Quality of life and disease experience in patients with heart failure with reduced ejection fraction in Spain: a mixed-methods study.

OBJECTIVES: To gather insights on the disease experience of patients with heart failure (HF) with reduced ejection fraction (HFrEF), and assess how patients' experiences and narratives related to the disease complement data collected through standardised patient-reported outcome measures (PROMs). Also, to explore new ways of evaluating the burden experienced by patients and caregivers. DESIGN: Observational, descriptive, multicentre, cross-sectional, mixed-methods study. SETTING: Secondary care, patient's homes. PARTICIPANTS: Twenty patients with HFrEF (New York Heart Association (NYHA) classification I-III) aged 38-85 years. MEASURES: PROMs EuroQoL 5D-5L (EQ-5D-5L) and Kansas City Cardiomyopathy Questionnaire and patient interview and observation. RESULTS: A total of 20 patients with HFrEF participated in the study. The patients' mean (SD) age was 72.5 (11.4) years, 65% were male and were classified inNYHA functional classes I (n=4), II (n=7) and III (n=9). The study showed a strong impact of HF in the patients' quality of life (QoL) and disease experience, as revealed by the standardised PROMs (EQ-5D-5L global index=0.64 (0.36); Kansas City Cardiomyopathy Questionnaire total symptom score=71.56 (20.55)) and the in-depth interviews. Patients and caregivers often disagreed describing and evaluating perceived QoL, as patients downplayed their limitations and caregivers overemphasised the poor QoL of the patients. Patients related current QoL to distant life experiences or to critical moments in their disease, such as hospitalisations. Anxiety over the disease progression is apparent in both patients and caregivers, suggesting that caregiver-specific tools should be developed. CONCLUSIONS: PROMs are an effective way of assessing symptoms over the most recent time period. However, especially in chronic diseases such as HFrEF, PROM scores could be complemented with additional tools to gain a better understanding of the patient's status. New PROMs designed to evaluate and compare specific points in the life of the patient could be clinically more useful to assess changes in health status.

Tercer caso de vasculitis leucocitoclástica cutánea secundaria al uso de oxacilina: reporte de caso / Third case in the literature of cutaneous leukocytoclastic vasculitis secondary to oxacilin use

Resumen La vasculitis leucocitoclastica es una patologìa que compromete los vasos pequeños y cuya causa predominantemente se ha descrito como idiopatica. Se presenta el caso de una mujer de 78 años hipertensa, diabética y con enfermedad renal crónica en estadio 5, que presentó lesiones limitadas a la piel posterior a la administración de oxacilina para manejo de bacteremia por SAMS. La presentación clínica se basó en purpuras palpables predominantemente en miembros inferiores y lesiones dolorosas coalescentes que formaban ampollas de contenido hemorrágico. Estas lesiones resolvieron gradualmente después del cambio de la terapia mencionada anteriormente. La biopsia fue compatible con vasculitis leucocitoclástica, con paraclínicos que descartaron causas infecciosas y autoinmunes.

Abstract Leukocytoclastic vasculitis is a pathology that involves small vessels and whose cause has been predominantly described as idiopathic. The clinical case of a 78-year-old woman with hypertension, diabetic and chronic stage 5 kidney disease, who presented limited skin lesions after administration of oxacillin for management of bacteremia by MSSA. The clinical presentation consisted on palpable purpura predominantly in the lower limbs and painful coalescent lesions that formed blisters of hemorrhagic content. Lesions gradually resolved after the change of the therapy mentioned above. The biopsy was compatible with leukocytocastic vasculitis, with paraclinics who ruled out infectious and autoimmune causes.

