Waning and boosting of antibody Fc-effector functions upon SARS-CoV-2 vaccination.

Since the emergence of SARS-CoV-2, vaccines targeting COVID-19 have been developed with unprecedented speed and efficiency. CoronaVac, utilising an inactivated form of the COVID-19 virus and the mRNA26 based Pfizer/BNT162b2 vaccines are widely distributed. Beyond the ability of vaccines to induce production of neutralizing antibodies, they might lead to the generation of antibodies attenuating the disease by recruiting cytotoxic and opsonophagocytic functions. However, the Fc-effector functions of vaccine induced antibodies are much less studied than virus neutralization. Here, using systems serology, we follow the longitudinal Fc-effector profiles induced by CoronaVac and BNT162b2 up until five months following the two-dose vaccine regimen. Compared to BNT162b2, CoronaVac responses wane more slowly, albeit the levels remain lower than that of BNT162b2 recipients throughout the entire observation period. However, mRNA vaccine boosting of CoronaVac responses, including response to the Omicron variant, induce significantly higher peak of antibody functional responses with increased humoral breadth. In summary, we show that vaccine platform-induced humoral responses are not limited to virus neutralization but rather utilise antibody dependent effector functions. We demonstrate that this functionality wanes with different kinetics and can be rescued and expanded via boosting with subsequent homologous and heterologous vaccination.

Waning and boosting of functional humoral immunity to SARS-CoV-2.

Since the emergence of the SARS-CoV-2 virus, we have witnessed a revolution in vaccine development with the rapid emergence and deployment of both traditional and novel vaccine platforms. The inactivated CoronaVac vaccine and the mRNA-based Pfizer/BNT162b2 vaccine are among the most widely distributed vaccines, both demonstrating high, albeit variable, vaccine effectiveness against severe COVID-19 over time. Beyond the ability of the vaccines to generate neutralizing antibodies, antibodies can attenuate disease via their ability to recruit the cytotoxic and opsinophagocytic functions of the immune response. However, whether Fc-effector functions are induced differentially, wane with different kinetics, and are boostable, remains unknown. Here, using systems serology, we profiled the Fc-effector profiles induced by the CoronaVac and BNT162b2 vaccines, over time. Despite the significantly higher antibody functional responses induced by the BNT162b2 vaccine, CoronaVac responses waned more slowly, albeit still found at levels below those present in the systemic circulation of BNT162b2 immunized individuals. However, mRNA boosting of the CoronaVac vaccine responses resulted in the induction of significantly higher peak antibody functional responses with increased humoral breadth, including to Omicron. Collectively, the data presented here point to striking differences in vaccine platform-induced functional humoral immune responses, that wane with different kinetics, and can be functionally rescued and expanded with boosting.

High prevalence of clarithromycin resistance and effect on Helicobacter pylori eradication in a population from Santiago, Chile: cohort study and meta-analysis.

Helicobacter pylori (H. pylori) eradication using standard triple therapy (STT) with proton pump inhibitors (PPI), amoxicillin and clarithromycin (CLA) has been the standard in Latin America. However, CLA resistance is a rising problem affecting eradication rates. Genetic polymorphisms of CYP2C19, a PPI metabolizer may also affect eradication. The primary aims of this study were to evaluate the effect of clarithromycin resistance on H. pylori eradication in a population from Santiago, and to establish the pooled clarithromycin resistance in Santiago, Chile. Symptomatic adult patients attending a tertiary hospital in Santiago were recruited for this study. CLA resistance and the polymorphisms of CYP2C19 were determined on DNA extracted from gastric biopsies, using PCR. The STT was indicated for 14 days and eradication was determined by a urea breath test 4-6 weeks after therapy. A meta-analysis of CLA resistance studies among adult residents in Santiago was performed. Seventy-three out of 121 consecutive patients had positive rapid urease test (RUT) and received STT. Sixty-nine patients (95%) completed the study. The H. pylori eradication rate was 63% and the prevalence of CLA resistance was 26%. According to the CYP2C19 polymorphisms, 79.5% of the RUT-positive patients were extensive metabolizers. Multivariable analyses showed that only CLA resistance was significantly and inversely associated with failure of eradication (OR: 0.13; 95% confidence interval [95% CI], 0.04-0.49). A meta-analysis of two previous studies and our sample set (combined n = 194) yielded to a pooled prevalence of CLA resistance of 31.3% (95% CI 23.9-38.7). Our study shows that CLA resistance is associated with failure of H. pylori eradication. Given the high pooled prevalence of CLA resistance, consideration of CLA free therapies in Santiago is warranted. We could recommend bismuth quadruple therapy or high-dose dual therapy, according to bismuth availability. Further studies need to evaluate the best therapy.

