Real-World Data on Adult T-Cell Leukemia/Lymphoma in Latin America: A Study From the Grupo de Estudio Latinoamericano de Linfoproliferativos.

PURPOSE: Adult T-cell leukemia/lymphoma (ATLL) is an aggressive disease caused by the human T-cell leukemia virus type 1. Real-world data of ATLL in Latin America are lacking. PATIENTS AND METHODS: We analyzed patients with ATLL (acute, lymphomatous, chronic, and smoldering) encountered in 11 Latin American countries between 1995 and 2019. Treatment response was assessed according to the 2009 consensus report. Survival curves were estimated using the Kaplan-Meier method and log-rank test. RESULTS: We identified 253 patients; 226 (lymphomatous: n = 122, acute: n = 73, chronic: n = 26, and smoldering: n = 5) had sufficient data for analysis (median age 57 years). Most patients with ATLL were from Peru (63%), Chile (17%), Argentina (8%), and Colombia (7%). Hypercalcemia was positively associated with acute type (57% v lymphomatous 27%, P = .014). The median survival times (months) were 4.3, 7.9, 21.1, and not reached for acute, lymphomatous, chronic, and smoldering forms, with 4-year survival rates of 8%, 22%, 40%, and 80%, respectively. First-line zidovudine (AZT)-interferon alfa (IFN) resulted in an overall response rate of 63% (complete response [CR] 24%) for acute. First-line chemotherapy yielded an overall response rate of 41% (CR 29%) for lymphomatous. CR rate was 42% for etoposide, cyclophosphamide, vincristine, doxorubicin, and prednisone versus 12% for cyclophosphamide, vincristine, doxorubicin, and prednisone-like regimen (P < .001). Progression-free survival at 1 year for acute type patients treated with AZT-IFN was 67%, whereas 2-year progression-free survival in lymphomatous type patients who achieved CR after chemotherapy was 77%. CONCLUSION: This study confirms Latin American ATLL presents at a younger age and has a high incidence of lymphomatous type, low incidence of indolent subtypes, and worse survival rates as compared with Japanese patients. In aggressive ATLL, chemotherapy remains the preferred choice for lymphomatous favoring etoposide-based regimen (etoposide, cyclophosphamide, vincristine, doxorubicin, and prednisone), whereas AZT-IFN remains a good first-line option for acute subtype.

Calidad de servicio a pacientes en consultorio externo de geriatría de un hospital de la seguridad social: un estudio cualitativo / Quality of service at the geriatric outpatient department of a social security hospital: a qualitative study

Objetivo: Determinar la calidad de servicio a pacientes adultos mayores en niveles asistenciales ambulatorios de geriatría. Materiales y métodos: Estudio cualitativo con un grupo de 45 participantes mayores de 60 años que acudieron para atención médica al servicio de Geriatría del Hospital Guillermo Almenara Irigoyen entre enero y junio de 2005. Resultados: Se determinó que el 77 % de los participantes se mostraron satisfechos con la calidad de atención, además las categorías que presentaron mayores quejas fueron la falta de interacción médico paciente, falta de empatía y seguridad durante su atención del servicio. Los aspectos que destacaron fueron la confiabilidad y la entrega de información. Conclusiones: La falta de interacción médico paciente y la falta de empatía son los problemas más destacables.

Objective: To determine the quality of service to elderly patients in geriatric outpatient levels of care. Materials and methods: A qualitative study with a group of 45 participants over 60 years of age who attended the geriatric department of the Hospital Guillermo Almenara Irigoyen between January and June 2005. Results: It was determined that 77 % of the participants were satisfied with the quality of care. The categories with the greatest complaints were lack of patient-physician interaction, lack of empathy, and lack of safety during their health care. Aspects that stood out were reliability and information submission. Conclusions: The lack of patient-physician interaction and lack of empathy are the most outstanding problems in the geriatric department.

