management, 2. Confrontation skills, 3. Stress management and 4. Preparation for the isolation to family level. It is measured anxiety and depression by the hospital anxiety and depression scale (HADS); and the level information about the disease process and transplantation by a categorical scale designed for this research. The assessments are realized at following phases: the moment of diagnosis, at the revenue in chamber of isolation, at hundred days, at six months, one year and two years after BMT. Two principal groups were studied: an intervention group, which received the psychological intervention program and a control group for which did not apply the program due to the mechanics of revenue. In this work it appears as the patients who receive the psychological intervention before the transplant, they obtain minor levels in anxiety and depression; showing a level of information higher than it the patient did not receive the above mentioned intervention. These results stress the importance of psychological intervention for BMT patients (AU)

Interleukin-10 promoter polymorphism as risk factor to develop invasive pulmonary aspergillosis.

This present study was undertaken to examine the role of the host response to Aspergillus fumigatus in the development of clinical symptoms of invasive pulmonary aspergillosis (IPA). The natural outcome and response to IPA infection varies between individuals. Whereas some variation may be attributable to fungi and environmental variables, it is probable that host genetic background also plays a significant role. Interleukin (IL)-10 has a key function in the regulation of cellular immune responses and is involved in various inflammatory diseases. IL-10 promoter carries a polymorphism that has been associated to production levels. Our aim was to investigate the role of this polymorphism in susceptibility to develop IPA infection. The study included 120 haematological patients and 124 age and sex-matched controls and bi-allelic IL-10 -1082(G/A) polymorphism was examined. Genotypic (p=0.385) and allelic frequencies (p=0.527, OR=0.89, 95% CI=0.78-1.60) were similar between patients and healthy controls. IPA was diagnosed in 59 of the 120 patients according to consensus criteria published by the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group (EORTC/IFICG). Our results provide evidence that IL-10 -1082(AA) genotype is associated with resistance to develop IPA (p=0.001). Allele frequency of IL-10 -1082A allele was weakly associated with susceptibility to develop IPA infection (p=0.052). In conclusion, these results suggest that differential production of IL-10 may alter the risk for IPA in haematological patients.

Variable number of tandem repeats of TNF receptor type 2 promoter as genetic biomarker of susceptibility to develop invasive pulmonary aspergillosis.

Tumor necrosis factor alpha (TNF-alpha) and lymphotoxin alpha (LT-alpha) are pivotal mediators of inflammatory responses in fungal infection diseases. We hypothesized that polymorphisms in genes of these cytokines or their receptors might increase the susceptibility of hematologic patients to develop invasive pulmonary aspergillosis (IPA). One hundred two hematologic patients and 124 age-matched controls were enrolled in the study, and the following standard single nucleotide polymorphisms were investigated: TNF-alpha -308 and +489, LT-alpha +252 and Tumor Necrosis Factor Receptor 2 (TNFR2) +676. Variable number of tandem repeats (VNTRs) at position -322 of the TNFR2 gene were also studied. Genotypic and allelic frequencies were similar between patients and controls. IPA was diagnosed in 54 of the 102 patients according to consensus criteria published by the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group. TNF-alpha and LT-alpha polymorphisms were not associated with presence of IPA. Susceptibility to IPA was strongly associated with VNTR at position -322 in the promoter region of the TNR2 gene (p = 0.029) but was not associated with the presence of TNFR2 +676 polymorphism. A genetic difference in TNFR2 promoter VNTR may play a major role in susceptibility to IPA infection.