Síndrome antifosfolípido y tumores cardiacos

Presentamos el caso de una paciente mujer de 31 años con antecedente de litiasis coraliforme bilateral. Ella inició la enfermedad un mes antes del ingreso con trombocitopenia y anemia hemolítica autoinmune. Fue diagnosticada con Síndrome de Evans, inicialmente tuvo marcadores de autoinmunidad negativos, finalmente presentó disnea progresiva y se le encontró 4 masas intracardiacas en aurícula derecha y marcadores positivos para síndrome antifosfolípido. A pesar de la anticoagulación y preparación para cirugía cardiaca, la paciente tuvo una muerte súbita.

We present the case of a 31-year-old female patient with a history of bilateral staghorn lithiasis, who started the disease one month before admission with thrombocytopenia and autoimmune hemolytic anemia. She was diagnosed with Evans Syndrome, initially she had negative autoimmunity markers, finally presented progressive dyspnea and 4 intracardiac masses were found in the right atrium and positive markers for antiphospholipid syndrome. Despite anticoagulation and preparation for cardiac surgery, she presented sudden death.

Adherence to antiretroviral therapy and the associated factors among people living with HIV/AIDS in Northern Peru: a cross-sectional study.

BACKGROUND: There are approximately 72,000 people living with HIV/AIDS (PLHIV) in Peru. Non-adherence to antiretroviral therapy (ART) is the most important factor for therapeutic failure and the development of resistance. Peru has achieved moderate progress in meeting the 90-90-90 targets, but only 60% of PLHIV receiving ART are virally suppressed. The purpose of this study was to understand ART adherence in the Peruvian context, including developing sociodemographic and clinical profiles, evaluating the clinical management strategies, and analyzing the relationships between the variables and adherence of PLHIV managed at a regional HIV clinic in Lambayeque Province (Northern Peru). METHODS: This was a cross-sectional study with 180 PLHIV adults, non-randomly but consecutively selected with self-reported ART compliance (78.2% of the eligible population). The PLHIV profile (PLHIV-Pro) and the Simplified Medication Adherence Questionnaire (SMAQ) were used to collect sociodemographic information, clinical variables, and data specific to ART adherence. Descriptive analysis of sociodemographic and clinical characteristics was performed. Bivariate analysis was performed with the Mann-Whitney test, Chi square test, and Yates correction. RESULTS: The 180 PLHIV sample included 78.9% men, 49.4% heterosexual, 45% with a detectable HIV-1 viral load less than 40 copies/ml, 58.3% not consistently adherent, and only 26.1% receiving Tenofovir + Lamivudine + Efavirenz. Risk factors significant for non-adherence included concurrent tuberculosis, discomfort with the ART regime, and previous pauses in ART. Multivariate analysis of nested models indicated having children is a protector factor for adherence. CONCLUSIONS: Self-reported adherence appeared to be low and the use of first-line therapy is not being prescribed homogeneously. Factors associated with nonadherence are both medical and behavioral, such as having tuberculosis, pausing ART, or experiencing discomfort with ART. The Peruvian government needs to update national technical standards, monitor medication availability, and provide education to health care professionals in alignment with evidence-based guidelines and international recommendations. Instruments to measure adherence need to be developed and evaluated for use in Latin America.

Nivel de conocimientos, actitudes y prácticas en relación al test de papanicolaou en mujeres del distrito de Chiclayo - 2010 / Level of knowledges, attitudes and practices of pap test in women of Chiclayo during 2010

Evaluar el nivel de conocimientos, actitudes y prácticas en relación al test de Papanicolaou en mujeres de 20 a 45 años. Diseño descriptivo, transversal; se entrevistaron 116 mujeres, 44,8 % tuvieron nivel alto de conocimientos, 47,4% actitud favorable y 38,8%, nivel de prácticas correcto. En las mujeres con actitud desfavorable con respecto al PAP se halló 5,6 veces más probabilidades de solamente haber concluido estudios en el colegio: OR: 5,6 (IC95%: 2,2-15,23 p< 0,05). El motivo más frecuente por el que no se habrían realizado el test, fue por falta de tiempo.(AU)

To evaluate the level of knowledge, attitudes and practices regarding the Papanicolau test in women from 20 to 45 years from Chiclayo during 2010. Descriptive, cross-sectional, prospective study; 116 women were interviewed. The mean age was 33,5 ± 7,6 years; 44,8% had a high level of knowledge, 47,4% had favorable attitudes and 38,8% good practices. The odds of the women with unfavorable attitude toward PAP was 5,6 of only having concluded the school studies: OR:5,6 (IC: 2,2-15,23 p < 0,05). Conclusions: The levels of knowledge, attitudes and practices are low in this population; an association was found between level of attitudes and educational level; the main reason why women have not performed PAP was lack of time.(AU)