Differential Immune Checkpoint and Ig-like V-Type Receptor Profiles in COVID-19: Associations with Severity and Treatment.

Identifying patients' immune system status has become critical to managing SARS-CoV-2 infection and avoiding the appearance of secondary infections during a hospital stay. Despite the high volume of research, robust severity and outcome markers are still lacking in COVID-19. We recruited 87 COVID-19 patients and analyzed, by unbiased automated software, 356 parameters at baseline emergency department admission including: high depth immune phenotyping and immune checkpoint expression by spectral flow cytometry, cytokines and other soluble molecules in plasma as well as routine clinical variables. We identified 69 baseline alterations in the expression of immune checkpoints, Ig-like V type receptors and other immune population markers associated with severity (O2 requirement). Thirty-four changes in these markers/populations were associated with secondary infection appearance. In addition, through a longitudinal sample collection, we described the changes which take place in the immune system of COVID-19 patients during secondary infections and in response to corticosteroid treatment. Our study provides information about immune checkpoint molecules and other less-studied receptors with Ig-like V-type domains such as CD108, CD226, HVEM (CD270), B7H3 (CD276), B7H5 (VISTA) and GITR (CD357), defining these as novel interesting molecules in severe and corticosteroids-treated acute infections.

HIV among migrants in precarious circumstances in the EU and European Economic Area.

HIV epidemics in the EU and European Economic Area are increasingly diverse in transmission modes and groups affected. Substantial gaps in data exist on HIV burden and access to the HIV continuum of care among migrants living in this region, particularly individuals in precarious circumstances such as migrants with irregular status. Migrants have a higher HIV burden compared with the general population, and high rates of post-migration HIV acquisition. Migrants also face challenges in access to health and HIV services, with irregular migrants, foreign-born key populations such as men who have sex with men, sex workers, and people who inject drugs, and migrants from sub-Saharan Africa being most affected. Intersecting factors negatively affect their access to services along the full continuum of care, including prevention and psychosocial services. Ensuring equitable access to general health and HIV services, regardless of immigration status, and implementing interventions to reduce stigma and discrimination are crucial to ending AIDS by 2030.

Health and illness in migrants and refugees arriving in Europe: analysis of the electronic Personal Health Record system.

BACKGROUND: The electronic Personal Health Record (ePHR) is a health information system that registers health data on newly arriving migrants and was implemented in eight European countries (Bulgaria, Croatia, Cyprus, Greece, Italy, Romania, Serbia and Slovenia). This is a cross-sectional study aimed to describe the health problems and health status of all migrants attended at health clinics as part of the health assessment programme established in the reception centres (2016-2019). METHODS: Data were collected on demographics, clinical and laboratory findings and diagnostics performed, including medical records. We classified all diseases using pre-specified algorithms according to information on pre-specified variables from the ePHR questionnaire, ICD-10 codes, positive laboratory findings or review of medical records. Crude proportions were calculated and odds ratios (OR) estimated using logistic regression modelling. RESULTS: The ePHR dataset contained a total of 19 564 clinical episodes in 14 436 individuals, recorded between January 2016 and October 2019. Most individuals (75%) were refugees or asylum seekers (22%) from 92 different nationalities. There were 2531/19 564 (12.9%) infectious diseases episodes reported during the study period, being 1283/2531 (50.7%) of them pharyngo-tonsillitis, 529 (20.9%) scabies, 158 (6.2%) viral hepatitis and 156(6.1%) lower respiratory infections. There were 2462 (17.1%) individuals with non-communicable diseases reported; including 821 (5.7%) cardiovascular diseases, 1183 (8.2%) neurological condition, 644 (4.5%) Diabetes mellitus and 212 (1.5%) kidney disease cases. Having Diabetes Mellitus (adjusted OR, aOR 3.3, [95% confidence interval, CI 2.7-4.1], P < 0.001), and neurological disorders (aOR 1.8, [95% CI 1.4-2.2], P < 0.001) were associated with cardiovascular disorders in the multivariable logistic regression model.Mental health problems were reported in 641/14 436 (4.4%) individuals and were associated with increasing age. Furthermore, 610 episodes of acute injuries were reported among 585/14 436 (4.1%) people, 517 (88.4%) of them in men (P < 0.001). CONCLUSIONS: The ePHR is a valuable tool to efficiently collect health-related data to better address migrant health issues. We described a mostly healthy population with many acute infectious disease episodes particularly in children, but also with significant number of chronic conditions and less frequent injuries or mental health problems.