Lower heart rate variability is associated with higher plasma concentrations of IL-6 in type 1 diabetes.

OBJECTIVE: In type 1 diabetes, cardiovascular autonomic neuropathy (CAN) is associated with cardiovascular risk factors related to insulin resistance, which in turn are associated with low-grade systemic inflammation. Reduced heart rate variability (HRV) is considered one of the first indicators of CAN. Since the autonomic nervous system interacts with systemic inflammation, we evaluated CAN to study its possible association with low-grade systemic inflammation. DESIGN: Cross-sectional study of a group of 120 subjects diagnosed with type 1 diabetes mellitus 14 years before. METHODS: Information recorded: 1) clinical characteristics: sex, age, body mass index, waist-to-hip ratio (WHR), blood pressure (BP), smoking, alcohol intake, insulin dose, HbA1c, and lipid profile; 2) plasma levels of soluble fractions of tumour necrosis factor alpha receptors 1 and 2, IL-6, and C-reactive protein; 3) insulin resistance by estimation of the glucose disposal rate (eGDR); and 4) tests for CAN: HRV in response to deep breathing (E/I ratio), HRV in response to the Valsalva maneuver, and changes in systolic BP responding to standing. RESULTS: A significant negative correlation was found between E/I ratio and plasma concentrations of IL-6 (r=-0.244, P=0.032), which remained significant after adjusting for potential confounding factors (age, sex, HbA1c, WHR, diastolic BP, triglycerides, HDL-cholesterol, retinopathy, nephropathy, peripheral neuropathy, insulin dose, and smoking; r=-0.231, P=0.039). No other significant associations were found between inflammation-related proteins, tests for CAN, and eGDR. CONCLUSIONS: These findings suggest a link between low-grade inflammation and early alterations of CAN in type 1 diabetes and may be of importance in the pathogenesis of CAN and/or its clinical implications.

Exploring language barriers to Evidence-based Health Care (EBHC) in post-graduate medical students: a randomised trial.

BACKGROUND: Understanding the written English language might be a barrier when teaching Evidence-based Health Care (EBHC) to Spanish-speaking physicians. AIM: To quantify the magnitude of this potential barrier. METHOD: Cochrane Review abstracts in English or in Spanish were randomly distributed among first-year residents at the Pontificia Universidad Catolica of Chile. Residents answered investigator-designed questionnaires to measure their comprehension while the time needed to complete the task was recorded. RESULTS: Groups were similar at baseline. Mean score for those reading in Spanish was 11.9 +/- 2.8 (range 5 to 18) compared to 10.5 +/- 3.8 (range 1 to 17) for those reading in English (p=0.04). Low scores ( pound 9) were twice as frequent for the English group than for the Spanish group (16.7% vs 34.7%; p=0.042). The time to complete the task was also longer for the group reading in English. CONCLUSION: Language should be taken into account when teaching EBHC to Spanish-speaking physicians.

[Hafnia alvei in a rare case of severe pneumonia in a postanesthesia recovery unit]. / Hafnia alvei: una causa infrecuente de neumonía grave en la unidad de reanimación.

An 85-year-old man with a history of moderate chronic obstructive pulmonary disease in treatment with anticholinergic drugs was admitted to the recovery unit for postoperative monitoring after right inguinal herniorrhaphy surgery and removal of a strangulated intestinal section. On the third day after surgery the patient developed radiographic signs consistent with pneumonia and required mechanical ventilation. Two blood cultures and a respiratory secretion sample grew a microorganism identified as Hafnia alvei. H. alvei is a gram-negative bacillus that colonizes the digestive tract of humans and animals and in immunodepressed patients it can colonize the mouth and pharynx. Isolation of H. alvei is described in the literature on pediatric patients and those with a history of immune deficiency or chronic disease. Infection has a severe impact on general health. We report a rare and interesting case of pneumonia and bacteremia from H. alvei infection acquired by an immunocompetent patient soon after arrival in the postoperative recovery unit. The patient died of the infection.

