Respetando la intimidad del paciente en la ecografía escrotal / Respecting the privacy of the patient in the scrotal ultrasound

No disponible

Association between climate, pollution and hospitalization for pemphigus in the USA.

BACKGROUND: Little is known about the impact of ultraviolet exposure, climate factors and pollutants on pemphigus. AIM: To determine whether these factors are associated with pemphigus exacerbation resulting in hospitalization. METHODS: The analysis used data from the 2002-2012 National Inpatient Sample in the USA, including 68 476 920 children and adults, and measurements of relative humidity (%), ultraviolet (UV) index, outdoor air temperature and particulate matter of ≤ 2.5 or ≤ 10 µm (PM2.5 and PM10). RESULTS: Higher rates of admission primarily for pemphigus occurred during the summer and autumn months (June-November), with the highest admission rates in July and October (both 19.7 per million). There was significant statewide variation of the prevalence of hospitalization for pemphigus, with apparent hotspots located in the southwest and northeast states. Hospitalization for a primary diagnosis of pemphigus vs. other diagnosis was associated with significantly lower humidity [mean (95% confidence interval): 64.8% (63.2-66.4%) vs. 66.4% (65.6-67.3%); analysis of variance, P < 0.01) and higher temperature [58.7 (57.1-60.2) vs. 56.3 (55.8-56.7)°F, P = 0.001], UV index [6.0 (5.7-6.2) vs. 5.7 (5.6-5.7), P = 0.02], PM2.5 [12.9 (12.0-13.7) vs. 11.8 (11.5-12.0) mg/m3 , P < 0.001] and PM10 [26.2 (24.5-27.9) vs. 23.1 (22.6-23.6) mg/m3 , P < 0.001]. All associations remained significant in multilevel regression models that controlled for age, sex and race/ethnicity, except for ultraviolet index, which was associated with pemphigus hospitalization only for Hispanic patients [odds ratio (95% CI) for quartile 4: 2.07 (1.02-4.21)]. CONCLUSION: Increasing temperature, UV exposure and small particle air pollution are associated with increased hospitalization for pemphigus. Patients with pemphigus may benefit from avoidance of these potential environmental triggers.

¿Es posible humanizar la obtención de muestras de semen respetando la intimidad de los sujetos? Un estudio preliminar / It is possible to humanize the semen samples collection respecting privacy of subjects? A preliminary report

No disponible

Hospitalization, inpatient burden and comorbidities associated with bullous pemphigoid in the U.S.A.

BACKGROUND: Bullous pemphigoid (BP) is associated with significant disability and comorbid health disorders that may lead to or result from hospitalization. However, little is known about the inpatient burden and comorbidities of BP. OBJECTIVES: To obtain data on the inpatient burden and comorbidities of BP in the U.S.A. METHODS: We analysed data from the 2002 to 2012 National Inpatient Sample, including a representative 20% sample of all hospitalizations in the U.S.A. (72 108 077 adults). RESULTS: The prevalence of hospitalization for BP increased from 25·84 to 32·60 cases per million inpatients from 2002 to 2012. In multivariate logistic regression models with stepwise selection, increasing age, nonwhite ethnicity, higher median household income, being insured with Medicare or Medicaid, and increasing number of chronic conditions were all associated with hospitalization for BP (P < 0·05 for all). The top three primary discharge diagnoses for patients with a secondary diagnosis of BP were septicaemia (prevalence 5·51%, 95% confidence interval 5·03-5·99), pneumonia (4·60%, 4·19-5·01) and urinary tract infection (3·52%, 3·15-3·89). Patients with BP also had numerous autoimmune, infectious, cardiovascular and other comorbidities. Interestingly, BP was associated with multiple neuropsychiatric disorders, including demyelinating disorders, dementias (presenile, senile, vascular and other), paralysis, neuropathy (diabetic, other polyneuropathy), Parkinson disease, epilepsy, psychoses and depression. The mean annual age- and sex-adjusted in-hospital mortality rate was significantly higher in patients with a secondary diagnosis of BP compared with no BP (2·9%, range 2·8-3·9% vs. 2·1%, range 1·9-2·2%). Significant predictors of mortality in patients with BP included increasing age, nonwhite ethnicity and insurance with Medicaid or other payment status (P < 0·05 for all). CONCLUSIONS: Hospitalization for BP increased significantly between 2002 and 2012. Moreover, there were significant ethnic and healthcare disparities with respect to hospitalization and inpatient mortality from BP.