Hospital care for adolescents with cancer in Spain: Needs, resources and organisational model.

In Spain, adolescents with cancer are treated in Pediatric Onco-Hematology Units or in Adult Oncology Units. For this reason, the Spanish Federation of Parents of Children with Cancer carried out two surveys in 2013 and 2014 to know the differences in provision of psico-social services to the patients and their relatives among both types of Units. Twenty eight Pediatric and 18 Adult Units provided information. The results showed that the Pediatric Units were better adapted to the needs of the adolescent and family patients and to Spanish Health Authorities recommendations: more appropriate environment, resources for education and leisure, facilities to parents and relatives. Specialized Psycosocial care by psychologists and social workers is insufficient in both cases and the compliance with national and international recommendations is weak. However, specific adolescents' Units are starting to be created in Spain, following the experiences in other countries that define the new role of nurse as an essential linchpin in the care team.

SARS-CoV-2 Proteins Induce Endotoxin Tolerance Hallmarks: A Demonstration in Patients with COVID-19.

According to a large number of reported cohorts, sepsis has been observed in nearly all deceased patients with COVID-19. We and others have described sepsis, among other pathologies, to be an endotoxin tolerance (ET)-related disease. In this study, we demonstrate that the culture of human blood cells from healthy volunteers in the presence of SARS-CoV-2 proteins induced ET hallmarks, including impairment of proinflammatory cytokine production, low MHC class II (HLA-DR) expression, poor T cell proliferation, and enhancing of both phagocytosis and tissue remodeling. Moreover, we report the presence of SARS-CoV-2 blood circulating proteins in patients with COVID-19 and how these levels correlate with an ET status, the viral RNA presence of SARS-CoV-2 in plasma, as well as with an increase in the proportion of patients with secondary infections.

Potential Role of the Galectin-9/TIM-3 Axis in the Disparate Progression of SARS-CoV-2 in a Married Couple: A Case Report.

We report the disparate clinical progression of a couple infected by SARS-CoV-2 based on their immune checkpoint (IC) levels and immune cell distribution in blood from admission to exitus in patient 1 and from admission to discharge and recovery in patient 2. A detailed clinical follow-up accompanied by a longitudinal analysis of immune phenotypes and IC levels is shown. The continuous increase in the soluble IC ligand galectin-9 (Gal-9) and the increment in T-cell immunoglobulin and mucin domain-containing 3 (TIM-3) protein in T cells in patient 1 suggests an activation of the Gal-9/TIM-3 axis and, subsequently, a potential cell exhaustion in this patient that did not occur in patient 2. Our data indicate that the Gal-9/TIM-3 axis could be a potential target in this clinical setting, along with a patent effector memory T-cell reduction.

COVID-19 in children with neuromuscular disorders.

OBJECTIVE: Children with neuromuscular disorders have been assumed to be a particularly vulnerable population since the beginning of COVID-19. Although this is a plausible hypothesis, there is no evidence that complications or mortality rates in neuromuscular patients are higher than in the general population. The aim of this study is to describe the clinical characteristics and outcome of COVID-19 in children with neuromuscular disorders. METHODS: A registry of children with neuromuscular conditions and laboratory-confirmed-SARS-CoV-2 infection was set up by the Neuromuscular Working Group of the Spanish Pediatric Neurology Society (SENEP). Data to be collected were focused on the characteristics and baseline status of the neuromuscular condition and the course of COVID-19. RESULTS: Severe complications were not observed in our series of 29 children with neuromuscular disorders infected by SARS-CoV-2. Eighty-nine percent of patients were clinically categorized as asymptomatic or mild cases and 10% as moderate cases. Patients with a relatively more severe course of COVID-19 had SMA type 1 and were between 1 and 3 years. CONCLUSIONS: The course of COVID-19 in children with neuromuscular disorders may not be as severe as expected. The protective role of young age seems to outweigh the risk factors that are common in neuromuscular patients, such as a decreased respiratory capacity or a weak cough. Further studies are needed to know if this finding can be generalized to children with other chronic diseases.