Criptococosis y linfocitopenia T CD4 idiopática: Reporte de un caso / Cryptococcosis and idiopathic CD4 T lymphocytopenia: A case report

Resumen La linfocitopenia T CD4 idiopática (LCI) es un síndrome clínico inusual que se caracteriza por un déficit de células T CD4+ circulantes en ausencia de infección por VIH u otra condición de inmunosupresión. Los pacientes con dicha enfermedad pueden presentarse asintomáticos o con infecciones oportunistas, las más frecuentes son por criptococo, micobacterias o virales como herpes zoster. Presentamos el caso de un hombre de 32 años, sin antecedentes, en quien se descartó infección por retrovirus, con recuento de linfocitos T CD4+ menor a 300 células/m3; se diagnosticó LCI posterior al diagnóstico de criptococomas cerebrales mediante hallazgos imagenológicos los cuales fueron congruentes con estudios microbiológicos.

Summary Idiopathic CD4 T lymphocytopenia (ICL) is an unusual clinical syndrome characterized by a deficit of circulating CD4 + T cells in the absence of HIV infection or another immunosuppression condition. Patients with this disease may present asymptomatic or with opportunistic infections, the most frequent are cryptococcus, mycobacteria or viral such as herpes zoster. We present a case of a 32-year-old man with no prior disease, in whom retrovirus infection was discarded, with CD4 + T lymphocyte count less than 300 cells/m3; ICL was diagnosed after the diagnosis of brain cryptococomas by imaging findings which were consistent with microbiological studies.

Validation of the FACT-Lym scale to measure quality of life in Colombian patients with lymphoma / Validación de la escala FACT-Lym para la evaluación de la calidad de vida en pacientes colombianos con linfoma

Abstract Introduction: Instruments for measuring quality of life must be validated before being used in different cultural contexts. There is a specific scale (FACT-Lym) to assess health-related quality of life (HRQOL) in patients with lymphoma, but it has not been validated in Colombia yet. Objective: To determine the clinimetric properties of the FACT-Lym scale in Colombian patients with lymphoma. Materials and methods: A validation study of a scale was conducted based on the classical test theory. The FACT-Lym scale was administered to 301 patients diagnosed with different types of lymphomas and treated at the National Cancer Institute of Colombia, and their sociodemographic and clinical data were recorded. The statistical analysis included exploratory factor analysis, confirmatory factor analysis, construct validity, internal consistency, test-re-test reliability and sensitivity to change. Results: The exploratory factor analysis confirmed a two-factor structure of the scale, while the confirmatory analysis showed adequate adjustment of the model. Internal consistency was measured using the Cronbach's alpha coefficient (>0.8 on the global scale and on each of the factors). Correlation values significantly different from zero were found between the FACT-Lym scale and the FACT-G scale domains. No significant changes were observed in any domain of the FACT-Lym scale after the completion or suspension of treatment. Conclusions: The validation of the FACT-Lym questionnaire in Colombia showed it has a consistent factorial structure and adequate reliability. However, its sensitivity to change should be verified by evaluating its performance in other patient groups.

Resumen Introducción. Los instrumentos para medir la calidad de vida se deben validar antes de ser utilizados en diferentes contextos culturales. En la actualidad existe una escala específica (FACT-Lym) para medir la calidad de vida en pacientes con linfoma, sin embargo esta no ha sido validada en Colombia. Objetivo. Establecer las propiedades clinimétricas de la escala FACT-Lym en pacientes colombianos con linfoma. Materiales y métodos. Se realizó un estudio de validación de escalas según la teoría clásica de test. Se aplicó la escala FACT-Lym a 301 pacientes del Instituto Nacional de Cancerología diagnosticados con diferentes tipos de linfoma y se registraron sus datos sociodemográficos y clínicos. El análisis estadístico incluyó análisis factorial exploratorio, análisis factorial confirmatorio, validez de constructo, consistencia interna, confiabilidad test re-test y sensibilidad al cambio. Resultados. El análisis factorial exploratorio confirmó una estructura de dos factores de la escala, mientras que el análisis confirmatorio mostró un adecuado ajuste del modelo estructural. La consistencia interna se midió con el coeficiente alfa de Cronbach (>0.8 en la escala global y en cada uno de los factores). Se encontraron valores de correlación significativamente diferentes a cero entre la FACT-Lym y los dominios de la escala FACT-G. No se observaron cambios significativos en ninguno de los dominios de la FACT-Lym luego de completar o suspender el tratamiento. Conclusiones. La validación de la escala FACT-Lym en Colombia mostró que esta tiene una estructura factorial consistente y una adecuada confiabilidad. Sin embargo, su sensibilidad al cambio debe verificarse evaluando su desempeño en otras poblaciones.