Comorbidities and inpatient mortality for pemphigus in the U.S.A.

BACKGROUND: The morbidity and mortality associated with pemphigus and its treatments have not been fully described. Previous studies have found conflicting results about certain comorbidities and were limited by small sample sizes. OBJECTIVES: To determine the morbidity and mortality from pemphigus and its treatments in the U.S.A. METHODS: We examined a cross-sectional cohort of 87 039 711 hospitalized patients in the U.S.A. to determine the inpatient comorbidities and mortality of pemphigus. RESULTS: In multivariate survey logistic regression models adjusting for age, sex and race/ethnicity, pemphigus and its treatments were associated with 39 of 122 comorbidities examined. The disorders most strongly associated with pemphigus were Cushing syndrome [adjusted odds ratio (OR) 17·23, 95% confidence interval (CI) 2·41-122·90], adrenal insufficiency (4·08, 1·71-9·73), myasthenia gravis (6·92, 2·55-18·79), mucositis (17·19, 7·73-38·22), herpes infection (7·98, 3·62-17·62), fungal infections (4·03, 3·60-4·52), insomnia (18·02, 2·46-131·88) and hidradenitis (5·34, 1·33-21·43). Among malignancies, only leukaemia (OR 1·56, 95% CI 1·08-2·24) and non-Hodgkin lymphoma (1·52, 1·15-2·03) were associated with pemphigus, but not any solid organ malignancies. Patients with a secondary diagnosis of pemphigus had higher inpatient mortality (3·20%, 95% CI 2·71-3·69) than those with a primary (1·60%, 1·29-1·91) or no (1·78%, 1·78-1·78) diagnosis of pemphigus (P < 0·001). CONCLUSIONS: Pemphigus is associated with increased inpatient mortality, likely through its association with numerous comorbid health conditions. Patients with pemphigus require improved access to dermatological care and increased screening for the myriad of comorbidities.

A brief and rapid procedure to measure the intensity of depressive symptoms in Primary Care.

INTRODUCTION: Depression occupies a substantial part of medical visit attendance. However, medical practitioners have very little time so that a brief, quick and reliable procedure to evaluate the intensity of symptoms and their changes could be useful. Our objective has been to analyze the reliability of a self-applied Visual Analogue Scale (VAS) to measure symptom intensity in depressed patients within this context. MATERIAL AND METHODS: One hundred depressed outpatients (ICD-10) stated their clinical situation on a VAS. The psychiatrist evaluated them using a Global Clinical Impression (GGI) and Hamilton Depression Rating Scale (HDRS-17). RESULTS AND CONCLUSIONS: The patient's VAS showed high correlation with the HDRS-17 and with the GCI used by the psychiatrist (r = 0.63 and r=0.58; p=0.000). This suggests that the use of a VAS in Primary Care could be useful and reliable for these purposes within the medical contexts of those having little time availability. Key-words: Depression, primary care, medical patients, assessment, evaluation.

A study of the relationship between impulsiveness and obsessiveness in the general population. Inconsistency of the idea of the spectrum.

INTRODUCTION: The obsessivity and the impulsivity as personality traits have been object of few studies on the general population. The authors outline as objective to study if such features are co-existing constructs, as advocate some authors or the opposite extremes of a continuum as assert other. MATERIAL AND METHODS: They are studied the answers to a questionnaire on obsessive traits of the personality (MIRAP) and other referred to the impulsivity as trait, also, (ECIRYC) of a random sample of 418 subject extracted of the general population. They are applied multivariate statistic analysis technical (Factorial Analysis, Correspondence Analysis, and linear Regression Analysis) to establish the type of relationship that have the two studied personality traits. RESULTS: The total scores of the MIRAP and the ECIRYC are correlated of a manner statistically significant (r = .39; p< .01). The Correspondence Analysis of those total scores distributed in deciles and two linear Regression Analysis show, also, a direct relationship between both traits that it is statistically significant. The obsessivity and the impulsivity do not correlate with the principal factor of the opposite trait. All the factors of both traits are grouped mutually in a factor in a positive way, except the impulsive factor "haste" that makes it negatively with the obsessive factor "order". CONCLUSIONS: Our results indicate that the obsessivity and the impulsivity, as personality traits, they are constructs convergent and not opposite poles of a continuum. But, simultaneously, one of the five factors of each trait ("haste" and "order"), yes are behaved as opposite extremes of a continuum, within conceptual framework, wider, of the traits to those which belong.

