Coordinated treatment between addiction and mental health services vs. uncoordinated treatment for patients with dual diagnosis: higher dropout rates but lower impairement of functional disability.

Dual pathology is often found in addiction and mental health centers. Although there are integrated services for these patients, most countries have developed joint action protocols between addiction and mental health centers. The objective is to analyze the progress of patients diagnosed with dual pathology, comparing the therapeutic outcomes of those who exclusively attend either addiction or mental health centers with those patients who follow a program in which the two services are coordinated. It is hypothesized that patients assisted in coordinate manner will present a better evolution on psychopathological symptomatology, drug use and functional impairment.

Tratamiento coordinado entre centros de adicciones y salud mental vs. tratamiento no coordinado para pacientes con patología dual: mayor abandono, pero menor deterioro de la discapacidad funcional / Coordinated treatment between centres addiction and mental health centres vs. uncoordinated treatment for patients with dual pathology: greater dropout, but less deterioration of functional disability

Introducción: Los pacientes con patología dual son generalmente tratados en centros de salud mental y adicciones.Aunque hay servicios integrados para estos pacientes, lo máscomún es desarrollar protocolos de actuación conjunta entreestos centros. El objetivo de este estudio es analizar el progreso terapéutico de pacientes diagnosticados de patologíadual, comparando los resultados de pacientes atendidos enlos centros de adicciones exclusivamente, de salud mentalo bien atendidos de manera coordinada entre ambos servicios. La hipótesis es que los pacientes atendidos de maneracoordinada presentarán una mejor evolución en términos dela sintomatología psicopatológica, consumo de drogas y discapacidad funcional.Método. La muestra está formada por 182 pacientesatendidos en centros de adicción (n = 62), de salud mental (n= 51) y tratados a través del protocolo de actuación conjunta(n = 62). Los instrumentos administrados fueron la WHODAS2.0, BSI-18 y la SDSS.Resultados. No se encontraron diferencias estadísticamente significativas entre la evaluación basal y el seguimiento ni en la WHODAS 2.0 ni en el BSI-18. Se encontróun incremento del consumo de cocaína en los tres grupos,aunque fue estadísticamente significativa en los pacientesde adicciones y de salud mental. Hubo una mayor tasa deabandono del tratamiento en los pacientes atendidos de manera coordinada. En términos de cambio fiable, entre los pacientes atendidos de manera coordinada hubo más pacientesque mejoraron en la WHODAS 2.0.Conclusiones. Los hándicaps de asistir a dos redes asistenciales pueden estar explicando el mayor abandono de lospacientes que siguen el protocolo de actuación conjunta. Sinembargo, los pacientes que se mantienen en esta modalidadterapéutica muestran un menor deterioro de la funcionalidad en comparación con las otras dos modalidades. (AU)

Background: Dual pathology is often found in addictionand mental health centers. Although there are integratedservices for these patients, most countries have developedjoint action protocols between addiction and mental healthcenters. The objective is to analyze the progress of patientsdiagnosed with dual pathology, comparing the therapeuticoutcomes of those who exclusively attend either addictionor mental health centers with those patients who followa program in which the two services are coordinated. It ishypothesized that patients assisted in coordinate mannerwill present a better evolution on psychopathological symptomatology, drug use and functional impairment. Methods. The sample was 182 dual pathology patientstreated in addictions centers (n=62), mental health centers(n=51) and treated in a coordinated manner (n=62). The instruments administered was WHODAS 2.0, BSI-18 and SDSS.Results. In general, no statistically significant differences were found between baseline and follow up inWHODAS and BSI-18. More cocaine use was found inthree groups but was statistically significant in patientsattended by addictions center and mental health centers.High percentages of abandonment were found in patientsattending coordinate services. In terms of reliable change, among those receiving the coordinated treatment,there were more patients who showed improvements inthe WHODAS 2.0 dimensions.Conclusions. The inconvenience caused by going to different treatment networks may partially explain these resultsrelated with abandonment. However, patients who remain intreatment in coordinated services, show lower functionalitydeterioration than patients in other modalities. (AU)

A Mycobacterium tuberculosis Dormancy Antigen Differentiates Latently Infected Bacillus Calmette-Guérin-vaccinated Individuals.