Diferencias de especie en las concentraciones plasmáticas y tisulares de florfenicol entre ovinos y conejos / Species differences in plasma and tissue concentrations of florfenicol between sheep and rabbits

RESUMEN Objetivo. Comparar las concentraciones plasmáticas y tisulares de florfenicol (FFC) y su metabolito florfenicol amina (FFC-a) entre ovinos y conejos, posterior a la administración intramuscular de 20 mg/kg de FFC. Materiales y métodos. Cinco ovinos Suffolk Down y seis conejos Neozelandés fueron utilizados en el estudio. Se colectaron muestras de sangre, previo a la administración de FFC, y a las 0.25, 0.5, 1, 1.5, 2, 3 y 4 horas posteriores al tratamiento. A las 4 horas posteriores al tratamiento, a los animales se les aplicó la eutanasia. Las concentraciones plasmáticas y tisulares de FFC y FFC-a fueron determinadas mediante HPLC. Resultados. Las concentraciones plasmáticas máximas, tasa de absorción, vida media de absorción, tasa de distribución y área bajo la curva de FFC, fueron significativamente mayores en conejos respecto a los ovinos. Asimismo, para FFC-a, las concentraciones plasmáticas máximas y área bajo la curva de concentraciones plasmáticas en el tiempo fueron significativamente mayores en conejos respecto a los ovinos. La proporción de metabolito fue mayor en conejos (12.7±3.07%) en comparación con ovinos (3.99±0.87%) (p<0.05), al igual que las concentraciones tisulares de FFC y FFC-a. Conclusiones. Se observaron diferencias significativas en la farmacocinética y concentraciones tisulares de FFC y FFC-a entre estas dos especies. La mayor concentración de FFC-a en conejos indica un mayor nivel de metabolismo de FFC, respecto a los ovinos. Esto es importante de considerar al momento de establecer dosificaciones y frecuencia de administración de FFC en conejos.

ABSTRACT Objective. The aim of this study was to compare tissue and plasma concentrations of florfenicol (FFC) and its metabolite florfenicol amine (FFC-a) between sheep and rabbits, after intramuscular administration of 20 mg FFC/kg. Materials and methods. Five Suffolk Down sheep and six New Zealand rabbits were used in this study. Blood samples were collected before FFC administration and at 0.25, 0.5, 1, 1.5, 2, 3 and 4 hours after treatment. At 4 hours after treatment, euthanasia was applied to animals. Plasma and tissue concentrations of FFC and FFC-a were determined by HPLC. Results. For FFC, maximum plasma concentrations, absorption rate, absorption half-life, distribution rate, and area under the plasma concentration-time curve were all found to be significantly higher in rabbits than in sheep. Similarly, for FFC-a, significantly higher maximum plasma concentrations and area under the concentration-time curve were observed in rabbits as compared to sheep. The metabolite ratio was higher in rabbits (12.7±3.07%) compared to sheep (3.99±0.87%) (p<0.05), as were the tissue concentrations of FFC and FFC-a. Conclusions. Significant differences in the pharmacokinetics and tissue concentrations of FFC, and its metabolite FFC-a, were observed between these two animal species. The higher concentrations of FFC-a in rabbits indicate a greater level of FFC metabolism as compared to sheep. This should be considered when establishing dosage and frequency of FFC administration for rabbits.

Two cationic peroxidases from cell walls of Araucaria araucana seeds.

We have previously reported the purification and partial characterization of two cationic peroxidases from the cell walls of seeds and seedlings of the South American conifer, Araucaria araucana. In this work, we have studied the amino acid composition and NH2-terminal sequences of both enzymes. We also compare the data obtained from these analyses with those reported for other plant peroxidases. The two peroxidases are similar in their amino acid compositions. Both are particularly rich in glycine, which comprises more than 30% of the amino acid residues. The content of serine is also high, ca 17%. The two enzymes are different in their content of arginine, alanine, valine, phenylalanine and threonine. Both peroxidases have identical NH2-terminal sequences, indicating that the two proteins are genetically related and probably are isoforms of the same kind of peroxidase. The amino acid composition and NH2-terminal sequence analyses showed marked differences from the cationic peroxidases from turnip and horseradish.

