Alloimmunization to the D antigen by a patient with weak D type 21.

Antibodies of apparent D specificity may be found in D+ patients. We report a D+, multi-transfused Caucasian woman with myelodysplasia who exhibited several alloantibodies. One antibody was a moderately strong (2+) anti-D that persisted for 9 months, until the woman died. Molecular analysis of the patient's RHD gene identified the rare weak D type 21 (938C > T) allele. D alloantibodies do not occur in patients with most weak D types, but some patients with a weak D phenotype, including those with type 21, can produce antibodies to nonself epitopes of the wild-type D antigen.

Sufrimiento existencial en el final de la vida. La perspectiva de un médico / No disponible

Objetivo: describir los cambios en la persona, el significado, la esperanza y la espiritualidad de los pacientes en el final de la vida, y facilitar la comprensión de cómo el Cuidado Paliativo puede reducir el sufrimiento existencial. Método: se realizó búsqueda y consulta de artículos referidos a esos tópicos en publicaciones relacionadas con Cuidado Paliativo y en fuentes electrónicas de acceso gratuito. Resultados: se encontraron 40 artículos con conceptos y definiciones que se utilizaron para organizar el contenido del manuscrito. Conclusiones: esta revisión sugiere que para comprender, diagnosticar y tratar el sufrimiento existencial es necesario conocer su origen y su relación con diferentes procesos que tienen múltiples definiciones complejas que dificultan su comprensión y aplicación práctica en Cuidado Paliativo (AU)

Objective: to describe changes in the person, meaning, hope, and spirituality of patients at the end of their lives, and to facilitate understanding on how palliative care can reduce their existential suffering. Method: a search and consultation of articles on these issues was carried out in publications related to palliative care, and in free electronic sources. Results: forty articles were identified with concepts and definitions that were used to organize the manuscript contents. Conclusions: this review suggests that, in order to understand, diagnose, and treat existential suffering, it is necessary that its sources be known, and its relationship to the various processes with multiple complex definitions that render practical use difficult in palliative care be understood (AU)

Evaluación del sufrimiento de los cuidadores esponsables de pacientes con cáncer asistidos en un centro de cuidados paliativos en Argentina / No disponible

Introducción: La enfermedad incurable de un paciente, y la tarea de asistirlo durante el período final, provocan sufrimiento en el cuidador responsable. Objetivo: Evaluar en los cuidadores responsables la intensidad y causas de sufrimiento, la percepción del control de los síntomas del paciente, las dificultades prácticas y emocionales, y la satisfacción con la tarea. Métodos: Se evaluaron a los cuidadores responsables de 50 pacientes consecutivos con cáncer avanzado en cuidado paliativo. Los datos se obtuvieron en dos entrevistas (inicial y final), con una escala de sufrimiento completada en cada entrevista, y con datos de la historia clínica del paciente. Resultados: 72% de los cuidadores responsables eran mujeres, de edad media 44,8 años ± 14,5; 56% tenía enfermedades que requerían tratamiento y la mayoría dedicaron más de 12 horas por día a la asistencia del paciente. El sufrimiento de los cuidadores responsables fue elevado durante todo el tratamiento (inicial 7,5 ± 2,8, final 8,4 ± 1,8), y tuvieron la percepción de que el control de síntomas fue moderado (inicial 5,3 ± 3,3, final 5,7 ± 2,7). Reportaron baja dificultad práctica (2,3 ± 3,5); dificultad emocional moderada (5,7 ± 3,8) y gran satisfacción con su tarea (8,9 ± 1,6). Es necesario identificar las dificultades de los CR, brindarles instrucción y apoyo emocional y material adecuados para optimizar su capacidad de asistencia y reducir su sufrimiento (AU)

Introduction: when a patient has an incurable cancer and require scare by another person during the final stages of his or her life, the assigned caregiver experiences emotional distress and suffering. Objective: to evaluate the severity and causes of emotional distress incare givers supporting patients with end-stage cancer, measurements were obtained of the severity and causes of their suffering, of their perception of patient symptom control, of their emotional and practical difficulties, and of their satisfaction with the caring task. Methods: fifty caregivers of patients with advanced cancer undergoing palliative care were evaluated. Information was collected during two interviews (initial and final), with a suffering scale being completed in each interview, and from patient clinical records. Results: seventy-two percent of caregivers were women with a median age of 44.8 ± 14.5 years; 56% had illnesses that required treatment, and most of them devoted more than 12 hours a day to patient care. The suffering of caregivers was high throughout therapy (initial 7.5 ± 2.8; final 8.4 ± 1.8). They had the perception that symptom control for their patients was moderate (initial 5.3 ± 3.3; final 5.7 ± 2.7). They reported low practical difficulties (2.3 ± 3.5), moderate emotional difficulties (5.7 ±3.8), and great satisfaction with their task (8.9 ± 1.6).It is necessary that difficulties experienced by caregivers be identified, and that education as well as adequate emotional and material support be offered them in order to optimize their caring capacity and to reduce their suffering (AU)

