Osteoarticular mycobacterial infections in patients with the human immunodeficiency virus.

OBJECTIVE: Data about the characteristics of patients with the human immunodeficiency virus (HIV) and concomitant mycobacterial skeletal infection are scarce. Thus, our aim was to describe this condition in a cohort of 11 patients. METHODS: A review of the records of 11 HIV-positive individuals with microbiological confirmation of mycobacterial osteoarticular infection was conducted. The studied data included: age, sex, risk factor for the HIV days between the onset of symptoms and diagnosis, evidence of previous tuberculosis, location of the infection, isolated organism, diagnostic method, laboratory data (erythrocyte sedimentation rate, haemoglobin, leukocyte count), number of CD4+ lymphocytes, anti-retroviral therapy, treatment and outcome. RESULTS: Eight patients were men and 3 were women. The median age was 34.2 years (range 20-46 years). Previous tuberculosis was present in 5 cases. Mean days between the onset of symptoms and diagnosis was 124 (range 20-365 days). Infections involved the knee (4 cases), spine (3 cases), hip (2 cases), elbow (1 case) and tibia (1 case). ESR was frequently elevated. The CD4 count ranged from 0.03 to 0.779 x 10(9)/l (mean 0.245 x 10(9)/l). M. tuberculosis was the responsible organism in 9 cases, Mycobacerium tuberculosis plus Staphylococcus aureus in one case and M. Kansasii in one case. Patients received specific treatments with good results. Surgery was necessary in 4 cases. No deaths occurred. Four patients were anti-retroviral naive at the moment the diagnosis was made. The remainder 8 were on zidovudine therapy. CONCLUSION: The immunologic status of patients with HIV and concomitant mycobacterial skeletal infections is quite variable. The outcome of this condition seems to be good.

[Depression in the elderly and the role of family dynamics]. / La depresión del anciano y el papel de la dinámica familiar.

OBJECTIVE: The objective was to find the relationship between the lived experience within the family and depression in the elderly. DESIGN: The study had a crossover and descriptive design. SETTING: Carranque and Campanillas Health Districts, Málaga. PATIENTS: The target population was the over 65's. The sample consisted of 97 people attended at 2 health centres, one rural and one urban. MEASUREMENTS AND MAIN RESULTS: The main study variable was the results on the Yesavage Geriatric Depression Scale (GDS), which were contrasted through multiple linear regression with the variables of age, sex, marital status, tobacco dependency, number of people living together, presence of the children in the home (concretely, daughters), family income, ownership of the home, social support network, and Apgar Family II. The results showed that the GDS correlated only with the results of the Apgar Family II (p = 0.00003). CONCLUSIONS: When tackling the depression of elderly people in primary care, it is absolutely vital to look at the family context, as this is a factor strongly linked to the depression.

La depresión del anciano y el papel de la dinámica familiar / Depression in the elderly and the role of family dynamics

Objetivo. El objetivo es conocer la relación entre la vivencia de la dinámica familiar y la depresión en el anciano. Diseño. El diseño del estudio es descriptivo, transversal. Emplazamiento. Zona Básica de Salud de Carranque y Zona Básica de Salud de Campanillas, ambas de Málaga. Pacientes. La población diana es la población mayor de 65 años. La muestra está constituida por 97 sujetos atendidos en 2 centros de salud, uno rural y otro urbano. Mediciones y resultados principales. La principal variable de estudio es el resultado de la Escala de Depresión Geriátrica (GDS) de Yesavage, cuyos resultados se correlacionan mediante regresión lineal múltiple con las variables edad, sexo, estado civil, tabaquismo, número de convivientes, presencia de hijos en el domicilio (y concretamente, de hijas), ingresos familiares, titularidad de propiedad sobre el domicilio, red de apoyo social y Apgar Familiar II. Los resultados obtenidos muestran que el GDS se correlaciona únicamente con los resultados del Apgar Familiar II (p = 0,00003). Conclusiones. En el abordaje de la depresión del anciano en atención primaria resulta de gran importancia considerar el ámbito familiar por ser éste un factor fuertemente asociado a aquélla (AU)