[Improving inpatient pharmacoterapeutic process by Lean Six Sigma methodology]. / Mejora del proceso farmacoterapéutico del paciente hospitalizado mediante la metodología Lean Seis Sigma.

BACKGROUND: Lean Six Sigma methodology has been used to improve care processes, eliminate waste, reduce costs, and increase patient satisfaction. OBJECTIVE: To analyse the results obtained with Lean Six Sigma methodology in the diagnosis and improvement of the inpatient pharmacotherapy process during structural and organisational changes in a tertiary hospital. SCOPE: 1.000 beds tertiary hospital. DESIGN: prospective observational study. The define, measure, analyse, improve and control (DMAIC), were deployed from March to September 2011. An Initial Project Charter was updated as results were obtained. POPULATION AND SAMPLE: 131 patients with treatments prescribed within 24h after admission and with 4 drugs. VARIABLES: safety indicators (medication errors), and efficiency indicators (complaints and time delays). RESULTS: Proportion of patients with a medication error was reduced from 61.0% (25/41 patients) to 55.7% (39/70 patients) in four months. Percentage of errors (regarding the opportunities for error) decreased in the different phases of the process: Prescription: from 5.1% (19/372 opportunities) to 3.3% (19/572 opportunities); Preparation: from 2.7% (14/525 opportunities) to 1.3% (11/847 opportunities); and administration: from 4.9% (16/329 opportunities) to 3.0% (13/433 opportunities). Nursing complaints decreased from 10.0% (2119/21038 patients) to 5.7% (1779/31097 patients). The estimated economic impact was 76,800 euros saved. CONCLUSIONS: An improvement in the pharmacotherapeutic process and a positive economic impact was observed, as well as enhancing patient safety and efficiency of the organization. Standardisation and professional training are future Lean Six Sigma candidate projects.

Microtubule organization and L-type voltage-activated calcium current in olfactory neuronal cells obtained from patients with schizophrenia and bipolar disorder.

Olfactory neuroepithelial cells in culture have been proposed as a model to study the physiopathology of psychiatric disorders and biomarker characterization for diagnosis. In patients with schizophrenia (SZ) and bipolar disorder (BD) diminished microtubule-associated proteins expression occurs, which might lead to aberrant microtubular organization and which in turn may affect Ca(2+) voltage-activated currents. The aim of this work was to characterize of microtubule organization as well as of the L-type Ca(2+) current in neuronal precursors obtained from nasal exfoliates of patients with SZ and BD. Microtubule organization was studied by immunofluorescence with a specific anti-III ß-tubulin antibody and by quantification of globular and assembled tubulin by Western blot. L-type current recording was performed by whole-cell patch-clamp technique and nifedipine superfusion. The results showed differential altered microtubular organization in neuronal precursors of SZ and BD. Short microtubules were observed in BD neurons, while extensive, unstained subcellular areas and disorganized microtubules were evident in SZ neuronal precursors. Patients with BD showed a decrease in amounts of tubulin in total homogenates and 40% decrease in the globular fraction. However, L-type current in BD was similar to that in healthy subjects (HS). In contrast, this current in SZ was 50% lower. These reduction in L-type current in SZ together with differential microtubule alterations are potential biomarkers that may differentiates SZ and BD.

