Performance of the Finnish Diabetes Risk Score and a Simplified Finnish Diabetes Risk Score in a Community-Based, Cross-Sectional Programme for Screening of Undiagnosed Type 2 Diabetes Mellitus and Dysglycaemia in Madrid, Spain: The SPREDIA-2 Study.

AIM: To evaluate the performance of the Finnish Diabetes Risk Score (FINDRISC) and a simplified FINDRISC score (MADRISC) in screening for undiagnosed type 2 diabetes mellitus (UT2DM) and dysglycaemia. METHODS: A population-based, cross-sectional, descriptive study was carried out with participants with UT2DM, ranged between 45-74 years and lived in two districts in the north of metropolitan Madrid (Spain). The FINDRISC and MADRISC scores were evaluated using the area under the receiver operating characteristic curve method (ROC-AUC). Four different gold standards were used for UT2DM and any dysglycaemia, as follows: fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), HbA1c, and OGTT or HbA1c. Dysglycaemia and UT2DM were defined according to American Diabetes Association criteria. RESULTS: The study population comprised 1,426 participants (832 females and 594 males) with a mean age of 62 years (SD = 6.1). When HbA1c or OGTT criteria were used, the prevalence of UT2DM was 7.4% (10.4% in men and 5.2% in women; p<0.01) and the FINDRISC ROC-AUC for UT2DM was 0.72 (95% CI, 0.69-0.74). The optimal cut-off point was ≥13 (sensitivity = 63.8%, specificity = 65.1%). The ROC-AUC of MADRISC was 0.76 (95% CI, 0.72-0.81) with ≥13 as the optimal cut-off point (sensitivity = 84.8%, specificity = 54.6%). FINDRISC score ≥12 for detecting any dysglycaemia offered the best cut-off point when HbA1c alone or OGTT and HbA1c were the criteria used. CONCLUSIONS: FINDRISC proved to be a useful instrument in screening for dysglycaemia and UT2DM. In the screening of UT2DM, the simplified MADRISC performed as well as FINDRISC.

Afección vaginal de linfoma no hodgkiniano de célula grande difuso / Vaginal involvement in diffuse large B-cell non-Hodgkin´s lymphoma

Las metástasis vaginales son un fenómeno raro, pero constituyen el grupo mayoritario de tumores de vagina. La afección vaginal de los linfomas no hodgkinianos es muy infrecuente, y tanto en estadios avanzados como en las formas localizadas (presumiblemente primarias) la forma clínica de presentación es la aparición de un sangrado vaginal, y el hallazgo más común es una masa en la vagina. Las formas secundarias de afección vaginal se encuentran en edades más avanzadas y tienen una peor supervivencia que las primarias (AU)

Vaginal metastases are a rare phenomenon but are the most common type of vaginal tumor. Vaginal involvement in non-Hodgkin's lymphoma (NHL) is uncommon. Both low-stage (presumably primary) and high-stage vaginal NHL usually present with vaginal bleeding and a vaginal mass. Patients with secondary vaginal NHL are generally older than those with primary vaginal NHL and their survival is shorter (AU)

[The carpal tunnel syndrome in the oil toxic syndrome]. / El síndrome del túnel del carpo en el síndrome del aceite tóxico.

BACKGROUND: The toxic oil syndrome (TOS) is an autoimmune disease caused by the ingestion of aniline-denatured rapeseed oil. The carpal tunnel syndrome (CTS) is an entrapment neuropathy due to the median nerve entrapment, which is associated with both occupational activities and autoimmune diseases. The objective of this work was to know the frequency and characteristics of CTS in TOS patients. PATIENTS AND METHODS: Between December 1977 and July 2000, 744 TOS patients were evaluated. The inclusion criteria were: the clinical records for patients diagnosed between May 1981 and November 1997; and for patients diagnosed between December 1997 and July 2000, symptoms with the classical or likely pattern according to the Katz's hand diagram and one of the following findings: a) abnormal electromyogram, and b) hypalgesia in the median nerve territory and positive Tinel and/or Phalen signs. RESULTS: A total of 70 patients (63 women, 90%) were diagnosed; 48 of them had been diagnosed before 1997 and 22 subsequently. The mean age of patients was 47.6 (20-78) years. In 36 patients (51.4%), a bilateral CTS was present. Fifty-six patients (81.4%) had a diagnostic EMG, and 31 (44.2%) were obese, 13 (18.6%) diabetic, and 4 (6%) had hypothyroidism. Most of these cases (48; 68.6%) were housewives. CONCLUSIONS: TOS patients have a high frequency of CTS; therefore, this condition must be suspected in patients with associated obesity and diabetes mellitus.

