Subtipo Persecutorio Del Trastorno Delirante: Estudio De Series De 129 Casos / Persecutory Subtype Of Delusional Disorder. Descriptive Study Of 129 Cases

Resumen Objetivo. El objetivo de este estudio es conocer las características demográficas, factores ambientales, factores de riego psicosociales, y clínicas del subtipo persecutorio en un grupo de pacientes con trastorno delirante (TD). Metodología. Estudio epidemiológico retrospectivo sobre un Registro de Casos en el Dispensario de Psiquiatría e Higiene Mental de Córdoba sobre pacientes con TD según criterios DSM-IV-TR. Aquellos pacientes que cumplieron con los criterios de inclusión definidos constituyeron nuestra muestra final de 261 casos, de ellos 129 casos presentaban el subtipo persecutorio. Las variables sobre las que se recogió información en base a protocolos, fueron agrupadas con el orden siguiente: I. Variables de los datos sociodemográficos y generales. II. Variables de los Factores de riesgo del TD (familiares y personales). III. Variables del Cuadro Clínico y el Diagnostico del TD (Presentación, sintomatología delirante, funcionalidad y discapacidad, utilización de los recursos sanitarios, tratamiento, problemas psicosociales, evolución y curso). Resultados. La proporción hombres versus mujeres en el subtipo persecutorio fue de 1,04. Solo el 5,4% de estos pacientes tenía estudios primarios. Un 65,9%, al realizar la primera consulta psiquiátrica, se encontraba casado y el 50,4% convivían en el hogar. Un 14,7% consumió previamente alcohol y un 0,8% otras sustancias. Las ideas de referencia y de persecución se presentaron el 98,4% y en el 99,2% de los casos respectivamente. Conclusiones. Son necesarios futuros estudios prospectivos para investigar los factores de riesgo del subtipo persecutorio del TD.

Objective. The objective of this study is to investigate the demographic, environmental, psychosocial and clinical characteristics of the persecutory subtype in a group of patients with delusional disorder (DD). Methodology. Retrospective descriptive study of DD cases registered at Psychiatry and Mental Hygiene Clinic of Cordoba according to DSM-IV-TR criteria was conducted. We obtained a sample of 261 DD patients who met the inclusion criteria; of them 129 cases has persecutory subtype. Data and variables collected were divided into 4 groups: I. Socio-demographic and general data. II. DD risk factors (personal and family). III. DD clinical picture and diagnosis (presentation, symptoms, disability, use of health care resources, treatment, and evolution). Results. The proportion of males versus females of the persecutory subtype was of 1.04. Only 5.4% of patients had primary level of education. At the first visit of the psychiatry clinic, 65.9% of the patients were married and about half of them shared home. About 14.7% of patients had a past history of alcohol consumption, and only 0.8% consumed other drugs. Ideas of reference and of persecution were found in 98.4% and 99.2% respectively. Conclusions. It is necessary to conduct future prospective studies to investigate the risk factors associated with the persecutory subtype of DD.

Trastorno delirante y conducta suicida: estudio descriptivo de 26 casos / Delusional disorder and suicidal behavior: descriptive study of 26 cases