Impacto de la salud bucal sobre la calidad de vida de los niños de 11 a 14 años de tres escuelas nacionales de Asunción / Impact of oral health on the quality of life of children from 11 to 14 years of taking three National Schools from Asunción

INTRODUCCIÓN: La cavidad bucal no es solo una parte importante de nuestro sistema digestivo, es un lugar cargado de emociones desde el inicio de la vida. Todas las personas deberían contar con una salud bucal que permita cumplir con sus funciones físicas y emocionales. La calidad de vida y la salud bucal están estrechamente relacionadas. OBJETIVO: Conocer el impacto de la salud bucal de los niños de 11 a 14 años de tres Escuelas Nacionales de Asunción en su calidad de vida. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo y de corte transverso. Realizado en niños (n=133) de tres escuelas nacionales de Asunción en el año 2016, donde se utilizó el cuestionario de autopercepción (CPQ 11-14) del impacto de las condiciones bucales en su versión corta en español. Los datos fueron procesados en el programa Excel. RESULTADOS: El 63% de los encuestados tiene una autopercepción de Regular en cuanto a la salud de sus dientes. El 37% respondió haber tenido problemas en sus actividades diarias por causa de sus dientes. El 43% manifestó tener Sintomatología oral (empaquetamiento dentario 67,2%, dolor dentario (50,4%), sangrado en las encías (48,6%) y problemas para dormir por dolor (28%), el 26% reportó una Limitación funcional. La hipersensibilidad fue la limitación con mayor frecuencia (53%), seguido por problemas para comer cosas duras (28%). El 18% presentó afección en el Bienestar emocional y el 10% en el ámbito Bienestar social. En la evaluación de necesidad de salud bucal percibida se concluyó que los encuestados necesitan asistir al dentista para una evaluación, pues existe impacto físico y emocional en la calidad de vida de los encuestados.

INTRODUCTION: The oral cavity is not only an important part of our digestive system, is a place full of emotions from the beginning of life. Every ones hould have an oral health that can effectively meet their physical and emotional functions. Quality of life and oral health are closely related. OBJECTIVE: Tok now the impact of oral health of children from 11 to 14 years of three national schools of Asuncion in their quality of life. METHODS: Observational, descriptive and transverse sectional study. Involving children (n = 133) of three National Schools of Asunción in 2016, where the self-perception questionnaire (CPQ 11-14) the impact of oral conditions in its short version in spanish was used. The data were processed in the Excel program. RESULTS: 63% of respondent shave a self-perception Regular regarding the health of your teeth. 37% of respondent shave had problems in their daily activities because of their teeth. 43% reported Oral symptoms (67.2%), packaging tooth toothache (50.4%), bleeding gums (48.6%) and pain trouble sleeping (28%), 26% reported a Functional limitation. The hypersensitivity was limited more often (53%), followed by trouble eating hard (28%) things. the 18% presented condition in the emotional well being and 10% in the field Social welfare in assessing perceived need for oral health was concluded that respondents need to attend to the dentist for an evaluation, as there is physical and emotional impact on the quality of life of respondents.

Psychological characteristics of patients on the liver transplantation waiting list with depressive symptoms.

INTRODUCTION: Untreated psychiatric morbidity can worsen the quality of life in the posttransplantation stage. Therefore, it is important to detect and treat alterations associated with depression in transplantation patients from the beginning of the process. The objective of this study was to determine the psychological characteristics of patients on the liver transplantation waiting list with emotionally depressed symptoms. MATERIAL AND METHODS: We evaluated 70 patients on the liver transplantation waiting list for psychopathological symptoms of depression using the Symptom Assessment-45 Questionnaire (González and Cuevas) using chi-squared tests, Student t tests, and logistic regression analysis. RESULTS: Forty-seven percent of the patients on the liver transplantation waiting list showed relevant depressive-type psychopathological symptoms. The presence of the following factors were associated with the emotionally depressed characteristics of these patients: psychiatric mental disorders (P = .015); no partner (P = .009); and alcohol abuse (P = .050). Other related factors included the following: obsessive-compulsive-type emotional alterations (P = .001); interpersonal sensitivity (P < .001); anxiety (P < .001); hostility (P = .017); phobic anxiety (P = .017); and paranoid ideation (P = .029). With regard to coping strategies, these patients used defenselessness (P < .001) and anxious preoccupation (P = .016). With regard to the social-family setting, emotionally depressed patients had nonfunctional family and/or social support, according to the global MOS (Medical Outcomes Study-Social Support Survey) index (P = .008) and the total Apgar Family Score (P < .001). CONCLUSIONS: Almost half of the patients on the liver transplantation waiting list showed emotionally depressed-type symptoms. Other emotional-type alterations were related to this psychological profile: coping strategies of defenselessness and anxious preoccupation as well as nonfunctional social and/or family support.