Functional assessment as a predictor of cognitive impairment: a retrospective cohort study. / La valoración funcional como predictor de deterioro cognitivo: cohorte retrospectiva.

INTRODUCTION: It is estimated that major neurocognitive disorders will affect 115.4 million people by 2050, representing a significant financial burden for society. Likewise, functional dependence for basic or instrumental activities of daily life is usually a consequence of the greater prevalence of disabling pathologies, and of the progressive decrease of the physiological reserve due to aging. OBJECTIVES: To determine the ratio between the functional test and prediction of deterioration of cognitive function in geriatric patients. To determine which factors are associated with decreased cognitive functions in elderly patients. METHODS: This is a retrospective cohort study. We included participants who attended the Geriatrics Outpatient Services of the Naval Medical Center of Peru from 2010 to 2014. Two groups were formed, the first comprised those who presented physiological loss of cognitive functions, defined as the decrease less than 4.1 points in the score of the Mini Mental State Examination during follow-up and a second group who had a pathological loss of cognitive functions, defined as a decrease of 4.2 points in average or more in the Mini Mental State Examination score during follow-up. Patients were followed for four years, performing functional evaluations, as well as collecting data on comorbidities and sociodemographic factors. RESULTS: We included 368 patients, whose mean age was 75.8 years and 50.91% male. Female gender (53.72%), poor education (62.81%), and comorbidities were statistically more frequent in the pathological cognitive decline group. Functional assessment variables had a worse disease progress through follow-up in the group with pathological disease progress of the Mini Mental State Examination score, including Timed Up and Go Test. CONCLUSIONS: Score values of Timed Up and Go Test manage to predict the risk of a pathological decrease in Mini Mental State Examination regardless of sociodemographic factors, comorbidities, and functional assessment.

INTRODUCCIÓN: Se estima que los trastornos neurocognitivos mayores afectarán a 115,4 millones de personas en 2050, lo que representa una carga financiera importante para la sociedad. Asimismo, la dependencia funcional para actividades básicas o instrumentales de la vida diaria suele ser consecuencia de la mayor prevalencia de patologías discapacitantes, y de la progresiva disminución de la reserva fisiológica propia del envejecimiento. OBJETIVOS: Se persiguen dos objetivos: determinar la relación entre los test funcionales y la predicción de deterioro de funciones cognitivas en pacientes geriátricos; y establecer qué factores están asociados a disminución de las funciones cognitivas en pacientes geriátricos. MÉTODOS: Estudio de tipo cohorte retrospectiva. Incluimos participantes que acudieron a los servicios ambulatorios de geriatría del Centro Médico Naval de Perú desde 2010 hasta 2014. Se formaron dos grupos, el primero con los que presentaron pérdida fisiológica de funciones cognitivas, definida como la disminución menor a 4,1 puntos en el puntaje del Mini Mental State Examination durante el seguimiento y otro con una pérdida patológica de funciones cognitivas, definida como la disminución de 4,2 puntos en promedio o más en el puntaje de esta misma encuesta durante el seguimiento. Los pacientes fueron seguidos por cuatro años, período en el que se les efectuaron evaluaciones funcionales y se recogieron datos de comorbilidades y factores sociodemográficos. RESULTADOS: Se incluyeron 368 pacientes, cuya media de edad fue de 75,8 años y 50,91% fueron hombres. El género femenino (53,72%), la presencia de un bajo grado de instrucción (62,81%) y la presencia de comorbilidades fueron más prevalentes en el grupo con disminución de Mini Mental State Examination patológico. Las variables de evaluación funcional, incluyendo al Timed Up and Go Test, presentaron promedios inadecuados durante el seguimiento de cuatro años en el grupo con evolución patológica del puntaje del Mini Mental State Examination, en comparación con el grupo sano. CONCLUSIONES: Los valores del puntaje del Timed Up and Go Test logran predecir el riesgo de una disminución patológica del Mini Mental State Examination, independientemente de factores sociodemográficos, comorbilidades y valoración funcional.