Telemedicina en cáncer: nuevas alternativas / Telemedicina in Cancer: new alternatives / Telemedicina no Câncer: novas alternativas

Introducción: El cáncer ha sido reportado como la segunda causa de muerte a escala mundial. Las tecnologías de la información y comunicación son una herramienta importante para mejorar el bienestar general de los pacientes oncológicos y apoyar su proceso de atención. Objetivo: El objetivo de este artículo es brindar información actualizada y estructurada de la telemedicina en el área de oncología y de las nuevas alternativas que existen en Colombia y en el mundo, mediante una revisión documental de la literatura. Metodología: Se realizó una búsqueda de la literatura mediante Pubmed, Scielo, Web of Science, Scopus, Sciencedirect, y metabuscadores como World Wide Science Startpage (Ixquick). Se revisaron artículos desde el 2002 hasta el 2018, y la estrategia de búsqueda incluyó términos MeSH como "e-health", "telemedicine" y "neoplasms". Resultados: Se reclutaron 67 artículos; se encontró que las principales aplicaciones de la teleoncología incluyen telediagnóstico, teleconsulta, teleeducación sanitaria y profesional, teleterapia y telerrehabilitación. Conclusiones: La teleoncología mejora la calidad de vida de los pacientes oncológicos y fortalece las herramientas académicas en los profesionales de salud, al mejorar la prestación de los servicios de salud.

Introduction: Cancer has been reported as the second cause of death worldwide, information and communication technologies are useful to improve the general well-being of cancer patients and support their attention process. Objective: The aim of this article is to provide updated and structured information on telemedicine in the area of oncology and the new alternatives that exist in Colombia and in the world, through a documentary review of the literature. Methodology: A literature search was carried out by Pubmed, Scielo, Web of Science, Scopus, Sciencedirect, and metasearch engines such as World Wide Science Startpage (Ixquick). Articles were reviewed from 2002 to 2018 and the search strategy included the MeSH terms such as "e-health", "telemedicine" and "neoplasms". Results: 67 articles were recruited and it was found that the main applications of teleoncology include telediagnosis, teleconsultation, health and professional teleeducation, teletherapy and telerehabilitation. Conclusion: Teleoncology improves the quality of life of cancer patients and strengthens the academic tools of health professionals improving the provision of health services

Introdução: O Câncer tem sido relatado como a segunda causa de morte em todo o mundo; as tecnologias de informação e comunicação são úteis para melhorar o bem-estar geral dos pacientes com Câncer e apoiar seu processo de. Objetivo: O objetivo deste artigo é fornecer informações atualizadas e estruturadas sobre telemedicina na área de oncologia e as novas alternativas existentes na Colômbia e no mundo, através de uma revisão documental da literatura. Metodologia: Uma pesquisa bibliofigura foi realizada pelos motores Pubmed, Scielo, Web of Science, Scopus, Sciencedirect e metassearch, como o World Wide Science Startpage (Ixquick). Os artigos foram revisados de 2002 a 2018 e a estratégia de pesquisa incluiu termos do MeSH como "e-health", "telemedicine" e "neoplasms". Resultados: foram recrutados 67 artigos e constatou-se que as principais aplicações da teleoncologia incluem telediagnóstico, teleconsulta, teleducação profissional e em saúde, teleterapia e telerreabilitação. Conclusão: A teleoncologia melhora a qualidade de vida dos pacientes com câncer e fortalece as ferramentas atenção acadêmicas dos profissionais de saúde, melhorando a prestação de serviços de saúde