Psychological care: social and family support for patients awaiting a liver transplant.

INTRODUCTION: In patients awaiting a transplant, the help received from friends and/or family members is considered to be an important factor in the transplantation process. Our objective was to determine the level of social/family support for patients on the liver transplant waiting list and to determine the relationship between clinical psychopathology and the level of social/family support. MATERIALS AND METHODS: The study population consisted of 70 patients on the liver transplant waiting list. We used the following instruments: (1) Medical Outcomes Study-Social Support Survey (MOS) Questionnaire. For size of the social network, four support dimensions and a global support index for emotional support, material/instrumental support, leisure/free time activities, and love/care; (2) Family Apgar Questionnaire for personal perception of family function; (3) SA-45 questionnaire of psychopathologic symptoms for somatizations, obsessive-compulsivity, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. RESULTS: The MOS showed that the mean size of the social network of these patients was 12 people. In these patients, social/family support was nonfunctional in 20% of the cases. By dimensions, the patients had the following percentage of nonfunctional support: 24% in emotional support; 10% material/instrumental support; 23% social relations of leisure/free-time activities; and 11% compassionate love/care support. The patients with nonfunctional support had the following associated psychopathologic symptoms (SA-45): depression (79% vs 39%; P = .008), anxiety (86% vs 46%; P = .008), hostility (43% vs 12%; P = .009), and psychoticism (14% vs 2%; P = .039) compared to functional patients. The Family Apgar showed that 27% of patients perceived a family dysfunction. These patients had greater interpersonal sensitivity-type emotional symptoms (32% vs 8%; P = .012), depression (79% vs 35%; P = .001), anxiety (79% vs 45%; P = .011), and hostility (42% vs 10%; P = .002) compared to normally functioning patients. CONCLUSIONS: Nearly a quarter of patients on the liver transplant waiting list have social/family support that is nonfunctional, which leads to greater emotional psychopathologic symptoms that would need to be treated.

A non-invasive method to isolate the neuronal linage from the nasal epithelium from schizophrenic and bipolar diseases.

Brain imaging and histopathological studies suggest that neurodevelopmental anomalies play a key role in the etiology of schizophrenia (SZ) and bipolar disorder (BD). New neuron formation and maturation occur in human olfactory epithelium throughout life. Therefore, the olfactory epithelium has been proposed as a model to study alterations in neurodevelopment, particularly in some psychiatric diseases. However, former studies were done with olfactory epithelium biopsies taken post mortem or under anesthesia from patients with SZ and BD. In this work we have developed a new method to obtain viable neural precursors by exfoliation of the anterior region of the medial lateral turbinate of the nasal cavity from healthy controls, and ambulatory patients. Cells were propagated to establish neural precursor banks. Thawed cells showed cytoskeletal phenotypes typical of developing neurons. They also conserved the ability to differentiate in presence of 2mM dibutyril-cyclic adenosine monophosphate, and maintained voltage-operated Ca(2+) currents in culture. Moreover, proportions of neuronal maturation stages were maintained in cultured exfoliates obtained from SZ and BD patients. Data support that neural precursors obtained from a nasal exfoliate are an excellent experimental model to later approach studies on biomarkers, neural development and cellular alterations in the pathophysiology of SZ and BD.

Obsessive-compulsive psychological symptoms of patients on the liver transplant waiting list.

INTRODUCTION: Patients on the liver transplant waiting list have increased emotional and clinical symptoms. The presence of psychopathologic symptoms associated with obsession-compulsion as a reflection of alterations due to anxiety disorders is common in these patients. OBJECTIVE: To evaluate obsessive-compulsive psychopathological symptoms in patients on the liver transplant waiting list. MATERIALS AND METHODS: The study included 50 patients on the liver transplant waiting list. The instrument was the SA-45 questionnaire (Derogatis, 75), whose Spanish version was adapted by González Rivera and De las Cuevas (1988). This dimension was evaluated using five statements. RESULTS: Among of the patients on the liver transplant waiting list, 46% had no relevant obsessive-compulsive symptoms. Of these, 28% had no symptoms and 18% had some symptoms, but the overall evaluation in these patients was no greater than the cutoff point. The remaining 54% had relevant obsessive-compulsive clinical symptoms, most commonly (1) "Having difficulty making decisions" (P<3.45·10(-9)); (2) "Having difficulty concentrating" (P<1.70·10(-8)); (3) "One's mind goes blank" (P<3.04·10(-4)); (4) "Having to repeatedly check everything being done" (P<1.37·10(-1)); and (5) "Having to do things slowly to make sure they are done properly" (P<5.02·10(-1)). CONCLUSIONS: Many patients on the liver transplant waiting list have obsessive-compulsive psychopathologic symptoms. Their detection and application of adequate psychological treatment are important to minimize the effects of emotional changes onward from the pretransplant phase.