IFN-γ release assays (IGRAs) are better indicators of Mycobacterium tuberculosis infection than the tuberculin skin test (TST) in Bacillus Calmette-Guérin (BCG)-vaccinated populations. However, IGRAs do not discriminate active and latent infections (LTBI) and no gold standard for LTBI diagnosis is available. Thus, since improved tests to diagnose M. tuberculosis infection are required, we assessed the efficacy of several M. tuberculosis latency antigens. BCG-vaccinated healthy donors (HD) and tuberculosis (TB) patients were recruited. QuantiFERON-TB Gold In-Tube, TST and clinical data were used to differentiate LTBI. IFN-γ production against CFP-10, ESAT-6, Rv2624c, Rv2626c and Rv2628 antigens was tested in peripheral blood mononuclear cells. LTBI subjects secreted significantly higher IFN-γ levels against Rv2626c than HD. Additionally, Rv2626c peptide pools to which only LTBI responded were identified, and their cumulative IFN-γ response improved LTBI discrimination. Interestingly, whole blood stimulation with Rv2626c allowed the discrimination between active and latent infections, since TB patients did not secrete IFN-γ against Rv2626c, in contrast to CFP-10 + ESAT-6 stimulation that induced IFN-γ response from both LTBI and TB patients. ROC analysis confirmed that Rv2626c discriminated LTBI from HD and TB patients. Therefore, since only LTBI recognizes specific epitopes from Rv2626c, this antigen could improve LTBI diagnosis, even in BCG-vaccinated people.

IFNG-mediated immune responses enhance autophagy against Mycobacterium tuberculosis antigens in patients with active tuberculosis.

Protective immunity against Mycobacterium tuberculosis (Mtb) requires IFNG. Besides, IFNG-mediated induction of autophagy suppresses survival of virulent Mtb in macrophage cell lines. We investigated the contribution of autophagy to the defense against Mtb antigen (Mtb-Ag) in cells from tuberculosis patients and healthy donors (HD). Patients were classified as high responders (HR) if their T cells produced significant IFNG against Mtb-Ag; and low responders (LR) when patients showed weak or no T cell responses to Mtb-Ag. The highest autophagy levels were detected in HD cells whereas the lowest quantities were observed in LR patients. Interestingly, upon Mtb-Ag stimulation, we detected a positive correlation between IFNG and MAP1LC3B-II/LC3-II levels. Actually, blockage of Mtb-Ag-induced IFNG markedly reduced autophagy in HR patients whereas addition of limited amounts of IFNG significantly increased autophagy in LR patients. Therefore, autophagy collaborates with human immune responses against Mtb in close association with specific IFNG secreted against the pathogen.

Tuberculosis por inoculación / Inoculation tuberculosis

Una bacterióloga sufrió un accidente por punción con una aguja con jeringa que contenía una cepa de Mycobacterium tuberculosis en un dedo de la mano. La zona de la punción se inflamó y la expresión del dedo 15 días después del accidente arrojó una gota de pus que puesta al microscopio permitió observar 3 bacilos ácido-alcohol resistentes con la técnica de Ziehl-Neelsen. Se diagnosticó tuberculosis por inoculación accidental y fue tratada como tal. Se discuten las características de este caso encuadrado como tuberculosis cutánea, cuando se produce como infección exógena por inoculación directa.

A bacteriologist suffered a puncture accident while manipulating a Mycobacterium tuberculosis strain, affecting a finger. The involved area swelled and a drop of pus came out after pressure on the finger 15 days afterwards. This was stained by Ziehl-Neelsen technique, and three acid-fast bacilli were observed. Tuberculosis was diagnosed, and proper treatment was started. We discuss the case, classified as cutaneous tuberculosis produced by exogenous infection through accidental direct inoculation.

Tuberculosis por inoculación / Inoculation tuberculosis

Una bacterióloga sufrió un accidente por punción con una aguja con jeringa que contenía una cepa de Mycobacterium tuberculosis en un dedo de la mano. La zona de la punción se inflamó y la expresión del dedo 15 días después del accidente arrojó una gota de pus que puesta al microscopio permitió observar 3 bacilos ácido-alcohol resistentes con la técnica de Ziehl-Neelsen. Se diagnosticó tuberculosis por inoculación accidental y fue tratada como tal. Se discuten las características de este caso encuadrado como tuberculosis cutánea, cuando se produce como infección exógena por inoculación directa. (AU)

A bacteriologist suffered a puncture accident while manipulating a Mycobacterium tuberculosis strain, affecting a finger. The involved area swelled and a drop of pus came out after pressure on the finger 15 days afterwards. This was stained by Ziehl-Neelsen technique, and three acid-fast bacilli were observed. Tuberculosis was diagnosed, and proper treatment was started. We discuss the case, classified as cutaneous tuberculosis produced by exogenous infection through accidental direct inoculation. (AU)

[Lady Windermere syndrome. Female by nature]. / Síndrome de Lady Windermere. Femenino por naturaleza.

