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1.
Artigo em Inglês | MEDLINE | ID: mdl-31551518

RESUMO

We aimed at analyzing the outcome of allogeneic stem cell transplant (ASCT) in adult patients with acute lymphoblastic leukemia (ALL), comparing Haploidentical (Haplo) with HLA-matched (sibling and unrelated) donors. Between 2008 and 2017, we collected data from 236 patients (median age 31 years; range 16-64; 90% HCT-CI 0-1) who underwent unmanipulated ASCT in first complete remission and subsequent remissions in 15 Argentinian centers. Donors were HLA-matched (n = 175; 74%) and Haplo (n = 61; 26%). Two-year overall survival (OS) was 55% (95% CI 47-63) for the HLA-matched group and 49% (95% CI 34-62) for the Haplo group (p = 0.351). For OS, crude HR, adjusted HR for covariates (HR 1.24; 95% CI 0.77-1.99; p = 0.363) and HR including a propensity score in the model (HR 1.22; 95% CI 0.71-2.08; p = 0.414) showed no impact of donor category on the OS. No difference was found in terms of nonrelapse mortality, relapse, leukemia-free survival, and grade 3-4 acute graft-versus-host disease (GVHD); 2-year incidence of chronic GVHD was higher in HLA-matched vs Haplo group (p = 0.028). Patients with ALL who underwent ASCT were young subjects with low HCT-CI. In this setting, a Haplo donor represents an alternative widely available in the absence of an HLA-matched donor. Relapse remains a challenge for all donor categories.

2.
Artigo em Inglês | MEDLINE | ID: mdl-31435033

RESUMO

Allogeneic stem cell transplant (alloSCT) is a current treatment option for patients with refractory/relapsed classic Hodgkin lymphoma (CHL), including those who have failed an autologous transplantation. We performed a retrospective multicenter analysis of 113 patients (median age 28 years; range 14-56; 54% males) with refractory/relapsed (R/R) CHL who had undergone alloSCT in Argentina. Kaplan-Meier was used to estimate overall (OS) and progression-free survival (PFS). Relapse rate (RR) and non-relapse mortality (NRM) were estimated with cumulative incidence analysis. Disease status at transplant was complete remission (CR) in 39%, partial remission (PR) in 44%, and stable/progressed disease (S/PD) in 17% of the patients. Donor type was matched related (MRD) in 60%, unrelated (URD) in 19%, and haploidentical (HID) in 21% of the patients. OS and PFS at 2 years were 43% and 27%, respectively, for all the cohort. In the univariate analysis, patients in CR showed better OS (p ≤ 0.001) and PFS (p ≤ 0.001), and lower NRM (p = 0.04). HID had better PFS (p = 0.04) and lower RR (p = 0.02). In the multivariate analysis, CR showed a significant impact on OS and PFS, and HID on PFS. AlloSCT is a feasible procedure in patients with CHL. Those in CR at the time of the transplant had better outcomes. Haploidentical transplantation is associated with better PFS in these patients with poor prognosis.

4.
Retin Cases Brief Rep ; 12(3): 181-183, 2018 Summer.
Artigo em Inglês | MEDLINE | ID: mdl-27828901

RESUMO

PURPOSE: To report on a case of Fusarium solani subretinal abscess in a patient with acute myeloid leukemia treated with an allogenic bone marrow transplant. METHODS: A 47-year-old male with a history of acute myeloid leukemia with intermediate cytogenetic risk was admitted in our hospital. The disease relapsed after two cycles of chemotherapy. He was then treated with an allogenic bone marrow transplant, with busulfan, cyclophosphamide, and thymoglobulin. One week after the procedure, a sepsis of unknown origin in neutropenia occurred. Blood cultures and sputum were negative for bacteria and fungi. At the eighth week after the procedure, the patient had acute vision loss of the right eye. Funduscopy in the right eye revealed an inferior temporal yellowish white elevated lesion of approximately 10 disk areas and superficial perifoveal and perilesional hemorrhages. RESULTS: Vitrectomy was performed and samples from the vitreous and the subretinal abscess material were sent for analysis. Vitreous and subretinal specimens grew colonies of a fungus morphologically consistent with F. solani. CONCLUSION: Fusarium solani should be included in the differential diagnosis of subretinal abscesses.