Un estudio de la relación entre impulsividad y obsesividad en la población general. Inconsistencia de la idea del espectro / A study of the relationship between impulsiveness and obsessivity in the general population. Inconsistency of the idea of the spectrum

Introducción. La obsesividad y la impulsividad como rasgos de la personalidad han sido objeto de pocos estudios sobre la población general. Los autores plantean como objetivo estudiar si tales rasgos son constructos coexistentes, como abogan algunos autores o los polos opuestos de un continuum como afirman otros. Material y Métodos. Se estudian las respuestas a un cuestionario sobre rasgos obsesivos de la personalidad (MIRAP) y otro referido a la impulsividad como rasgo (ECIR y C) de 418 sujetos extraídos al azar de la población general. Se aplican técnicas de análisis estadístico multivariantes (Análisis Factorial, Análisis de Correspondencias, Análisis de Regresión lineal) para establecer el tipo de relación que tienen los dos rasgos estudiados. Resultados. Las puntuaciones totales del MIRAP y la ECIR y C correlacionan de un modo estadísticamente significativo(r=0,39; p<0,01). El Análisis de Correspondencias de esas puntuaciones totales distribuidas en deciles y dos Análisis de Regresión lineal muestran, también, una relación directa entre ambos rasgos que es estadísticamente significativa. La obsesividad y la impulsividad no correlacionan con el principal factor del rasgo opuesto. Todos los factores de ambos rasgos se agrupan factorialmente entre sí de forma positiva, excepto el factor impulsivo “precipitación” que lo hace negativamente con el factor obsesivo “orden”. Conclusiones. Nuestros resultados señalan que la obsesividad y la impulsividad, como rasgos de la personalidad, son constructos convergentes y no polos opuestos de un continuum. Pero, simultáneamente, uno de los factores de cada rasgo (“precipitación” y “orden”), entre cinco, sí se comportan como polos opuestos de un continuum, dentro del marco conceptual, más amplio, de los rasgos a los que pertenecen (AU)

Introduction. The obsessivity and the impulsivity as personality traits have been object of few studies on the general population. The authors outline as objective to study if such features are co-existing constructs, as advocate some authors or the opposite extremes of a continuum as assert other. Material and Methods. They are studied the answers to a questionnaire on obsessive traits of the personality (MIRAP) and other referred to the impulsivity as trait, also, (ECIRYC) of a random sample of 418 subject extracted of the general population. They are applied multivariate statistic analysis technical (Factorial Analysis, Correspondence Analysis, and linear Regression Analysis) to establish the type of relationship that have the two studied personality traits. Results. The total scores of the MIRAP and the ECIRYC are correlated of a manner statistically significant(r = 0.39; p< 0.01). The Correspondence Analysis of those total scores distributed in deciles and two linear Regression Analysis show, also, a direct relationship between both traits that it is statistically significant. The obsessivity and the impulsivity do not correlate with the principal factor of the opposite trait. All the factors of both traits are grouped mutually in a factor in a positive way, except the impulsive factor “haste” that makes it negatively with the obsessive factor “order”. Conclusions. Our results indicate that the obsessivity and the impulsivity, as personality traits, they are constructs convergent and not opposite poles of a continuum. But, simultaneously, one of the five factors of each trait (“haste” and “order”), yes are behaved as opposite extremes of a continuum, within conceptual framework, wider, of the traits to those which belong (AU)

The axial diagnostic and sensitive-to-change for depression index: diagnostic utility and use in studies of therapeutic evaluation.