Coping styles of patients on the liver transplant waiting list.

INTRODUCTION: Chronic end-stage liver disease is a difficult situation for the patient. OBJECTIVE: The objective of this study was to analyze the disease coping styles of patients on the liver transplant waiting list. MATERIALS AND METHODS: The study included 50 patients on the liver transplant waiting list. The instrument used was the Mental Adjustment to Cancer Scale (Ferrero, 94). Coping scales were as follows: fighting spirit, hopelessness, anxious preoccupation, fatalism, and negation. RESULTS: Only 6% of subjects adapted well, whereas 94% adapted badly: 89% poor fighting spirit, 32% hopelessness, 50% anxious preoccupation, 28% fatalism, and 30% negation. Of those who had a poor fighting spirit, 88% also used another type of maladaptive style. The associated statements were (P<.05) as follows: "I value my life more"; "I don't think about the disease"; "I think about people who are worse off." Regarding hopelessness, 100% of those who confessed hopelessness also showed maladaptive signs. The associated statements were (P<.05) as follows: "I cannot cheer myself up"; "I cannot help myself"; "I've given up." Regarding anxious preoccupation, nearly all of these patients (96%) provided dysfunctional answers. The most associated were (P<.05) as follows: "I don't have any plans"; "I feel a lot of anxiety"; "I'm very angry." Regarding fatalism, all of the patients also had maladaptive behavior. The main types were (P<.05) as follows: "Nothing will change things"; "I cannot control the situation"; "I don't need information." Regarding negation, Only 14% used this style, and in 86% negation was associated with other inadequate coping styles. CONCLUSIONS: Patients on the liver transplant waiting list were maladaptive to their disease. It is important to establish adequate psychological care for these patients, given the important repercussions in the posttransplantation phase.

Importance of introduction of a psychological care unit in a liver transplantation unit.

BACKGROUND: Psychological changes in terminally ill patients with liver disease are underestimated. Therefore, a psychological care unit was introduced in the liver transplantation unit in a transplantation hospital in Spain. OBJECTIVES: To describe the establishment of the psychological care unit in a liver transplantation unit and to review its operation, and to evaluate and diagnose psychological changes in patients on the waiting list for liver transplantation. MATERIALS AND METHODS: Variables evaluated included consultations, interviews, level of care provided, appointments postponed, difficulties, and cost-effectiveness. Psychopathologic symptoms were evaluated using the Symptom Assessment-45 questionnaire (Derogatis, 1975), examining 9 psychopathologic dimensions. RESULTS: Thirty-eight patients were given an appointment, and 28 were interviewed. Twelve postponed the appointment. The level of support provided to patients on the waiting list was 70%. The hospital structure was used to develop the care unit, which is why it was only necessary to employ 1 professional psychologist. Of patients assessed, 54% exhibited relevant clinical symptoms of depression, and 47 demonstrated anxiety. Patients with symptoms of depression reported "loss of interest"; those with anxiety reported feeling "worried and tense." Of these patients, an increased presence of symptoms was associated with various emotional problems such as hostility (33%), somatization (60%), obsession/compulsion (73%), interpersonal sensitivity (40%), phobic anxiety (20%), paranoid ideation (20%), and psychosis (6%). CONCLUSIONS: Patients on the waiting list for liver transplantation demonstrate increased clinical symptoms of depression and anxiety. Therefore, it is of great importance to introduce a psychological care unit to detect and treat these conditions. Introduction of the liver transplant unit program has improved multidisciplinary care and is cost-effective.