Assuntos
Abscesso/microbiologia , Infecções Oculares Fúngicas/microbiologia , Fusarium/isolamento & purificação , Leucemia Mieloide Aguda/complicações , Doenças Retinianas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade
5.
Biol Blood Marrow Transplant ; 23(10): 1646-1650, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28669923

RESUMO

The hematopoietic cell transplantation-specific comorbidity index (HCT-CI) score is a useful tool to assess the risk for nonrelapse mortality (NRM) after allogeneic hematopoietic stem cell transplantation. Although the HCT-CI has been investigated in autologous stem cell transplantation (ASCT), its use is limited. To improve on the current use of the HCT-CI score on the morbidity and mortality after ASCT, we assessed the 100-day morbidity defined as orotracheal intubation (OTI), dialysis or shock (vasopressors need), 100-day NRM, early composite morbidity-mortality (combined endpoint that included any previous endpoints), and long-term NRM. We retrospectively reviewed a cohort of 1730 records of adult patients who received an ASCT in Argentinean center's between October 2002 and August 2016. Median follow-up was 1.15 years, and median age was 53 years. Diseases were multiple myeloma (48%), non-Hodgkin lymphoma (27%), and Hodgkin lymphoma (17%); 51% were in complete or partial remission; and 13% received ≥ 3 chemotherapy lines before transplant (heavily pretreated). Early NRM (100-day) was 2.7%, 5.4% required OTI, 4.5% required vasopressors, and 2.1% dialysis, with an early composite morbidity-mortality of 6.8%. Long-term (1 and 3 years) NRM was 4% and 5.2% and overall survival 89% and 77%, respectively. High-risk HCT-CI patients had a significant increase in 100-day NRM compared with intermediate and low risk (6.1% versus 3.4% versus 1.8%, respectively; P = .002), OTI (11% versus 6% versus 4%, P = .001), shock (8.7% versus 5.8% versus 3%, P = .001), early composite morbidity-mortality (13% versus 9 % versus 4.7%, P < .001), and long-term NRM (1 year, 7.7% versus 4% versus 3.3%; and 3 years, 10.8% versus 4% versus 4.8%, respectively; P = .002). After multivariate analysis these outcomes remained significant: early composite morbidity-mortality (odds ratio [95% confidence interval] compared with low risk: intermediate risk 2.1 [1.3 to 3.5] and high risk 3.3 [1.9 to 5.9]) and NRM (hazard ratio [95% confidence interval] compared with low risk: intermediate risk .97 [.8 to 2.4] and high risk 3.05 [1.3 to 4.5]). No significant impact was observed in overall survival. Other than comorbidities, significant impact was observed for heavily pretreated patients, age ≥ 55 years, non-Hodgkin lymphoma, and bendamustine-etoposide-citarabine-melphalan conditioning. We confirmed that the HCT-CI had a significant impact on NRM after ASCT, and these findings are mainly due to early toxicity express as 100-day NRM and the 3 main morbidity outcomes as well as the composite endpoint.


Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Prognóstico , Adolescente , Adulto , Idoso , Comorbidade , Feminino , Transplante de Células-Tronco Hematopoéticas/mortalidade , Doença de Hodgkin/terapia , Humanos , Linfoma não Hodgkin/terapia , Masculino , Pessoa de Meia-Idade , Mortalidade , Mieloma Múltiplo/terapia , Estudos Retrospectivos , Medição de Risco/métodos , Transplante Autólogo , Adulto Jovem
7.
8.
Cancer Epidemiol ; 44 Suppl 1: S158-S167, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27678318