Cambios evolutivos pulmonares en la ecografía torácica en pacientes con COVID-19 / Time course of lung changes on thoracic ultrasound of mild COVID-19 patients

No disponible

Malformación congénita de seno dural con resolución espontánea / Congenital malformation of dural sinus that resolved spontaneously

No disponible

Características del líquido sinovial en pacientes con artritis idiopática juvenil / Characteristics of synovial fluid in patients with juvenile idiopathic arthritis

Introducción: El análisis del líquido sinovial (LS) es una herramienta importante en el diagnóstico de pacientes con artritis idiopática juvenil (AIJ). Pacientes y métodos: Análisis retrospectivo de las características citológicas del LS obtenido de pacientes con AIJ en el periodo 2008-2016. Resultados: Se analizaron 102 LS de 59 pacientes. El 66% fueron mujeres y la forma clínica más frecuente fue la AIJ oligoarticular persistente (52,5%). La mediana de edad al inicio fue de 5 años (RIC 2,4-11,8). El LS generalmente era de características inflamatorias (mediana leucocitos 11.757/mm3; RIC 4.543-18.800) con predominio de polimorfonucleares (PMN, 61%; RIC 30-75). Ocho pacientes (14%) presentaron recuentos inferiores a 2.000 cél/mm3, con predominio de mononucleares (80%), mientras que 3 pacientes (5%) presentaron recuentos superiores a 50.000cél/mm3, con predominio de PMN (90%). No se encontraron diferencias en los recuentos celulares entre las distintas formas de AIJ. La mediana del recuento de leucocitos de pacientes positivos para ANA fue un 20% inferior a la de niños negativos para ANA (9.340 vs. 11.600/mm3; p = 0,23). La proporción de PMN en LS tendía a aumentar conforme se incrementaba la VSG (p < 0,001) y/o la PCR (p = 0,03). No existe correlación del índice JADAS-10 con el recuento en LS (p = 0,4). El LS en artrocentesis simultáneas de diferentes articulaciones mostró una correlación significativa (p = 0,001). Conclusiones: El LS de pacientes con AIJ generalmente tiene características inflamatorias, aunque un 19% presentó recuentos inferiores a 2.000 o superiores a 50.000cél/mm3. Los recuentos en pacientes positivos para ANA tendían a ser menores que en los negativos para ANA (no significativo). La proporción de PMN aumentaba con los reactantes

Introduction: Synovial fluid (SF) analysis is an important tool for the diagnosis of patients with juvenile idiopathic arthritis (JIA). Patients and methods: A retrospective analysis was carried out of cytological features of SF samples obtained from patients with JIA during the period 2008-2016. Results: A total of 102 SF samples from 59 patients were analysed. JIA was more common in females (66%). The most frequent form was persistent oligoarticular JIA (52.5%). The median age at onset was 5 years (IQR 2.4-11.8). SF usually showed an inflammatory pattern (median white blood cells count 11,757/ mm3; IQR 4,543-18,800), with a predominance of polymorphonuclear (PMN) cells (61%; IQR 30-75). Eight patients (14%) had white blood cells counts of less than 2,000 cells/mm3, with predominance of mononuclear cells (80%), whereas 3 patients (5%) had white blood cells counts higher than 50,000 cells/mm3, with a predominance of PMN cells (90%). Synovial white blood cells count did not show significant differences among the different forms of JIA. The median synovial white blood cells count in ANA-positive patients was 20% lower than in ANA-negative (9,340 vs. 11,600/mm3; P = .23). The proportion of PMN increased with increasing levels of ESR (P < .001) and/or CRP (P = .03). No significant correlation was found between JADAS-10 and synovial white blood cells count (P = .4). SF obtained from different joints in simultaneous arthrocentesis showed a significant correlation P = .001). Conclusion: SF from JIA patients usually had inflammatory characteristics, although 19% of the patients showed white blood cells counts below 2,000cells/mm3 or higher than 50,000 cells/mm3. SF cell count was non-significantly lower in ANA-positive patients, and the proportion of PMN increased with increasing levels of ESR/CRP

Hospital care for adolescents with cancer in Spain: Needs, resources and organisational model. / Atención hospitalaria a adolescentes con cáncer en España: necesidades, recursos y modelo organizativo.

