Adherencia terapéutica y control de los factores de riesgo cardiovasculares en usuarios de atención primaria / Therapeutic compliance and cardiovascular risk factors control in primary attention users / A aderência terapêutica e o controle dos fatores de risco cardiovasculares em utentes de atenção primária

Objetivo: Identificar la situación que presentan las personas con factores de riesgo cardiovascular respecto a la adherencia terapéutica, y conocer la relación de esta conducta con el control de dichos factores. Método: Estudio de tipo cuantitativo y transversal. La muestra estuvo constituida por 257 personas con diagnóstico de hipertensión arterial, diabetes mellitus tipo 2 y dislipidemias. Para recolectar los datos se revisó la ficha clínica y se utilizó un cuestionario, y la Escala de Conductas en Salud, para medir adherencia terapéutica. Para procesar los datos se utilizó el programa SPSS v15.0; se usaron medidas de tendencia central y de dispersión; para evaluar la asociación entre variables se recurrió a la t de Student. Resultados: La Escala de Conductas en Salud reflejó la baja adherencia de la muestra, ya que solo 4 (1.5%) personas obtuvieron el puntaje máximo, es decir, que siempre siguen las indicaciones entregadas por el equipo de salud. Se encontró que solo el 22.6% tenía controlada la enfermedad. Se encontraron asociaciones estadísticamente significativas entre el control integral de los factores de riesgo estudiados con la escala global de la Escala de Conductas en Salud, y las subescalas Seguimiento de la dieta y Seguimiento de las actividades prescritas. Conclusiones: El control de los factores de riesgo cardiovascular constituye un complejo conjunto de interacciones, en el cual la adherencia terapéutica puede ser solamente uno de los factores relacionados con él, y por esta razón pueden existir otras variables que influyen en el control de estas enfermedades.

Objective: To identify the situation of persons with cardiovascular risks in relation to their therapeutic compliance, and establish the association of this conduct with the control of those risks. Method: Quantitative and transversal study. The sample included 257 persons diagnosed with arterial hypertension, diabetes mellitus type 2, and dyslipidemia. In order to estimate the therapeutic compliance, data were collected through the clinical history, a questionnaire, and a health behavior scale. Data were processed with SPSS v15.0. Central tendency and dispersion measures were used, and the Student's t test was used to estimate the variables association. Results: The health behaviors scale used showed an overall low-therapeutic-compliance level among the participants. Only 4 individuals (1.5%) obtained the maximum score (absolute compliance with the instructions given by the health team). It was also found that only 22.6% in the sample monitored their condition. Statistically significant associations were found between the control of the studied risk factors measured by the global health behaviors scale and the sub-scales of "following the diet" and "following prescribed activities". Conclusions: The control of cardiovascular risk factors implies a set of complex interactions of which therapeutic compliance is probably just one more. In other words, there could also be other variables which have an impact on the control of these illnesses.

Objetivo: Identificar a situação que apresentam as pessoas com fatores de risco cardiovascular referente à aderência terapêutica, e estabelecer a relação dessa conduta com o controle dos fatores. Método: Estudo de tipo quantitativo e transversal. A amostra foi constituída por 257 pessoas com diagnóstico de hipertensão arterial, diabetes mellitus tipo 2 e dislipidemias. Para a coleta de dados revisou-se a ficha clínica e utilizou-se um questionário, bem como a Escala de Condutas em saúde para medir a aderência terapêutica. Para o processamento de dados utilizou-se o programa SPSS v15.0, usaram-se medidas de tendência central e de dispersão, para avaliar a associação entre as variáveis, precisou-se da t de Student. Resultados: A Escala de Condutas em saúde e as subescalas "Continuação da dieta" e "continuação das atividades prescritas". Conclusões: O controlo dos fatores de risco cardiovascular constitui um complexo conjunto de interações no qual, a aderência terapêutica pode ser apenas um dos fatores relacionados com ele, e por esta razão podem existir outras variáveis que influenciam no controlo destas doenças.

Long-term follow-up of radiation accident patients in Peru: review of two cases.

Overexposure to radioactive sources used in radiotherapy or industrial radiography may result in severe health consequences. This report assesses the initial clinical status and the medical and psychological long-term follow-up of two radiation accident patients from Peru during the mid-to-late 1990s: one patient exposed to a radiotherapy (60)Co source in Arequipa, the other patient to a (192)Ir source in Yanango. Commonalities and differences are described. The main causes in both accidents were human error and the failure to apply appropriate safety guidelines and standard operating procedures. Education and training of the personnel working with radiation sources are essential to prevent accidents. The experience gained from the medical management of the two patients is valuable for future treatment of such patients.

Sindrome de prune - Belly: comunicación de un caso clínico / Prune Belly symdrome: a clinic case communication

Se expone el caso de un bebé con Síndrome de Prune Belly, nacido en la maternidad del Hospital Daniel Bracamonte, con una sobrevida de 3 meses, tiempo durante el cual se pudo seguir su evolución. es una malformación congénita rara, más aún en una ciudad con una población no mayor de 150.000 habitantes. Se aprovecha el caso para realizar una revisión de la patología y la descripción correspondiente

Ifosfamide plus cisplatin as primary chemotherapy of advanced ovarian cancer.