RESUMO

RATIONALE AND OBJECTIVE: Hodgkin lymphoma (HL) is largely curable owing to improvements in treatment since the 1960s; nevertheless, high mortality rates have been reported in Central and South America. We describe the current burden of HL in the Central and South American region. METHODS: We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries, and national-level mortality data from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence rates (ASRs) and age-standardized mortality rates (ASMRs) per 100,000 person-years for 2003-2007 and present distributions by histological subtype. RESULTS: HL incidence rates varied 7-fold in males and 11-fold in females (male-to-female ratio 1:1-2.5:1). The highest ASRs were seen Argentina, Brazil, Costa Rica (males), Cuba (males) and Uruguay (females), whereas the lowest were in Bolivia and El Salvador. ASMRs varied by 4-fold in males and 6-fold in females (male-to-female ratio 1:1-4.3:1), with ASMRs <0.7 for most countries, except Cuba (≥1.0). In most countries, age-specific incidence rates of HL showed a bimodal pattern. Trends in HL in Argentina, Brazil, Chile, and Costa Rica remained stable in 1997-2008. Of all HL cases, 48% were unspecified as to histological subtype. Nodular sclerosis and mixed cellularity were the most frequent histologies. CONCLUSION: The geographic variation in HL across the region may in part reflect differences in data quality and coverage, and differences in the adoption of modern therapies and healthcare access. Our results highlight the need for high-quality data and increased coverage in order to provide vital guidance for future cancer control activities.

9.
Hematology ; 21(3): 162-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26147089

RESUMO

INTRODUCTION: Allogeneic hematopoietic stem cell transplantation (AHSCT) is a curative approach for patients with myelodysplastic syndrome (MDS). METHODS: In this multicenter retrospective study, we analyzed the outcome of adult patients with MDS who underwent AHSCT in Argentina and evaluated the prognostic factors associated with progression-free survival (PFS), overall survival (OS), cumulative incidence (CI) of relapse, and non-relapse mortality (NRM). RESULTS: We analyzed data from 87 adults (median age: 43 years, range 18-66) who underwent SCT after myeloablative (n = 60) or non-myeloablative conditioning (n = 27), and from related (n = 62) or unrelated (n = 25) donors. For all patients, unadjusted 4-year PFS and OS were 37% and 38%, respectively; no significant differences were found between recipients of related or unrelated donors. One-year CI of relapse and NRM were 21% and 20%, respectively. In the multivariate analysis, intermediate disease risk index (DRI) and acute graft versus host disease AGVHD of all grades (I-IV) were independent variables associated with better PFS and lower relapse CI; only intermediate DRI was associated with better OS. CONCLUSIONS: AHSCT is a feasible procedure in Argentina, with more than 30% of the patients achieving long-term survival. Recipients with unrelated donors had at least similar outcome than those with related donors. DRI may be useful to identify patients at higher risk of relapse after transplantation.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Síndromes Mielodisplásicas/mortalidade , Síndromes Mielodisplásicas/terapia , Adolescente , Adulto , Idoso , Aloenxertos , Argentina/epidemiologia , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida
10.
Medicina (B Aires) ; 75(4): 201-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26339873