In Spain, adolescents with cancer are treated in paediatric onco-haematology units or in adult oncologyunits. For this reason, the Spanish Federation of Parents of Children with Cancer carried out 2 surveys, one in 2013 and other in 2014, to determine the differences in provision of psycho-social services to the patients and their relatives between the 2 types of units. Twenty-eight paediatric and 18 adult units provided information. The results showed that the paediatric units were better adapted to the needs of the adolescent and family patients and to Spanish health authority recommendations: more appropriate environment, resources for education and leisure, facilities for parents and relatives. Specialised psycho-social care from psychologists and social workers is insufficient in both cases and the compliance with national and international recommendations is weak. However, specific units for adolescents are starting to be created in Spain, following the experiences in other countries that define the new role of the nurse as an essential linchpin in the care team.

[Characteristics of synovial fluid in patients with juvenile idiopathic arthritis]. / Características del líquido sinovial en pacientes con artritis idiopática juvenil.

INTRODUCTION: Synovial fluid (SF) analysis is an important tool for the diagnosis of patients with juvenile idiopathic arthritis (JIA). PATIENTS AND METHODS: A retrospective analysis was carried out of cytological features of SF samples obtained from patients with JIA during the period 2008-2016. RESULTS: A total of 102 SF samples from 59 patients were analysed. JIA was more common in females (66%). The most frequent form was persistent oligoarticular JIA (52.5%). The median age at onset was 5 years (IQR 2.4-11.8). SF usually showed an inflammatory pattern (median white blood cells count 11,757/mm3; IQR 4,543-18,800), with a predominance of polymorphonuclear (PMN) cells (61%; IQR 30-75). Eight patients (14%) had white blood cells counts of less than 2,000 cells/mm3, with predominance of mononuclear cells (80%), whereas 3 patients (5%) had white blood cells counts higher than 50,000 cells/mm3, with a predominance of PMN cells (90%). Synovial white blood cells count did not show significant differences among the different forms of JIA. The median synovial white blood cells count in ANA-positive patients was 20% lower than in ANA-negative (9,340 vs. 11,600/mm3; P=.23). The proportion of PMN increased with increasing levels of ESR (P<.001) and/or CRP (P=.03). No significant correlation was found between JADAS-10 and synovial white blood cells count (P=.4). SF obtained from different joints in simultaneous arthrocentesis showed a significant correlation P=.001). CONCLUSION: SF from JIA patients usually had inflammatory characteristics, although 19% of the patients showed white blood cells counts below 2,000cells/mm3 or higher than 50,000cells/mm3. SF cell count was non-significantly lower in ANA-positive patients, and the proportion of PMN increased with increasing levels of ESR/CRP.

Risk of coronary artery involvement in Kawasaki disease.

INTRODUCTION: Kawasaki disease refers to systemic vasculitis with risk of coronary artery disease. Our objective is to identify risk factors associated with coronary artery disease in patients with complete and incomplete Kawasaki disease. MATERIAL AND METHODS: Descriptive, retrospective study conducted in patients diagnosed with Kawasaki disease in a tertiary-care hospital between 2008 and 2014. The American Heart Association diagnostic criteria were used to define complete and incomplete Kawasaki disease. RESULTS: Thirty-one children were diagnosed with Kawasaki disease; 24 met the criteria for the complete form, and 7, for the incomplete form of this condition. Five had coronary artery disease. One of them had incomplete Kawasaki disease (1/7= 14.3%), and the remaining four had the complete form (4/24= 16.7%). No significant differences were found between both groups (p= 1.0). Patients with coronary artery involvement had a higher C-reactive protein level (median: 16.2 mg/dL versus 8.4 mg/dL, p= 0.047) and lower albuminemia (median: 3.2 mg/dL versus 3.99 mg/dL, p= 0.002). CONCLUSIONS: The risk of coronary artery involvement in incomplete Kawasaki disease is similar to that in complete Kawasaki disease; therefore, in patients with the incomplete form, immunoglobulin therapy should not be delayed. In our population, C-reactive protein and albumin levels were related to a higher risk of coronary artery involvement.