Fármacos en cuidados paliativos. Experiencia de una unidad en un hospital de media y larga estancia / No disponible

Objetivo: Conocer el tipo de fármacos utilizados en una unidad de cuidados paliativos, así como los cambios que se producen en diferentes momentos de la estancia hospitalaria. Método: Estudio retrospectivo en 100 pacientes seleccionados de forma aleatoria. Análisis de las prescripciones realizadas en cada enfermo en tres momentos diferentes de su estancia hospitalaria: en el primer día del ingreso, en el día mitad de la estancia y en el último día de la estancia. Codificación de los principios activos y grupos farmacológicos según el sistema de clasificación ATC (Anatomical Therapeutic Chemical classification). Resultados: se analizaron 1.267 prescripciones y se identificaron 56 principios farmacológicos diferentes. Los 10 grupos farmacológicos más frecuentemente utilizados fueron: analgésicos opioides, antiulcerosos, neurolépticos, corticoides, ansiolíticos, AINE y otros analgésicos, laxantes, antisecretores, procinéticos e hipnóticos-sedantes. La administración de analgésicos opioides, neurolépticos, antisecretores e hipnóticos-sedantes aumentó de manera significativa durante la estancia hospitalaria, mientras que la utilización de antiulcerosos, corticoides, ansiolíticos, diuréticos, antibióticos, antitrombóticos, antidiabéticos, antihipertensivos y el grupo de otros fármacos disminuyó de forma significativa. Conclusiones: los analgésicos opioides, los antiulcerosos y los neurolépticos son los fármacos más frecuentemente prescritos, siendo el momento evolutivo de la enfermedad un factor condicionante del tipo y número de fármacos utilizados. El seguimiento y monitorización del uso de los fármacos puede convertirse en un instrumento de utilidad en el control sintomático de los pacientes terminales

Objective: to know the type of drugs used in a palliative care unit, as well as the changes taking place at different times during hospital stays. Method: a retrospective study of 100 randomly selected patients. An analysis of prescriptions for each patient at three different times during their hospital stay: first day after admission, mid stay, and last day in hospital. The pharmacological codification of active principles and drug classes was performed according to the ATC (Anatomical Therapeutic Chemical classification) system. Results: In all, 1,267 prescriptions were analyzed and 56 different pharmacologic principles were identified. The 10 most frequently used drug classes were: analgesic opioids, gastric protection agents, neuroleptics, corticosteroids, anxiolytics, NSAID and other analgesics, laxatives, spasmolytics, prokinetics, and hypnotic-sedatives. The administration of analgesic opioids, neuroleptics, spasmolytics and hypnotic-sedatives increased in a significant way during hospital stay, whereas the use of gastric protection agents, corticosteroids, anxiolytics, diuretics, antibiotics, heparins/oral anticoagulants, antidiabetics, antihypertensive agents, and other drugs decreased significantly. Conclusions: analgesic opioids, gastric protection agents, and neuroleptics are the most frequently prescribed drugs, with the evolutionary stage of disease being a factor that conditions the type and number of drugs used. The follow-up and monitoring of drug use may become a useful instrument for symptom control in terminal patients

Frequency of asymptomatic peripheral arterial disease in patients entering the department of general and internal medicine of a general-care hospital.

BACKGROUND: The fact that a high prevalence of asymptomatic peripheral arterial disease (PAD) in the population has repeatedly been noted in recent years, without there being data as to how often asymptomatic PAD has to be anticipated in inpatients treated for divergent internal diseases led us now to performing a screening study in a general-care hospital. PATIENTS AND METHODS: The study population consisted of 990 patients (51.8% women, 48.2% men) with a mean age of 65.2 years (40-93 years) who had to be treated in a hospital for various internal diseases in the period from January 1994 to January 1995. Their case histories were taken, and their clinical findings and the ankle/brachial indices as calculated from Doppler ultrasonographic measurements of the systolic pressures in the malleolar and brachial arteries were used to ascertain how many of the patients presented with asymptomatic and symptomatic PAD. Further the frequency of risk factors (smoking, hypertension, diabetes mellitus, lipid disorders) was recorded for either patient group. RESULTS: The study showed that 6% of the 990 patients suffered from symptomatic PAD and that of the remaining 931 patients, 43.7% were diagnosed, on the basis of the ankle/brachial index (ABI) (< or = 0.9), to have asymptomatic PAD, while 56.3% showed no indication of PAD. CONCLUSIONS: The high number of cases of asymptomatic PAD among inpatients who underwent internal treatment--a percentage well above the figures published so far for outpatients--allows the conclusion that the determination of the ABI is well suited to screen patients older than 50 years even in a hospital setting so that early secondary prophylaxis can be initiated.

Chyloperitoneum in a peritoneal dialysis patient.

A woman with end-stage renal disease underwent peritoneal dialysis. On initiation of treatment, there was turbid peritoneal dialysis fluid, which proved to be of chylous rather than inflammatory origin. A low-fat and medium-chain triglycerides diet induced visible clearing of the fluid and a decrease in its triglyceride concentration. Challenge with a high-fat diet produced two early recurrences. After 8 months, dietary fat no longer induced chyloperitoneum. The patient was able to continue peritoneal dialysis at home without a recurrence.