RESUMO

We have retrospectively reviewed 137 medical records of patients older than 50 years receiving an allogeneic hematopoietic stem cell transplantation (HSCT) between January 1997 and July 2013. Median follow up was 1.3 years. Sex, age, diagnosis, disease stage, comorbidities (according to HCT-CI score), type of donor, histocompatibility, conditioning regimen and graft-versus-host disease (GVHD) prophylaxis were evaluated. The incidence and severity of acute and chronic GVHD, overall survival (OS), disease free survival (DFS), non-relapse mortality (NRM) and relapse were investigated according those variables. Acute GVHD incidence was 41% (7.3% GIII-IV). Patients with acute myeloid leukemia had lesser aGVH GII-IV (14% vs. 35%, p<0.01) comparing to the entire population. Extensive cGVHD incidence was 9.4%. Global OS 1-3 years was 44-20%, DFS 33-20%, relapse 35-41% and NRM 36-43% respectively. The presence of comorbidities showed a significant increase in NRM (CT-CI 0 vs. 1 vs ≥2: 1-3 years 17-24% vs. 40-46% vs. 45-67%, p=0.001, MA HR 2.03, CI 95% 1.02-5.29), as well as cyclosporine vs. tacrolimus (1-3 years 47-53% vs. 25-36%, p=0.01). Tacrolimus patients had higher 1-3 years OS (49-25% vs. 31-13%, p=0.01) and DFS (41-26% vs. 20-11%, p<0.01). Age, type of donor and myeloablative conditioning showed no significant differences in any outcome. Allogeneic HSCT is a valid therapeutic option for older patients in Argentina. The main risk factor for a significantly increased NRM and a trend to inferior OS was the number of comorbidities. Age was not a factor for a worse result. The other factor having a significant effect in better outcome was tacrolimus administration.


Assuntos
Doença Enxerto-Hospedeiro/mortalidade , Transplante de Células-Tronco Hematopoéticas/mortalidade , Fatores Etários , Idoso , Ciclosporina/uso terapêutico , Feminino , Doença Enxerto-Hospedeiro/prevenção & controle , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tacrolimo/uso terapêutico , Fatores de Tempo
11.
Medicina (B.Aires) ; 75(4): 201-206, Aug. 2015. graf, tab
Artigo em Inglês | LILACS-Express | ID: biblio-841495

RESUMO

We have retrospectively reviewed 137 medical records of patients older than 50 years receiving an allogeneic hematopoietic stem cell transplantation (HSCT) between January 1997 and July 2013. Median follow up was 1.3 years. Sex, age, diagnosis, disease stage, comorbidities (according to HCT-CI score), type of donor, histocompatibility, conditioning regimen and graft-versus-host disease (GVHD) prophylaxis were evaluated. The incidence and severity of acute and chronic GVHD, overall survival (OS), disease free survival (DFS), non-relapse mortality (NRM) and relapse were investigated according those variables. Acute GVHD incidence was 41% (7.3% GIII-IV). Patients with acute myeloid leukemia had lesser aGVH GII-IV (14% vs. 35%, p < 0.01) comparing to the entire population. Extensive cGVHD incidence was 9.4%. Global OS 1-3 years was 44-20%, DFS 33-20%, relapse 35-41% and NRM 36-43% respectively. The presence of comorbidities showed a significant increase in NRM (CT-CI 0 vs. 1 vs ≥ 2: 1-3 years 17-24% vs. 40-46% vs. 45-67%, p = 0.001, MA HR 2.03, CI 95% 1.02-5.29), as well as cyclosporine vs. tacrolimus (1-3 years 47-53% vs. 25-36%, p = 0.01). Tacrolimus patients had higher 1-3 years OS (49-25% vs. 31-13%, p = 0.01) and DFS (41-26% vs. 20-11%, p < 0.01). Age, type of donor and myeloablative conditioning showed no significant differences in any outcome. Allogeneic HSCT is a valid therapeutic option for older patients in Argentina. The main risk factor for a significantly increased NRM and a trend to inferior OS was the number of comorbidities. Age was not a factor for a worse result. The other factor having a significant effect in better outcome was tacrolimus administration.


