Factores asociados a la calidad de vida en adultos con dolor crónico musculoesqueléticoico musculoesquelético / Factors associated with quality of life in adults with chronic musculoskeletal musculoskeletal pain

Introducción. Se estima que una de cada cinco personas en el mundo sufre de dolor crónico y que el dolor musculoesquelético crónico (DMC) es la principal causa de dolor y discapacidad en la sociedad occidental. Objetivo. Analizar las características sociodemográficas, clínicas y funcionales que influyen en la calidad de vida (CV) de las personas con diagnóstico de DMC. Métodos. Estudio descriptivo observacional de corte transversal realizado en 101 pacientes con DMC. Se realizó prueba funcional con medición de la prueba de marcha de los 6 minutos, medición de la CV (cuestionario SF-36) y evaluación de la discapacidad (test WHODAS II) y de síntomas de depresión (cuestionario PHQ-9). Se describen características demográficas, clínicas y del estilo de vida. Resultados. El motivo de consulta más frecuente fue lumbalgia (35,6%), pero también se documentó sensibi-lización central (36,6%) y comorbilidades metabólicas (34,7%) y cardiovasculares (7,8%). El 90% de los pacientes eran sedentarios y el 53,5% obtuvo un desempeño menor a 350 metros en la prueba de marcha de los 6 minutos, o esta debió suspenderse por dolor. En relación con el cuestionario SF-36, las dimensiones relacionadas con mejor CV fueron género femenino, edad entre 34 y 64 años, estado civil casado, estratos socioeconómicos bajo y medio, residencia en zona urbana, nivel educativo secundaria, situación laboral activa, sobrepeso y no consumo de tóxicos. Conclusiones. El DMC menoscaba la CV de una manera más amplia que el dolor agudo. Según los resultados encontrados, existe relación entre los estilos de vida no saludables y una mala CV; lo anterior es un campo de profundización para nuevos estudios hacia promoción de hábitos saludables, manejo de las emociones y fortalecimiento de habilidades sociales por equipos multidisciplinarios como estrategia de prevención del DMC.

Introduction. It is estimated that one in five people in the world suffers from chronic pain and that chronic musculoskeletal pain (CMP) is the leading cause of pain and disability in Western society. Objective. To analyze the sociodemographic, clinical and functional characteristics that influence the quality of life (QoL) of people diagnosed with CMP. Methods. Observational cross-sectional descriptive study conducted in 101 patients with CMD. Functional testing was performed with measurement of the 6-minute walk test, measurement of QOL (SF-36 questionnaire) and assessment of disability (WHODAS II test) and depressive symptoms (PHQ-9 questionnaire). Demographic, clinical and lifestyle characteristics are described. Results. The most frequent reason for consultation was low back pain (35.6%), but central sensitization (36.6%) and metabolic (34.7%) and cardiovascular (7.8%) comorbidities were also documented. Ninety percent of the patients were sedentary and 53.5% performed less than 350 meters in the 6-minute walk test, or had to discontinue the test due to pain. In relation to the SF-36 questionnaire, the dimensions related to better CV were female gender, age between 34 and 64 years, married marital status, low and middle socioeconomic strata, residence in an urban area, secondary education level, active work situation, overweight and non-consumption of toxic substances. Conclusions. CMD undermines QOL in a more extensive way than acute pain. According to the results found, there is a relationship between unhealthy lifestyles and poor QOL; this is a field for further studies on the promotion of healthy habits, management of emotions and strengthening of social skills by multidisciplinary teams as a strategy for the prevention of CMD.

Childhood cancer in Latin America: from detection to palliative care and survivorship.

BACKGROUND: Treatment options for childhood cancer have improved substantially, although in many low- and middle-income countries survival is lagging behind. Integral childhood cancer care involves the whole spectrum from detection and diagnosis to palliative and survivorship care. METHODS: Based on a literature review and expert opinions, we summarized current practice and recommendations on the following aspects of childhood cancer in Latin America: diagnostic processes and time to diagnosis, stage at diagnosis, treatments and complications, survivorship programs and palliative care and end-of-life services. RESULTS: Latin America is a huge and heterogeneous continent. Identified barriers show similar problems between countries, both logistically (time and distance to centers, treatment interruptions) and financially (cost of care, cost of absence from work). Governmental actions in several countries improved the survival of children with cancer, but difficulties persist in timely diagnosis and providing adequate treatment to all childhood cancer patients in institutions with complete infrastructure. Treatment abandonment is still common, although the situation is improving. Cancer care in the region has mostly focused on acute treatment of the disease and has not adequately considered palliative and end-of-life care and monitoring of survivors. CONCLUSIONS: Decentralizing diagnostic activities and centralizing specialized treatment will remain necessary; measures to facilitate logistics and costs of transportation of the child and caretakers should be implemented. Twinning actions with specialized centers in high income countries for help in diagnosis, treatment and education of professionals and family members have been shown to work. Palliative and end-of-life care as well as childhood cancer survivorship plans are needed.