We have performed a phase II study to evaluate the activity and toxicity of ifosfamide and cisplatin as first-line treatment for advanced ovarian cancer. Patients were treated with cisplatin 100 mg/m2 on day 1 and ifosfamide 5 g/m2 in 18-hr continuous infusion on day 1 or 1.5 g/m2 bolus on days 1-5. Between August 1988 and March 1990, 30 women were entered in the trial, 26 of them with measurable disease. The overall clinical response rate was 69% (95% CI: 48-85%), including 34.6% complete responses (95% CI:17-55%). Reassessment laparotomy was performed in 12 cases, and 4 (33%) exhibited a pathologic complete response. For all patients, the median duration of progression-free survival was 14 months, and the median overall survival was 25 months. There were no major differences in the response rate or survival between the two ifosfamide administration modalities. Relevant toxicities were grade IV hematologic toxicity in 11/30 patients and grade IV renal toxicity in 2/30 patients. A patient with grade IV encephalopathy developed a trauma-related cerebral hemorrhage and died 2 months later. The combination of ifosfamide and cisplatin is active in first-line therapy in advanced ovarian cancer, although it does not seem to improve the efficacy or toxicity profile of conventional combinations.

One-session management of cervical intraepithelial neoplasia: a solution for developing countries.

Six hundred thirty-nine patients with CIN on referral Pap were evaluated cytocolposcopically at the first visit and decided whether to be treated the same day or not. One hundred ninety-two patients (30%) were considered negative. Follow-up evidenced later appearance of CIN in five of them. One hundred fifty-three (24%) were candidates for delayed treatment due to conditions contraindicating same-day treatment. Two hundred ninety-four patients (46%) were randomly allocated in LEEP (149) or excisional laser (145) arms, and treated the same day under local anesthesia. Both arms were comparable. There were three microinvasive carcinomas diagnosed in the surgical specimen. LEEP was faster and produced less bleeding than laser, although required a mean of four slices to remove the lesion. Arterial hypertension after anesthetic infiltration was detected in 26% of cases. Two intraoperative and two delayed bleeders required surgery. The size of lesion and surgical defect were larger than those reported in the literature. Margins were involved in 8 patients (2.7%). Only 4.7% (7/149) of patients randomized to LEEP and 3.4% (5/145) with excisional laser had persistent or recurrent CIN on follow-up. Factors predisposing to failure included depth of surgical defect, grade of lesion, and operator's expertise. With this approach, 69% of patients referred for cytology of CIN were adequately managed in the first visit, which contrasts to classical management that reaches the state of treatment in 30% of patients. LEEP appears to be faster, less costly, and requires less expertise. Its use in conjunction with adequate screening is recommended for developing countries.

One-Session Management of Cervical Intraepithelial Neoplasia: A Solution for Developing Countries. A Prospective, Randomized Trial of LEEP versus Laser Excisional Conization

Six hundred thirty-nine patients with CIN on referral Pap were evaluated cytocolposcopically at the first visit and decided whether to be treated the same day or not. One hundred ninety-two patients (30%) were considered negative. Follow-up evidenced later appearance of CIN in five of them. One hundred fifty-three (24%) were candidates for delayed treatment due to conditions contraindicating same-day treatment. Two hundred ninety-four patients (46%) were randomly allocated in LEEP (149) or excisional laser (145) arms, and treated the same day under local anesthesia. Both arms were comparable. There were three microinvasive carcinomas diagnosed in the surgical specimen. LEEP was faster and produced less bleeding than laser, although required a mean of four slices to remove the lesion. Arterial hypertension after anesthetic infiltration was detected in 26% of cases. Two intraoperative and two delayed bleeders required surgery. The size of lesion and surgical defect were larger than those reported in the literature. Margins were involved in 8 patients (2.7%). Only 4.7% (7/149) of patients randomized to LEEP and 3.4% (5/145) with excisional laser had persistent or recurrent CIN on follow-up. Factors predisposing to failure included depth of surgical defect, grade of lesion, and operator's expertise. With this approach, 69% of patients referred for cytology of CIN were adequately managed in the first visit, which contrasts to classical management that reaches the state of treatment in 30% of patients. LEEP appears to be faster, less costly, and requires less expertise. Its use in conjunction with adequate screening is recommended for developing countries.

Effect of host sex and litter on the population dynamics of Echinococcus granulosus in dogs.