Pulmonary disease due to nontuberculous myco bacteria is a well known clinical entity, being Mycobacterium avium complex the pathogen most frequently involved. The Lady Windermere syndrome is a variation of this disease, as interesting as it is little known.

Síndrome de Lady Windermere: Femenino por naturaleza / Lady Windermere syndrome: Female by nature

La enfermedad pulmonar por micobacterias ambientales es una entidad clínica conocida, siendo el Mycobacterium avium complex el patógeno involucrado con más frecuencia. El síndrome de Lady Windermere es una variedad de esta enfermedad, tan interesante como poco conocida.

Pulmonary disease due to nontuberculous myco bacteria is a well known clinical entity, being Mycobacterium avium complex the pathogen most frequently involved. The Lady Windermere syndrome is a variation of this disease, as interesting as it is little known.

[Pulmonary mycobacteriosis in non HIV patients, Buenos Aires City, 2003-2004]. / Micobacteriosis pulmonar en pacientes HIV negativos en la Ciudad de Buenos Aires, años 2003-2004.

Pulmonary disease, due to Mycobacteria other than tuberculosis, is mainly suspected in HIV + patients, or underlying other diseases. In our country, there is no updated information on the prevalence of this pulmonary disease, its treatment and evolution in immucocompetent patients. We present 10 cases of pulmonary disease due to Mycobacteria other than tuberculosis in non HIV patients: clinical-bacteriological diagnosis, treatment and evolution.

Micobacteriosis pulmonar en pacientes HIV negativos en la ciudad de Buenos Aires, años 2003-2004 / Pulmonary mycobacteriosis in non HIV patients, Buenos Aires City, 2003-2004

La enfermedad provocada por micobacterias ambientales es sospechada fundamentalmente en pacientesHIV positivos o con otras enfermedades de base. En nuestro país no hay información actualizadaacerca de la prevalencia, tratamiento y evolución de esta enfermedad en pacientes inmunocompetentes.Presentamos 10 casos de enfermedad pulmonar por micobacterias ambientales en pacientes inmunocompetentes:diagnóstico clínico-bacteriológico, tratamiento y evolución.

Pulmonary disease,due to Mycobacteria other than tuberculosis, is mainly suspected in HIV + patients, or underlyingother diseases. In our country, there is no updated information on the prevalence of this pulmonarydisease, its treatment and evolution in immucocompetent patients. We present 10 cases of pulmonary diseasedue to Mycobacteria other than tuberculosis in non HIV patients: clinical-bacteriological diagnosis, treatment andevolution.

Micobacteriosis pulmonar en pacientes HIV negativos en la ciudad de Buenos Aires, años 2003-2004 / Pulmonary mycobacteriosis in non HIV patients, Buenos Aires City, 2003-2004

La enfermedad provocada por micobacterias ambientales es sospechada fundamentalmente en pacientesHIV positivos o con otras enfermedades de base. En nuestro país no hay información actualizadaacerca de la prevalencia, tratamiento y evolución de esta enfermedad en pacientes inmunocompetentes.Presentamos 10 casos de enfermedad pulmonar por micobacterias ambientales en pacientes inmunocompetentes:diagnóstico clínico-bacteriológico, tratamiento y evolución. (AU)

Pulmonary disease,due to Mycobacteria other than tuberculosis, is mainly suspected in HIV + patients, or underlyingother diseases. In our country, there is no updated information on the prevalence of this pulmonarydisease, its treatment and evolution in immucocompetent patients. We present 10 cases of pulmonary diseasedue to Mycobacteria other than tuberculosis in non HIV patients: clinical-bacteriological diagnosis, treatment andevolution. (AU)

Micobacteriosis pulmonar en pacientes HIV negativos en la ciudad de Buenos Aires, años 2003-2004 / Pulmonary mycobacteriosis in non HIV patients, Buenos Aires City, 2003-2004

La enfermedad provocada por micobacterias ambientales es sospechada fundamentalmente en pacientesHIV positivos o con otras enfermedades de base. En nuestro país no hay información actualizadaacerca de la prevalencia, tratamiento y evolución de esta enfermedad en pacientes inmunocompetentes.Presentamos 10 casos de enfermedad pulmonar por micobacterias ambientales en pacientes inmunocompetentes:diagnóstico clínico-bacteriológico, tratamiento y evolución. (AU)

Pulmonary disease,due to Mycobacteria other than tuberculosis, is mainly suspected in HIV + patients, or underlyingother diseases. In our country, there is no updated information on the prevalence of this pulmonarydisease, its treatment and evolution in immucocompetent patients. We present 10 cases of pulmonary diseasedue to Mycobacteria other than tuberculosis in non HIV patients: clinical-bacteriological diagnosis, treatment andevolution. (AU)