Calidad de vida en una población con hemofilia: estudio de corte transversal en un centro de tratamiento de hemofilia / Quality of life in a population with haemophilia: a cross-sectional study from a single haemophilia treatment centre

RESUMEN Introducción: En pacientes con hemofilia la calidad de vida se puede afectar por factores como la artropatía, edad e intensidad del dolor. Objetivo: Evaluar la calidad de vida relacionada con la salud en personas con hemofilia, en Medellín durante 2014. Pacientes y métodos: Estudio descriptivo observacional de corte trasversal, realizado en 60 pacientes con hemofilia. Se describen las características demográficas, clínicas y de estilo de vida. Se realizó prueba funcional con medición de arcos de movilidad y test de marcha de 6 min, medición de calidad de vida relacionada con la salud (SF-36 y KIDSCREEN-27), evaluación de discapacidad (WHODAS II), dolor (EAV) y síntomas de depresión (PHQ-9). Resultados: Cincuenta y nueve pacientes aceptaron participar en el estudio, edad promedio de 28 (SD ± 14,8) anos, hemofilia leve 5%, moderada 20,3% y grave 74,5%. El 96,6% estaba en tratamiento con profilaxis y el 84% de los pacientes asistía a terapia física. La mayor comorbilidad fue artropatía hemofílica en el 71% de las personas, seguida de dislipidemia (27%), sobrepeso (20%) y tabaquismo (11,8%). La prueba de marcha reportó una distancia promedio de 584,2 metros y los puntajes del SF-36 fueron similares a los de la población general. Conclusión: Este grupo de pacientes con hemofilia, reporta una calidad de vida tan alta como la población general colombiana sin hemofilia. Este hallazgo reitera la importancia del tratamiento con profilaxis y de la participación activa de los pacientes en un programa de rehabilitación que promueva la independencia funcional y un estilo de vida saludable.

ABSTRACT Introduction: In patients with haemophilia, quality of life can be affected by factors like arthropathy, age, and pain intensity. Objective: To evaluate the health-related quality of life in patients with haemophilia in Medellin during 2014. Patients and methods: An observational, descriptive, cross-sectional study was conducted on 60 patients with confirmed diagnosis of haemophilia. Demographic, clinical and lifestyle characteristics are described. Functional test were performed including measuring ran-ges of mobility and the six-minute walk test. The health-related quality of life (SF-36 and KIDSCREEN-27), disability (WHODAS II), pain (VAS), and depressive symptoms (PHQ-9) were also evaluated. Results: A total of 59 patients agreed to participate in the study. The mean age was 28 years (SD ± 14.8), with mild haemophilia in 5%, moderate haemophilia in 20.3%, and severe haemophilia in 74.5%. Almost all (96.6%) of the patients were under treatment with prophylaxis, and 84% of the patients were having physiotherapy. The main comorbidity was haemop-hilic arthropathy in 71% of cases, followed by dyslipidaemia (27%), overweight (20%), and smoking (11.8%). The six-minute walk test reported mean distance of 584.2 metres, and the SF-36 scores were similar to the general population. Conclusion: This group of patients with haemophilia reported a quality of life as high as the general population in Colombia without haemophilia. This finding reiterated the importance of the treatment with prophylaxis and the active participation of patients in a rehabilitation program, which promotes functional independence and a healthy lifestyle.

Ultrastructure evidence of necrotic neural cell death in familial Alzheimer's disease brains bearing presenilin-1 E280A mutation.

Recently, it has been demonstrated that there is no obvious correlation between DNA fragmentation (according to Terminal dUTP Nick-End Labeling technique) and the severity of amyloid-beta (Abeta) deposition and neurofibrillary tangle (NFT) formation in patients bearing mutations in presenilin 1[E280A]. Indeed, it was observed in 10 out of 48 brain sections TUNEL-positive labeling, while none showed classical apoptotic morphology. Based on these findings, we were interested to determine whether cortical cells from temporal and hippocampus post mortem brain sections die either by an apoptotic or necrotic process in FAD-brain sections labeled TUNEL positive compared with normal brain subjects labeled TUNEL-negative using electron microscopy (EM). We found that FAD-brain sections labeled TUNEL positive display the typical morphological characteristics of cell death by necrosis i.e. the nuclear chromatin form flocculent aggregates with poorly defined edges and electron lucent (it does not appears black on EM); the chromatin aggregates are irregularly scattered through the nucleus; mitochondria are swoolen with flocculent matrix densities. No apoptotic bodies were observed in any of the brain areas studied. These results may indicate that necrosis is the most generalized cell death process occurring in terminal PS1E280A brains and the DNA fragmentation of nuclei labeled by TUNEL technique may reflect DNA vulnerability. Thus, cell death by necrosis and the accompanying histopathological observations such as severe deposition of amyloid plaques and NFTs, severe gliosis, cortical depopulation, influx of lymphocytes indicative of a chronic inflammation may have an important impact on future therapeutic strategies in the treatment of PS1E280A patients.