Se efectuó un análisis retrospectivo de 137 historias clínicas de pacientes mayores de 50 años que recibieron un trasplante alogénico de precursores hematopoyéticos (TAPH). Se evaluaron las siguientes características: sexo, edad, enfermedad, estadio, comorbilidades (según el HCT-CI), donante, acondicionamiento e inmunosupresión. Se analizó la incidencia de enfermedad injerto vs. huésped aguda (aEICH) y crónica (cEICH), supervivencia global (SG), supervivencia libre de enfermedad (SLE), recaída y mortalidad libre de enfermedad (MLE). Los trasplantes fueron realizados entre 1997-2013, mediana de seguimiento 1.3 años. La incidencia de aEICH fue de 41% (7.3% GIII-IV). Los pacientes con leucemia mieloide aguda presentaron menor incidencia de EICHa GII-IV (14% vs. 34%, p < 0.01). La incidencia de EICHc extenso fue de 9.4%. La SG a 1-3 años fue 44-20%, SLE 33-20%, recaída 35-41% y la MLE 36-43%. Los pacientes con comorbilidades tuvieron un aumento significativo de la MLE (HCT-CI 0 vs. 1 vs. ≥2: 1-3 años 17-24% vs. 40-46% vs. 45-67%, p = 0.001, AMV HR 2.03, IC 95% 1.02-5.29), al igual que el uso de ciclosporina vs. tacrolimus (1-3 años 47-53% vs. 25-36%, p = 0.01). Los pacientes que recibieron tacrolimus tuvieron una mayor SG (1-3 años 49-25% vs. 31-13%, p = 0.01) y SLE (1-3 años 41-26% vs. 20-11%, p < 0.01). La edad, tipo de donante y acondicionamiento no resultaron significativos para ningún evento. El TAPH es una herramienta terapéutica válida en pacientes mayores. Los factores pronósticos que inciden mayormente en el trasplante son las comorbilidades y no la edad. El otro factor que demostró un efecto significativo fue el uso de tacrolimus.

12.
Clin Transplant ; 27(4): E469-77, 2013 Jul-Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23758407

RESUMO

Post-transplant lymphoproliferative disorder (PTLD) is a major and potentially life-threatening complication after solid-organ transplantation. The aim of this study was to describe the disease characteristics, clinical practices, and survival related to PTLD in adult orthotopic liver transplant (OLT) recipients in South America. We conducted a survey at four different transplant groups from Argentina, Brazil, and Chile. Among 1621 OLT recipients, 27 developed PTLD (1.7%); the mean age at diagnosis was 53.7 (± 14) yr with a mean time of 39.7 (± 35.2) months from OLT to PTLD diagnosis. Initial therapy included reduction in immunosuppression alone in 23.1% of the patients. Either rituximab or chemotherapy was employed as initial or second-line therapy in 76.9% of the patients. PTLD location was frequently extranodal (80.7%) and mostly involving the transplanted liver (59.3%). The overall survival at one and five yr post-PTLD diagnosis was 53.8% and 46.2%, respectively. Significant univariate risk factors for post-PTLD mortality included lactate dehydrogenase ≥ 250 U/L (HR 9.66, p = 0.02), stage III/IV PTLD (HR 5.34, p = 0.004), and HCV infection (HR 7.68, p = 0.01). In conclusion, PTLD in OLT adult recipients is predominantly extranodal, and although mortality is high, long-term survival is possible.


Assuntos
Rejeição de Enxerto/etiologia , Imunossupressores/uso terapêutico , Falência Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Transtornos Linfoproliferativos/etiologia , Complicações Pós-Operatórias , Adulto , Idoso , Feminino , Seguimentos , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/mortalidade , Humanos , Transplante de Fígado/mortalidade , Transtornos Linfoproliferativos/tratamento farmacológico , Transtornos Linfoproliferativos/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , América do Sul , Taxa de Sobrevida , Fatores de Tempo , Adulto Jovem
13.
Perspect. bioét ; 18(34): 97-127, ene.-jun. 2013.
Artigo em Espanhol | BINACIS | ID: bin-130143

RESUMO

La problemática de los bancos de sangre de cordón umbilical, y en particular, la colecta de sangre del cordón umbilical plantea una serie de cuestiones científicas, médicas, éticas y de salud pública. En la Argentina existe un desconocimiento generalizado sobre qué es dicha colecta, para qué se puede realizar, y qué resultados se esperan de ella. Se relata un caso, elaborado a partir de experiencias reales, cuyo objetivo es que el lector se acerque a la problemática desde una situación concreta