El síndrome del túnel del carpo en el síndrome del aceite tóxico / The carpal tunnel syndrome in the oil syndrome

Aceptado para su publicación el 15 de marzo de 2001.d Fundamento. El síndrome del aceite tóxico (SAT) es una enfermedad de naturaleza autoinmune producida por el consumo de aceite de colza desnaturalizado con anilina. El síndrome del túnel del carpo (STC) es una neuropatía producida por compresión del nervio mediano, asociada a actividades profesionales y enfermedades autoinmunes. Realizamos este estudio con el objetivo de conocer la frecuencia y características del STC en los pacientes del SAT. Material y métodos. Evaluamos 744 enfermos de SAT entre diciembre de 1997 y julio de 2000. Criterios de inclusión: para los pacientes diagnosticados entre mayo de 1981 y noviembre de1997 la historia clínica y para los diagnosticados entre diciembre de 1997 y julio de 2000 los síntomas con patrón clásico o probable según el diagrama de Katz y uno de los siguientes hallazgos: a) electromiograma patológico, y b) hipoalgesia en el territorio del nervio mediano y signos de Tinel y/o Phalen positivos. Resultados. Encontramos 70 pacientes (9,4 por ciento), 48 diagnosticados antes de 1997 y 22 con posterioridad. La edad media era de 47,6 (20-78) años, siendo 63 (90 por ciento) mujeres. En 36 casos (51,4 por ciento) el STC era bilateral. Cincuenta y siete pacientes (81,4 por ciento) tenían EMG diagnóstico. Treinta y uno (44,2 por ciento) eran obesos, 13 (18,6 por ciento) diabéticos y 4 (6 por ciento) hipotiroideos. La mayoría (48 casos, 68,6 por ciento) eran amas de casa. Conclusiones. Los pacientes del SAT tienen una alta frecuencia de STC, por lo que hay que tener un alto índice de sospecha para esta patología, sobre todo si presentan obesidad y diabetes mellitus asociada (AU)

[Clinical and analytical findings in patients with toxic oil syndrome. Study of a cohort of 758 patients]. / Hallazgos clínicos y analíticos en pacientes afectados por el síndrome del aceite tóxico. Estudio de una cohorte de 758 pacientes.

OBJECTIVE: To report the symptoms and analytical findings observed in the collective of patients affected with the toxic oil syndrome (TOS) 18 years after the poisoning. METHODS: At the Centro de Investigación sobre el Síndrome del Aceite Tóxico (CISAT) we followed the clinical and analytical course of 758 patients affected with the TOS since December 1997 up to May 1999. Patients were evaluated by means of a previously standardized questionnaire in which a clinical review and a battery of complementary tests (thyroid hormones, spirometry with diffusion test and arterial gasometry) were included. One hundred and sixty-two patients underwent also echocardiogram because of presumptive pulmonary hypertension and/or heart disease. RESULTS: Out of the 758 patients, 516 were females and 242 males (M:F ratio 2:1), with ages ranging from 17 to 84 years (mean age 47 years). One of the most remarkable findings was the increased prevalence of cardiovascular risk factors: arterial hypertension (34%), dyslipemias (44%), overweight (40%), obesity (27%), carbohydrate intolerance (9%) and diabetes mellitus (9.4%). The most common reported symptoms were: cramps (78%), arthralgias (78%), and paresthesias (70%). Only 2.8% of patients reported to be asymptomatic. The analytical results most commonly changed were: changes in lipidic and carbohydrate metabolism (already reported), overt or subclinical hypothyroidism (6.6%) and respiratory changes in patients with no previous pulmonary disease: changes in spirometry (6%), diffusion test (8%) and hypoxemia (18%). Echocardiographic findings suggestive of PHT were obtained in 3.1% of cases. CONCLUSIONS: Although TOS occurred in 1981, this syndrome still has a relevant morbidity in a portion of the spanish population. To remark the high prevalence of cardiovascular risk factors with changes in lipidic and carbohydrate metabolism and subclinical hypothyroidism observed in our series. Further studies are necessary to evaluate the actual dimension of this poisoning.