Twenty-one Beagle dogs consisting of 10 males and 11 females and belonging to 3 litters were infected with 60,000 E. granulosus protoscolices each. They were killed on day 40, the parasites from their intestines recovered, and the number of worms, average number of proglottides per worm, average length per worm, percentage of worms with a uterine cavity, and percentage of egg-bearing worms were determined for each dog and analyzed per sex and litter. On average, the dogs had 1,253 +/- 339 worms (means +/- standard error) with 2.42 +/- 0.1 proglottides, were 1.59 +/- 0.07 mm long, and 25.6 +/- 4.8% of the worms presented a uterine cavity and 1.2 +/- 0.6% bore eggs. The number of worms exhibited a bimodal distribution with 19 dogs having less than or equal to 2,565 worms and 2 greater than or equal to 5,520 worms. Average number of proglottides also showed a bimodal distribution with 7 dogs having less than or equal to 2.1 proglottides per worm and 14 dogs having greater than or equal to 2.4 proglottides per worm. The parasites were significantly more numerous in females than in the males (1,964 +/- 573 vs. 681 +/- 202), had more proglottides (2.67 +/- 0.08 vs. 2.15 +/- 0.16), and were longer (1.72 +/- 0.07 vs. 1.44 +/- 0.11 mm). The percentages of parasites with a uterine cavity (27.8 +/- 5.9 vs. 23.2 +/- 8.1) or bearing eggs (1.0 +/- 0.5 vs. 1.5 +/- 1.8) were comparable in females and males.(ABSTRACT TRUNCATED AT 250 WORDS)

Humoral immunity in the prepatent primary infection of dogs with Echinococcus granulosus.

Twenty-one parasite-naive dogs were infected with 60,000 protoscolices of Echinococcus granulosus. Transformation of peripheral lymphocytes was investigated before and 29 days after the infection, immunoglobulin concentration and anti-hydatid fluid protein (HFP) titers in serum and feces before and at 35 days of infection, skin reactivity to HFP at 36 days, and characteristics of the parasites at 40 days. The infection caused a significant depression of the spontaneous, lipopolysaccharide-stimulated, and purified protein derivative-stimulated blastogenesis. Responses to phytohemagglutinin were unchanged and reactivity to concanavalin A was enhanced with the infection. Only the concentrations of IgG and IgA in the serum and IgA in the feces increased significantly after infection. Fifteen (71%) dogs produced significant serum titers of anti-HFP hemagglutinins but copro-antibodies were detectable in only 3 dogs at minimum titers. Titers were abolished by treatment with 2-mercaptoethanol. The serum of 11 (52%) dogs transferred passive cutaneous anaphylaxis to guinea pigs but none transferred skin reactivity to pups or rabbits. Five and 1 (but not 0.2) micrograms of HFP caused skin reactivity in 4 parasite-naive dogs. Nineteen (90.5%) infected dogs reacted significantly to skin inoculation of 0.2 microgram of HFP at 0.5 hours and 13 (62%) at 6 hours. The 7 dogs with the highest anti-HFP serum titers or the greatest skin reactivity at 6 hours had significantly less mature or fewer tissue parasites, respectively, than the 7 dogs with the smallest responses. Since there was evidence that the specific immunity was still developing at the time of the study, these results indicate that immunological diagnosis of, and artificial immunization against, canine echinococcosis are feasible.

Cell-mediated immunity in the prepatent primary infection of dogs with Echinococcus granulosus.

Cell-mediated immunity was studied in 21 parasite-naive dogs by transformation of peripheral lymphocytes with phytohemagglutinin (PHA), concanavalin A (Con A), or hydatid fluid protein (HFP) at 29 days of a primary infection with Echinococcus granulosus, and by delayed cutaneous hypersensitivity to HFP at 36 days of the infection. Infection depressed significantly the ability of unstimulated cells to proliferate but enhanced the response to Con A. The lymphocytes of four dogs reacted to HFP significantly above the average, and one dog exhibited cutaneous reactivity to 0.2 micrograms of HFP. Five or 1 but not 0.2 micrograms of HFP produced non-specific skin reactions in parasite-naive dogs. The 7 dogs with the highest reactivity to PHA or Con A had significantly fewer parasites than the 7 less reactive dogs. The differences in other parasite characteristics were not significant in the 7 dogs with the greatest or smallest reactivities. Correlation tests showed an inverse correlation of PHA reactivity with establishment and maturation of parasites, of Con A reactivity with growth and maturation, and of HFP with maturation.

Immunomodulation by nematodes: a review.

There is current evidence that infections with Trichinella spiralis, Ascaris suum, Nippostrongylus brasiliensis, Nematospiroides dubius (syn. Heligmosomoides polygyrus) and diverse filariae affect the immune responsiveness of their hosts. T. spiralis, or its extracts, can depress or enhance the heterologous humoral or cell-mediated immunities, and affect macrophage activity or the response to other invaders. These effects are induced by products of the migratory and early muscle larvae and appear to obey more than one single-mechanism. A suum acute infections or extracts depress responses involving T cell activity, but stimulate polygonal expansion of B-cells. Nippostrongylus brasiliensis causes polyclonal stimulation of IgE-producing cells, enhances immune responses during the first week of infection and inhibits them later on. Nematospiroides dubius depresses homologous and heterologous immunity and facilitates the permanence of other intestinal nematodes. Filarial worms appear to depress the homologous cell-mediated immunity and the heterologous humoral response by induction of suppressor cells and humoral factors. These phenomena are probably the result of evolutionary pressures on the parasites that facilitate their survival. In the host, they are likely to aggravate the homologous infection, facilitate intercurrent conditions and interfere with immunoprophylaxis procedures.