Assuntos
Humanos , Feminino , Bancos de Sangue/ética , Cordão Umbilical , Temas Bioéticos , Argentina , Relatos de Casos
14.
Perspect. bioét ; 18(34): 97-127, ene.-jun. 2013.
Artigo em Espanhol | LILACS | ID: lil-715152

RESUMO

La problemática de los bancos de sangre de cordón umbilical, y en particular, la colecta de sangre del cordón umbilical plantea una serie de cuestiones científicas, médicas, éticas y de salud pública. En la Argentina existe un desconocimiento generalizado sobre qué es dicha colecta, para qué se puede realizar, y qué resultados se esperan de ella. Se relata un caso, elaborado a partir de experiencias reales, cuyo objetivo es que el lector se acerque a la problemática desde una situación concreta


Assuntos
Humanos , Feminino , Argentina , Temas Bioéticos , Bancos de Sangue/ética , Cordão Umbilical , Relatos de Casos
15.
Rev. am. med. respir ; 13(1): 35-43, mar. 2013.
Artigo em Espanhol | BINACIS | ID: bin-130776

RESUMO

La comunicación entre médicos y pacientes es un aspecto fundamental de la atención de los individuos gravemente enfermos, sin embargo la mayoría de los médicos han tenido poca formación en comunicación. Los aspectos de comunicación más valorados por los pacientes son los que los ayudan a ellos y a sus familias a sentirse guiados, los que apuntan a fomentar la confianza y los que alimentan la esperanza. Si bien estas pueden ser consideradas cualidades abstractas, se derivan de un conjunto concreto de habilidades comunicacionales que (al menos hasta cierto punto) puede ser efectivamente enseñado y aprendido. Estas habilidades comunicacionales no son las mismas aptitudes de la "entrevista médica" que la mayoría de los profesionales aprendió en la escuela de medicina, y que están centradas en la consideración de los antecedentes médicos completos y los aspectos sociales y familiares. Las habilidades de comunicación necesarias en el tratamiento de enfermedades potencialmente graves son habilidades de segundo orden que se centran en situaciones difíciles. Una amplia variedad de estudios empíricos documentan que la comunicación médicopaciente es menos que óptima. Los médicos y las enfermeras no llegan a captar la totalidad de la gama de preocupaciones que afectan a las personas con enfermedades potencialmente graves, lo que aumenta el sufrimiento de los pacientes y sus seres queridos. Este trabajo analiza los problemas éticos que se suscitan en torno de esta situación comunicativa.(AU)


Patient-physician communication is a fundamental aspect of critically ill patients´ care, nevertheless many doctors lack proper training in this area. Communication aspects most valued by patients are those that help them and their families to feel guided, those aimed at building confidence and fueling hope. While these qualities can be considered abstract, they are derived from a specific set of communication skills that can be effectively taught and learned, at least to some extent. These communication skills are not the same skills of the "medical interview", which most professionals learn in medical schools and are focused on knowing a complete medical history as well as other social and family aspects. Communication skills necessary in treating potentially serious diseases are second order skills, focused on difficult situations. A wide variety of empirical studies shows that physician-patient communication is less than optimal. Doctors and nurses fail to capture the full range of concerns affecting people with potentially serious diseases, increasing the suffering of patients and their loved ones. This paper analyzes the ethical issues that arise from this failure in communication.(AU)