INTRODUCTION: The authors develop a new rating scale for to measure its sensibility to the change of the intensity of the depressive symptoms under the effects of antidepressants drugs, and for to analyze the predictive validity of its total score. Designate it: The Axial Diagnostic and Sensitive-to-Change for Depression Index (ADSCDI). For this, use only seven nuclear items for the depression diagnosis (mood, interest, impulse/drive, pleasure, energy, daily job and different quality) without vegetative symptoms or anxious. METHODOLOGY: The authors interview to 111 psychiatric outpatients attended consecutively in a Mental Health Center. Sixty were fulfilling the criteria for depressive episode of the ICD-10 and fifty and one were forming part of the group of control: psychiatric outpatients not depressed. They use for this a protocol of collection of data that contains the ADSCDI, where the patients indicate how are found on a Visual Analogical Scale in the one which quantify their answers in each item, the Hamilton Rating Scale for Depression of 17 articles (HRSD-17) and an Global Clinical Impression scale (GCI). Each depressed patient receipt the antidepressant treatment that better were adjusted to his clinical profile according to the psychiatrist that was trying to him. The depressed patients were evaluated a second time after thirty days of treatment. RESULTS: All the items of the ADSCDI perceive a change statistically significant in the intensity of the depressive symptoms (p=0.00). The total score of the ADSCDI, also, at same level of statistical significance that the total scores of the HRSD-17 and of the GCI p=0.000). The ADSCDI interrelates high and significatively with the HRSD-17 as with the GCI (r=0.77 and r=0.73 respectively; p=0.00). Equally makes it with the average of the "proportion of improvement" that evaluates, with the one evaluated by the HRSD-17 and the GCI (r=0.74 and r=0.68 respectively; p=0.000). A cut-off of 39 offers the best predictive values for the ADSCDI respect to the clinical and the ICD-10 criteria for depression. With a sensibility of 0.97, a specificity of 0.76 (of 0.88 with psychiatric patients free of symptoms), a total probability of guessing right of 93% and a kappa reliability of 0.74. The results improve when the ADSCDI is used as external criterion. For this new operative diagnostic criteria (ADCD), a cut-off of 40 offers a sensibility of 1.00, a specificity of 0.96 a probability of guessing right of 99% and a kappa reliability of 0.96. CONCLUSIONS: The ADSCDI offers sufficient concurrent validity with the HRSD-17 and the GCI. It can be considered a sensitive instrument to the change, with the advantage of containing, only, items that have shown be frequent, discriminant and predictives. The ADSCDI also is a good instrument to establish diagnostic of depression in the system ADCD/ADSCDI or in the ICD-10 one.

El Índice Diagnóstico Axial y de Seguimiento para la Depresión. Su utilidad diagnóstica y en estudios de evaluación terapéutica / The Axial Diagnostic and Sensitive-to-Change for Depression Index: Diagnostic utility and use in studies of therapeutic evaluation