Psychometric properties of a Spanish version of the McGill Pain Questionnaire in several Spanish-speaking countries.

OBJECTIVE: Versions of the McGill Pain Questionnaire are available in a several languages and are used in clinical studies and sociocultural or ethnic comparisons of pain issues. However, there is a lack of studies that compare the validity and reliability of the instrument in the countries where it is used. The current study investigates the psychometric properties of a Spanish version of the McGill Pain Questionnaire in five Spanish-speaking countries. DESIGN: The authors conducted a multicenter and transnational study with one investigator in each center. Patients were evaluated once with a Spanish version of the McGill Pain Questionnaire, a visual analog scale, and a verbal rating scale. SETTING: The study was performed in pain clinics and acute pain units of four Latin American countries (Argentina, Costa Rica, Mexico, and Panama) and Spain. PATIENTS: The study included 205 patients (84 with acute pain, 121 with chronic pain) from Latin America. Their data were compared with those of 282 Spanish patients. INTERVENTIONS: The McGill Pain Questionnaire, visual analog scale, and verbal rating scale were administered once to all patients. The McGill Pain Questionnaire was administered again to patients from Latin America countries to ascertain descriptor comprehension. OUTCOME MEASURES: Demographic data, McGill Pain Questionnaire parameters, and visual analog scale and a verbal rating scale scores were obtained from patients with chronic and acute pain. Psychometric properties of the Spanish version of the McGill Pain Questionnaire were established for each country by calculating the ordinal consistency by means of rank-scale correlation (Spearman test), intercategory correlation, and interparameter correlation (Pearson test). Concurrent validity was also calculated by comparing scores from the visual analog scale (Pearson test) and verbal rating scale (Spearman test) with questionnaire parameters (qualitative-to-quantitative comparisons). RESULTS: The Spanish version of the McGill Pain Questionnaire maintained a high internal validity when tested in different countries. Ordinal consistency, intercategory, interparameter, and qualitative-to-quantitative parameter correlations were similar in all countries. Few descriptors were considered to be inappropriate or difficult to understand. CONCLUSIONS: The psychometric properties of the Spanish version of the McGill Pain Questionnaire assessed in different Latin-American countries suggest that the questionnaire may be used to evaluate Spanish-speaking patients. The validity of this test should be extended with reliability studies to further establish its usefulness in the evaluation of pain.

Erythrocyte Fy antigen phenotyping helps differentiate so-called benign tertian malarias.

Isolated cases of malaria are increasing in frequency in nonendemic countries. Blood film examination remains a mainstay of diagnosis of these sporadic cases because immunologic and molecular methods are unavailable, expensive, and problematic. Two tertian malarial species, Plasmodium vivax and Plasmodium ovale, may appear to be similar morphologically. Plasmodium ovale infection is infrequent, and misdiagnosis of this species is common. Plasmodium vivax infection can be ruled out, however, if a patient's erythrocytes phenotype as Fy(a-b-), because these cells completely resist entry by the latter species.

Distinguishing full siblings from half-siblings in limited pedigrees.

BACKGROUND: Full siblings were compared with half-siblings to observe how well the two relationships could be distinguished by informative tests. STUDY AND DESIGN METHODS: Parentage analysis ascertained 25 pairs of full siblings and 25 pairs of half-siblings. The pairs were then examined for the sharing of alleles at three independent variable number of tandem repeat (VNTR) loci. A sibling index (SI) and a half-sibling index (HSI) were calculated for each pair, and an SI:HSI ratio was determined. RESULTS: The SI:HSI ratio favored full siblings in 18 of 25 full sibling pairs. The SI:HSI ratio exceeded 100 in 8 of those 25 pairs. Although the ratio favored half-siblings in 23 of 25 half-sibling pairs, as was expected with the use of only 3 loci, it exceeded 0.1 in all 25 pairs. CONCLUSION: Study of more than three highly informative loci is required to improve the identification of full siblings and might well permit the identification of half-siblings.

Risk investigations involving genetic identification.

Risk managers should consider misidentifications as causes of otherwise unexplained diagnostic and process errors. Genetic tests are powerful tools that can resolve problem cases and indicate ways to improve patient-sample identification. Genetic typing, especially for DNA markers, has provided evidence of patient or sample identity in 21 of 22 hospital and laboratory cases of accidental or intentional patient misidentification, specimen mislabeling, and sample contamination. Identity is established with very high probability if infrequent genetic markers are observed in both unknown and reference specimens. The odds of a match of markers express both the infrequency of finding the match by chance (in specified populations) and the adequacy of testing. Genetic tests establish nonidentity with virtual certainty.

Disposables as sources of preanalytical contamination and misdiagnosis.

Laboratory samples from two different patients produced false-positive results. Investigations indicated that the errors were produced by a combination of miniscule preanalytical contamination of disposables, suboptimal systems design, and very sensitive analytical systems. The errors may be avoidable by changing the configuration of workstations.