INTRODUCCIÓN: La enfermedad de Kawasaki es una vasculitis sistémica con riesgo de afectación coronaria. Nuestro objetivo es identificar los factores de riesgo asociados a la afectación coronaria en pacientes con enfermedad de Kawasaki completa e incompleta. MATERIAL AND MÉTODOS: Estudio descriptivo retrospectivo de los pacientes diagnosticados con enfermedad de Kawasaki en un hospital terciario entre 2008 y 2014. Se utilizaron los criterios diagnósticos de la Asociación Americana de Cardiología para definir la enfermedad de Kawasaki en su forma completa e incompleta. RESULTADOS: Treinta y un niños fueron diagnosticados con enfermedad de Kawasaki; 24 cumplían criterios para la forma completa y 7, para la incompleta. Cinco presentaron afectación coronaria. Uno de ellos presentaba enfermedad de Kawasaki incompleta (1/7= 14,3%), y los 4 restantes, enfermedad de Kawasaki completa (4/24= 16,7%). No se encontraron diferencias significativas en el riesgo de afectación coronaria entre ambos grupos (p= 1,0). Los pacientes con afectación coronaria tenían una proteína C reactiva mayor (mediana: 16,2 mg/dl vs. 8,4 mg/dl; p= 0,047) y una menor albuminemia (mediana: 3,2 mg/dl vs. 3,99 mg/dl; p= 0,002). CONCLUSIONES: El riesgo de afectación coronaria de la enfermedad de Kawasaki incompleta es similar al de la enfermedad de Kawasaki complet por lo que, en pacientes con la forma incompleta de la enfermedad, no se debería demorar el tratamiento con inmunoglobulina. En nuestra población, los valores de proteína C reactiva y de albúmina se relacionan con un mayor riesgo de afectación coronaria.

Riesgo de afectación coronaria en la enfermedad de Kawasaki / Risk of coronary artery involvement in Kawasaki disease

Introducción: La enfermedad de Kawasaki es una vasculitis sistémica con riesgo de afectación coronaria. Nuestro objetivo es identificar los factores de riesgo asociados a la afectación coronaria en pacientes con enfermedad de Kawasaki completa e incompleta. Material y métodos: Estudio descriptivo retrospectivo de los pacientes diagnosticados con enfermedad de Kawasaki en un hospital terciario entre 2008 y 2014. Se utilizaron los criterios diagnósticos de la Asociación Americana de Cardiología para definir la enfermedad de Kawasaki en su forma completa e incompleta. Resultados: Treinta y un niños fueron diagnosticados con enfermedad de Kawasaki; 24 cumplían criterios para la forma completa y 7, para la incompleta. Cinco presentaron afectación coronaria. Uno de ellos presentaba enfermedad de Kawasaki incompleta (1/7= 14,3%), y los 4 restantes, enfermedad de Kawasaki completa (4/24= 16,7%). No se encontraron diferencias significativas en el riesgo de afectación coronaria entre ambos grupos (p= 1,0). Los pacientes con afectación coronaria tenían una proteína C reactiva mayor (mediana: 16,2 mg/dl vs. 8,4 mg/dl; p= 0,047) y una menor albuminemia (mediana: 3,2 mg/dl vs. 3,99 mg/dl; p= 0,002). Conclusiones: El riesgo de afectación coronaria de la enfermedad de Kawasaki incompleta es similar al de la enfermedad de Kawasaki completa, por lo que, en pacientes con la forma incompleta de la enfermedad, no se debería demorar el tratamiento con inmunoglobulina. En nuestra población, los valores de proteína C reactiva y de albúmina se relacionan con un mayor riesgo de afectación coronaria.

Introduction: Kawasaki disease refers to systemic vasculitis with risk of coronary artery disease. Our objective is to identify risk factors associated with coronary artery disease in patients with complete and incomplete Kawasaki disease. Material and methods: Descriptive, retrospective study conducted in patients diagnosed with Kawasaki disease in a tertiary-care hospital between 2008 and 2014. The American Heart Association diagnostic criteria were used to define complete and incomplete Kawasaki disease. Results: Thirty-one children were diagnosed with Kawasaki disease; 24 met the criteria for the complete form, and 7, for the incomplete form of this condition. Five had coronary artery disease. One of them had incomplete Kawasaki disease (1/7= 14.3%), and the remaining four had the complete form (4/24= 16.7%). No significant differences were found between both groups (p= 1.0). Patients with coronary artery involvement had a higher C-reactive protein level (median: 16.2 mg/dL versus 8.4 mg/dL, p= 0.047) and lower albuminemia (median: 3.2 mg/dL versus 3.99 mg/dL, p= 0.002). Conclusions: The risk of coronary artery involvement in incomplete Kawasaki disease is similar to that in complete Kawasaki disease; therefore, in patients with the incomplete form, immunoglobulin therapy should not be delayed. In our population, C-reactive protein and albumin levels were related to a higher risk of coronary artery involvement.