Hallazgos clínicos y analíticos en pacientes afectados por el síndrome del aceite tóxico. estudio de una cohorte de 758 pacientes / Clinical and analytical findings in patients affected with the toxic oil syndrome. Study of a cohort of 758 patients

Objetivo. Describir la sintomatología y los hallazgos analíticos que el colectivo de pacientes afectados por el síndrome del aceite tóxico (SAT) presenta 18 años después de haber sufrido la intoxicación. Métodos. En el centro de Investigación sobre el Síndrome del Aceite Tóxico (CISAT) hemos seguido la evolución clínica y analítica de 758 pacientes afectados por el SAT desde diciembre de 1997 hasta mayo de 1999. Los pacientes fueron evaluados mediante un cuestionario previamente estandarizado en el que se incluía una revisión clínica y una batería de exploraciones complementarias, entre las que se incluían hormonas tiroideas, espirometría con prueba de difusión y gasometría arterial. A 162 pacientes se les realizó además ecocardiograma por presentar sospecha de hipertensión pulmonar y/o cardiopatía. Resultados. De los 758 pacientes, 516 eran mujeres y 242 varones (M:V-2:1), con edades comprendidas entre 17 y 84 años (edad media de 47 ñ años). Uno de los hallazgos más llamativos fue la elevada prevalencia de los factores de riesgo cardiovasculares: hipertensión arterial (34 por ciento), dislipidemias (44 por ciento), sobrepeso (40 por ciento), obesidad (27 por ciento), intolerancia hidrocarbonada (9 por ciento) y diabetes mellitus (9,4 por ciento). Los síntomas más frecuentemente referidos fueron: calambres (78 por ciento), artralgias (78 por ciento) y parestesias (70 por ciento). Únicamente referían estar asintomáticos el 2,8 por ciento de los afectados. Los resultados analíticos alterados con más frecuencia fueron: alteraciones del metabolismo lipídico e hidrocarbonado (ya referidos), hipotiroidismo franco o subclínico (6,6 por ciento) y alteraciones respiratorias en pacientes sin patología pulmonar previa conocida: alteraciones en la espirometría (6 por ciento), en la prueba de difusión (8 por ciento) e hipoxemia (18 por ciento). Se obtuvieron datos ecocardiográficos sugestivos de hipertensión pulmonar (HTP) en el 3,1 por ciento de los casos. Conclusiones. A pesar de que el SAT ocurrió en 1981, este síndrome sigue teniendo una importante morbilidad en parte de la población española, destacando la elevada prevalencia de factores de riesgo cardiovascular con alteraciones del metabolismo lipídico e hidrocarbonado e hipotiroidismo subclínico encontrados en nuestra serie. Son necesarios estudios ulteriores para evaluar la dimensión definitiva de esta epidemia (AU)

Valoración al ingreso del paciente crítico. Un indicador de calidad asistencial / Assessment of the critical patient at admission. An indicator of quality of care

Los objetivos de este trabajo han sido describir el tipo de información que registran los profesionales de enfermería al ingreso del paciente crítico en la Unidad de Cuidados Intensivos y determinar si existe relación entre el tipo de información registrada y el hecho de que el paciente ingrese con o sin intubación endotraqueal.Se estudió una muestra formada por 214 registros de ingreso realizados en nuestra unidad durante el año 1998, mediante una hoja de recogida de datos elaborada para este estudio, basada en los cuestionarios de valoración del modelo de Virginia Henderson. Se analizaron la presencia o ausencia de 71 variables clasificadas en cuatro bloques: datos de filiación, datos generales, necesidades básicas de Virginia Henderson y otros datos de valoración.La mayoría de los datos recogidos al ingreso son datos objetivos procedentes de la observación y/o exploración física del paciente. Estos datos se recogen en dos bloques: el de 'necesidades básicas de Virginia Henderson' (respirar normalmente, alimentarse e hidratarse, eliminar, moverse y mantener postura, mantener la temperatura corporal, higiene e integridad de la piel y evitar peligros) y el bloque de 'otros datos de valoración' (tratamiento médico, pruebas diagnósticas y terapéuticas y monitorización hemodinámica).La información sobre los antecedentes del paciente recogidos en el bloque de 'datos generales' se recoge en menor frecuencia.Los datos subjetivos obtenidos mediante la entrevista aparecen en una clara minoría. Estos datos se recogen en el bloque de 'necesidades básicas de Virginia Henderson' (dormir y descansar, vestirse y desvestirse, comunicarse, valores y creencias, sentirse realizado, entretenerse y aprender) (AU)

[Assessment of the critical patient at admission. An indicator of quality of care]. / Valoración al ingreso del paciente crítico. Un indicador de calidad asistencial.