16.
Rev. am. med. respir ; 13(1): 35-43, mar. 2013.
Artigo em Espanhol | LILACS | ID: lil-694811

RESUMO

La comunicación entre médicos y pacientes es un aspecto fundamental de la atención de los individuos gravemente enfermos, sin embargo la mayoría de los médicos han tenido poca formación en comunicación. Los aspectos de comunicación más valorados por los pacientes son los que los ayudan a ellos y a sus familias a sentirse guiados, los que apuntan a fomentar la confianza y los que alimentan la esperanza. Si bien estas pueden ser consideradas cualidades abstractas, se derivan de un conjunto concreto de habilidades comunicacionales que (al menos hasta cierto punto) puede ser efectivamente enseñado y aprendido. Estas habilidades comunicacionales no son las mismas aptitudes de la "entrevista médica" que la mayoría de los profesionales aprendió en la escuela de medicina, y que están centradas en la consideración de los antecedentes médicos completos y los aspectos sociales y familiares. Las habilidades de comunicación necesarias en el tratamiento de enfermedades potencialmente graves son habilidades de segundo orden que se centran en situaciones difíciles. Una amplia variedad de estudios empíricos documentan que la comunicación médicopaciente es menos que óptima. Los médicos y las enfermeras no llegan a captar la totalidad de la gama de preocupaciones que afectan a las personas con enfermedades potencialmente graves, lo que aumenta el sufrimiento de los pacientes y sus seres queridos. Este trabajo analiza los problemas éticos que se suscitan en torno de esta situación comunicativa.


Patient-physician communication is a fundamental aspect of critically ill patients´ care, nevertheless many doctors lack proper training in this area. Communication aspects most valued by patients are those that help them and their families to feel guided, those aimed at building confidence and fueling hope. While these qualities can be considered abstract, they are derived from a specific set of communication skills that can be effectively taught and learned, at least to some extent. These communication skills are not the same skills of the "medical interview", which most professionals learn in medical schools and are focused on knowing a complete medical history as well as other social and family aspects. Communication skills necessary in treating potentially serious diseases are second order skills, focused on difficult situations. A wide variety of empirical studies shows that physician-patient communication is less than optimal. Doctors and nurses fail to capture the full range of concerns affecting people with potentially serious diseases, increasing the suffering of patients and their loved ones. This paper analyzes the ethical issues that arise from this failure in communication.


Assuntos
Bioética , Comunicação em Saúde , Relações Médico-Paciente
17.
Haematologica ; 95(2): 276-83, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19713222

RESUMO

BACKGROUND: Many genetic factors play major roles in the outcome of hematopoietic stem cell transplants from unrelated donors. Transforming growth factor beta1 is a member of a highly pleiotrophic family of growth factors involved in the regulation of numerous immunomodulatory processes. DESIGN AND METHODS: We investigated the impact of single nucleotide polymorphisms at codons 10 and 25 of TGFB1, the gene encoding for transforming growth factor beta1, on outcomes in 427 mye-loablative-conditioned transplanted patients. In addition, transforming growth factor beta1 plasma levels were measured in 263 patients and 327 donors. RESULTS: Patients homozygous for the single nucleotide polymorphism at codon 10 had increased non-relapse mortality (at 3 years: 46.8% versus 29.4%, P=0.014) and reduced overall survival (at 5 years 29.3% versus 42.2%, P=0.013); the differences remained statistically significant in multivariate analysis. Donor genotype alone had no impact, although multiple single nucleotide polymorphisms within the pair were significantly associated with higher non-relapse mortality (at 3 years: 44% versus 29%, P=0.021) and decreased overall survival (at 5 years: 33.8% versus 41.9%, P=0.033). In the 10/10 HLA matched transplants (n=280), recipients of non-wild type grafts tended to have a higher incidence of acute graft-versus-host disease grades II-IV (P=0.052). In multivariate analysis, when analyzed with patients' genotype, the incidences of both overall and grades II-IV acute graft-versus-host disease were increased (P=0.025 and P=0.009, respectively) in non-wild-type pairs. CONCLUSIONS: We conclude that increasing numbers of single nucleotide polymorphisms in codon 10 of TGFB1 in patients and donors are associated with a worse outcome following hematopoietic stem cell transplantation from unrelated donors.


Assuntos
Doença Enxerto-Hospedeiro/genética , Transplante de Células-Tronco Hematopoéticas , Polimorfismo de Nucleotídeo Único , Fator de Crescimento Transformador beta1/genética , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Análise de Sobrevida , Fator de Crescimento Transformador beta1/sangue , Transplante Homólogo , Resultado do Tratamento
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