Intervención familiar en diagnóstico reciente e inicio de tratamiento del cáncer infantil / No disponible

La oncología pediátrica supone un campo de desarrollo profesional donde la figura del psicólogo desempeña importantes funciones. A lo largo del artículo se describen distintos aspectos psicosociales del abordaje sistémico del cáncer infantil. En primer lugar, se resumen los principales aspectos biológicos del cáncer y se ofrece una revisión de los presupuestos teóricos necesarios para el estudio y comprensión de estas realidades familiares donde se profundiza en el Modelo Psicosocial de Enfermedad (Rolland, 2000). Asimismo, se revisan los principales factores de riesgo y protección en las familias con un hijo con cáncer infantil y se exponen diferentes consideraciones con respecto a la comunicación del diagnóstico y la adaptación a la hospitalización. A partir de nuestra experiencia clínica en la planta de oncología pediátrica del Hospital «Virgen del Rocío» de Sevilla, en este trabajo se presenta un protocolo de actuación profesional que sistematiza la intervención psicológica orientada a ayudar a estas familias. En concreto, este protocolo describe la intervención psicológica llevada a cabo en el diagnóstico reciente y en el inicio del tratamiento del cáncer infantil, estructurando los diferentes objetivos a los que es necesario dar respuesta. Finalmente, se discuten diferentes consideraciones prácticas al hilo del protocolo descrito

Pediatric oncology is an area for professional development where the psychologist performs a crucial role. Different psycho-social aspects of the systemic approach to childhood cancer are described throughout this article. The first part summarizes the main biological aspects of cancer, followed by a review of the theoretical premises required for the study and understanding of these familiar realities, deepening on the Psychosocial Typology of Illness (Rolland, 2000). Furthermore, there is a review of the main risk and protection factors in families with one child with childhood cancer and also the exposition of different considerations related to the communication of the diagnosis and the adaptation to the hospitalization. In this article, a professional action protocol systematizing the psychological intervention intended to help this type of families is presented. This protocol is based on our personal clinical experience in the Paediatric Oncology Unit at Hospital «Virgen del Rocío» in Seville (Spain). Particularly, in this protocol the psychological intervention that take place during the diagnosis and at the beginning of the treatment of patients with childhood cancer is described, according to the proposed objectives. Finally, different practical considerations are discussed related to the described protocol

Does the type of event influence how user interactions evolve on Twitter?

The number of people using on-line social networks as a new way of communication is continually increasing. The messages that a user writes in these networks and his/her interactions with other users leave a digital trace that is recorded. Thanks to this fact and the use of network theory, the analysis of messages, user interactions, and the complex structures that emerge is greatly facilitated. In addition, information generated in on-line social networks is labeled temporarily, which makes it possible to go a step further analyzing the dynamics of the interaction patterns. In this article, we present an analysis of the evolution of user interactions that take place in television, socio-political, conference, and keynote events on Twitter. Interactions have been modeled as networks that are annotated with the time markers. We study changes in the structural properties at both the network level and the node level. As a result of this analysis, we have detected patterns of network evolution and common structural features as well as differences among the events.

Orientación y psicoterapia familiar con niños y adolescentes con enfermedad crónica / No disponible

El diagnóstico de una enfermedad crónica en un hijo es un acontecimiento que alterael funcionamiento de la familia. En algunas ocasiones es necesaria la intervención de losprofesionales de la psicología. Estas familias se enfrentan a situaciones estresantes quepueden afectarles a nivel individual, conyugal y/o familiar. Las técnicas de orientacióny terapia familiar son instrumentos muy útiles para abordar estos casos. En el presentetrabajo, nos centraremos en la descripción, explicación y comprensión del funcionamientode una familia con una adolescente que fue diagnosticada de cáncer. Desarrollaremosaspectos de la fase final de la intervención psicoterapeutica en las que se trataron dificultadesrelativas al curso crónico de la enfermedad y a la reincorporación a la vidacotidiana tras la finalización del tratamiento oncológico(AU)

A child chronic illness diagnosis is an event that disturbs the family functioning.Sometimes is necessary an psychologists intervention. These families cope stressfulsituations that may hurt them in an individual, conjugal or family level. Orientation andFamily Therapy techniques are very useful tools to broach these cases. This paper regardto the description, explanation and understanding of a teenager cancer diagnosed on 2004family functioning. We will try to develop some final phase aspects of the psychotherapyintervention where were treat some difficulties that concern to the illness chronic courseand the re-entry in the normal life after the oncological treatment finish(AU)