The type of information recorded by nurses at admission of critical patients to the Intensive Care Unit was described and the relation between the information recorded and the presence of absence of endotracheal intubation in the patient admitted was analyzed. A sample of 214 admission records of patients admitted to our unit in 1998 was studied using a data sheet based on Virginia Henderson assessment questionnaires. The presence or absence of 71 variables classified into four sections was analyzed: personal data, general data, Virginia Henderson basic needs, and other assessment data. Most data collected at admission were objective data obtained by observation and/or physical examination of the patient. These data were contained in two sections: "Virginia Henderson basic needs" (normal breathing, food and water intake, excretion, mobility, maintaining posture, conserving body temperature, skin hygiene and integrity, and avoiding danger) and "other assessment data" (medical treatment, diagnostic and therapeutic tests, and hemodynamic monitoring). Information about the patient's background in the section "general data" was obtained less frequently. Subjective data obtained from interviews was clearly limited. These data are included in the "Virginia Henderson basic needs" (sleep, rest, dressing and undressing, communicating, values and beliefs, feeling of satisfaction, absence of boredom, and intellectual stimulation).

[Cerebral abscess. Clinical review of 26 cases]. / Abscesos cerebrales. Revisión clínica de 26 casos.

BACKGROUND: The introduction of new diagnostic and therapeutic techniques has changed the clinical attitude and consequences of brain abscesses (BA). OBJECTIVE: To analyse clinical-radiological features, therapy, prognostic factors and evolution of BA in our institution. MATERIALS AND METHODS: Retrospective study of all clinical records of patients diagnosed with BA from 1982 to 1992. RESULTS: Twenty-six patients with a mean age of 46.2 years were selected. The incidence was 2.6 patients/10,000 admission/year. Among 17 patients (65%) some extraprenchymatous infectious focus was found, which was located at the otorhynolaryngeal area in twelve patients. Mean duration of symptoms was 12.9 days, headache being the most common of them (69%). With CT 18 patients had a single mass, eight patients multiple masses, and 21 patients a ring enhancement when the contrast material was introduced. The causative organism was recovered from 15 patients. The organism recovered more frequently were Streptococcus spp, Enterobacteriaceae and Staphylococcus aureus. Twenty patients (77%) underwent surgical therapy, which consisted in ablation (12) or drainage (8). All patients received antibiotics for a mean of 37 days: the most frequent antibiotic combination used was penicillin+chloramphenicol. Six patients died (23%) and 7 remained with sequelae. Although statistically non-significant, the acute presentation was associated with a higher mortality rate, and the use of dexamethasone was associated with a lower mortality rate (p = 0.053 and 0.062, respectively). CONCLUSIONS: BA is associated with a high mortality rate and a high sequelae rate despite appropriate diagnostic and therapeutic measures. ORL infection is the most frequent predisposing factor. The use of dexamethasone is not associated with a higher mortality rate.

[Fever and recurrent bacteremia as presentation form of secondary aortoenteric fistula]. / Fiebre y bacteriemia recurrente como forma de presentación de una fístula aortoentérica secundaria.

Secondary aortoenteric fistula is a rare complication, although very severe, of aortic revascularization surgery. The major cause is usually infection of the prosthetic material, which may happen short or long after the intervention. The most frequent forms of presentation are digestive hemorrhage, abdominal pain or unpleasantness, shock or other symptoms associated to the compression of adjacent structures. However, as in the present case, symptoms of systemic infection may be the only manifestation, with absence of local signs. This is why a high degree of clinical suspicion is needed. The most useful complementary techniques are computerized tomography, oral endoscopy and, probably, magnetic resonance, along with gammagraphy of indium-marked leukocytes. Therapy must combine long-term systemic antibiotherapy and resection of all infected material, with reconstruction of the vascular continuity following a route far away from the infected area.