Introducción. Los autores desarrollan una nueva escala para medir el cambio de la intensidad de los síntomas depresivos bajo los efectos de fármacos antidepresivos y analizarla validez predictiva de su puntuación total. La denominan: Índice Diagnóstico y de Seguimiento para la Depresión (IDASD). Para ello, utilizan solamente siete ítems nucleares para el diagnóstico de depresión (ánimo, interés, impulso, gusto/placer, energía, trabajo y distinta cualidad) sin síntomas vegetativos o ansiosos. Metodología. Los autores entrevistan a 111 pacientes psiquiátricos atendidos consecutivamente en régimen ambulatorio. Sesenta cumplían los criterios para episodio depresivo de la CIE-10 y 51 formaban parte del grupo de control: enfermos psiquiátricos no deprimidos. Utilizan para ello un protocolo de recogida de datos que contiene el IDASD, donde los pacientes señalan cómo se encuentran sobre una Escala Analógico-Visual en la que cuantifican sus respuestas en cada ítem, la Escala de Hamilton para la Depresión de 17ítems (EHD-17) y una Impresión Clínica Global (ICG). Cada paciente deprimido recibía el tratamiento antidepresivo que mejor se ajustaba a su perfil clínico según el psiquiatra que le trataba. Los pacientes deprimidos fueron evaluados una segunda vez tras 30 días de tratamiento. Resultados. Todos los ítems de la IDASD perciben un cambio en la intensidad de la sintomatología estadísticamente significativo (p = 0,00). La puntuación total del IDASD, también, al mismo nivel de significación estadística que las puntuaciones totales de la EHD-17 y de la ICG (p = 0,000). ElIDASD correlaciona alto y significativo tanto con la EHD-17como con la ICG (r = 0,77 y r = 0,73, respectivamente; p =0,00). Igualmente lo hace el promedio de la «proporción de mejoría» que evalúa, con la evaluada por la EHD-17 y la ICG(r = 0,74 y r = 0,68 respectivamente; p = 0,000). Un punto de corte de 39 ofrece las mejores prestaciones predictivas del IDASD respecto al criterio clínico y al criterio diagnóstico de depresión de la CIE-10. Con una sensibilidad de 0,97, una especificidad de 0,76 (de 0,88 con pacientes psiquiátricos asintomáticos), una probabilidad total de acertar de 93% y una fiabilidad kappa de 0,74. Los resultados mejoran cuando se utiliza como criterio externo el CDAD. Para ese nuevo criterio diagnóstico operativo (CDAD), un punto de corte de40 ofrece una sensibilidad de 1,00, una especificidad de 0,96 una probabilidad de acertar del 99% y una fiabilidad kappa de 0,96.Conclusiones. El IDASD ofrece suficiente validez concurrente con la EHD-17 y la ICG. Puede considerarse un instrumento sensible al cambio, con la ventaja de contener, tan sólo, ítems que han mostrado ser frecuentes, discriminantes y predictivos. El IDASD también es un buen instrumento para establecer diagnósticos de depresión en el sistema CDAD/IDASD o en el de la CIE-10 (AU)

Introduction. The authors develop a new rating scale for to measure its sensibility to the change of the intensity of the depressive symptoms under the effects of antidepressants drugs, and for to analyze the predictive validity of its total score. Designate it: The Axial Diagnostic and Sensitive-to-Change for Depression Index (ADSCDI).For this, use only seven nuclear items for the depression diagnosis (mood, interest, impulse/drive, pleasure, energy, daily job and different quality) without vegetative symptoms or anxious. Methodology. The authors interview to 111 psychiatric outpatients attended consecutively in a Mental Health Center. Sixty were fulfilling the criteria for depressive episode of the ICD-10 and fifty and one were forming part of the group of control: psychiatric outpatients not depressed. They use for this a protocol of collection of data that contains the ADSCDI, where the patients indicate how are found on a Visual Analogical Scale in the one which quantify their answers in each item, the Hamilton Rating Scale for Depression of 17 articles (HRSD-17) and an Global Clinical Impression scale (GCI). Each depressed patient receipt the antidepressant treatment that better were adjusted to his clinical profile according to the psychiatrist that was trying to him. The depressed patients were evaluated a second time after thirty days of treatment. Results. All the items of the ADSCDI perceive a change statistically significant in the intensity of the depressive symptoms (p=0.00). The total score of the ADSCDI, also, at same level of statistical significance that the total scores of the HRSD-17 and of the GCI (p=0.000).The ADSCDI interrelates high and significatively with the HRSD-17 as with the GCI (r=0.77 and r=0.73 respectively; p=0.00). Equally makes it with the average of the “proportion of improvement” that evaluates, with the one evaluated by the HRSD-17 and the GCI (r=0.74 and r=0.68 respectively; p=0.000). A cut-off of 39 offers the best predictive values for the ADSCDI respect to the clinical and the ICD-10 criteria for depression. With a sensibility of 0.97, a specificity of 0.76 (of 0.88 with psychiatric patients free of symptoms), a total probability of guessing right of 93% and a kappa reliability of 0.74. The results improve when the ADSCDI is used as external criterion. For this new operative diagnostic criteria (ADCD),a cut-off of 40 offers a sensibility of 1.00, a specificity of 0.96 a probability of guessing right of 99% and a kappa reliability of 0.96. Conclusions. The ADSCDI offers sufficient concurrent validity with the HRSD-17 and the GCI. It can be considered a sensitive instrument to the change, with the advantage of containing, only, items that have shown be frequent, discriminant and predictives. The ADSCDI also is a good instrument to establish diagnostic of depression in the system ADCD/ADSCDI or in the ICD-10 one (AU)