Resumen Introducción/antecedentes: La conducta suicida en el trastorno delirante (TD) ha sido escasamente estudiada. Objetivo: Profundizar en el conocimiento de las características demográficas, ambientales, psicosociales y clínicas del suicido en un grupo de pacientes con TD con la finalidad de contribuir a generar y sugerir estrategias que contribuyan a realizar nuevos estudios de mayor nivel explicativo. Método: Estudio epidemiológico descriptivo retrospectivo de Registro de Casos en el Dispensario de Psiquiatría e Higiene Mental de Córdoba sobre pacientes con TD según criterios DSM-IV-TR. Aquellos pacientes que cumplieron con los criterios de inclusión definidos constituyeron nuestra muestra final de 261 casos, de ellos 26 casos presentaron evidencias de intento de suicidio. Las variables sobre las que se recogió información en base a protocolos, fueron agrupadas con el orden siguiente: I. Sociodemográficos y generales. II. Factores de riesgo del TD (familiares y personales). III. Cuadro Clínico y el Diagnóstico del TD (Presentación, Sintomatología, Funcionalidad y Discapacidad, utilización de los recursos sanitarios, tratamiento, problemas psicosociales, evolución y curso) y medios letales utilizados. Resultados: La edad media de los pacientes fue de 47 años y el 60% fueron hombres. Los datos sociodemográficos muestran que los pacientes con intento de suicidio residían en núcleos rurales (46,2%), no tenían estudios en un 15,4%, un 57,7% no trabajaba y un 26,9% recibía una pensión por enfermedad o jubilación laboral. El subtipo persecutorio con 8 casos, fue el más frecuente, seguido de los subtipos de grandiosidad (6 casos) y celotípico (6 casos), mixto (3 casos), erotomaniaco (2 casos) y somático (1 casos). Discusión y conclusión: Son necesarios futuros estudios prospectivos para investigar los factores de protección, de riesgo y/o asociados al suicidio en el TD.

Introduction/Background: Suicidal behavior in delusional disorder (DD) patients has been poorly studied. Objective: Investigate the demographic, environmental, psychosocial and clinical characteristics of the suicidal behavior in a group of patients with DD. Method: Retrospective descriptive study of DD cases registered at Psychiatry and Mental Hygiene Clinic of Cordoba according to DSM-IV criteria was conducted. We obtained a sample of 261 DD patients who met the inclusion criteria, of them 26 cases presented evidence of suicidal behavior. Data and variables collected were divided into 4 groups: I. Socio-demographic and general data. II. DD risk factors (personal and family). III. DD clinical picture and diagnosis (presentation, symptoms, disability, use of health care resources, treatment, and evolution) and lethal methods used. Results: The mean age of the patients was 47 years old and 60% were males. Socio-demographic data show that 46.2% of patients with suicidal behavior lived in rural areas, only 15.4% were analphabet, 57.7% were unemployed, and 26.9% were receiving a pension because of illness or retirement. The persecutory subtype with 8 cases was the most frequent presentation, followed by grandiose (6 cases) and jealous (6 cases), mixed (3 cases), erotomanic (2 cases) and somatic (1 case) subtypes. Discussion and conclusion: It is necessary to conduct future prospective studies to investigate the protective and risks factors associated with the suicidal behavior in DD patients.

Hepatotoxicity of isotretinoin in patients with acne and Gilbert's syndrome: a comparative study.

OBJECTIVES: The objective of our follow-up study is to evaluate liver function tests (LFTs) and lipid profiles in patients with Gilbert's syndrome treated with isotretinoin because of severe acne. SETTING: Dermatology outpatient clinics of three regional hospitals of Jaén (Spain). PARTICIPANTS: Over 4 years, we included all patients diagnosed with severe acne. Only 37 patients were identified, of which 11 had Gilbert's syndrome. INTERVENTIONS: All patients were treated with isotretinoin and followed-up in our outpatient clinics after 10 and 20 weeks. Patients were subjected to an interview questionnaire which included data on age, gender, complete blood count, coagulation profile, fasting blood glucose, LFTs and lipid profiles. Data and results of patients with severe acne and Gilbert's syndrome were compared with those of 26 patients with only severe acne (control group). PRIMARY OUTCOME: Blood analyses were repeated in the follow-up visits. RESULTS: In patients with Gilbert's syndrome, bilirubin levels showed substantial decrease over the 20-week follow-up, with more decrease after 10 weeks. None of the control group patients had significant increase in total bilirubin levels after 10 and 20 weeks of follow-up. Liver enzymes were maintained within normal levels in both groups. Both study groups did not show significant pathological increase in lipid profile levels. LDL levels were increased in the two study groups, but this increase was less substantial in patients with Gilbert's syndrome. CONCLUSIONS: Our preliminary results suggest that oral isotretinoin could be an effective, safe treatment for patients with Gilbert's syndrome, and may lower bilirubin levels in the first 10 weeks of treatment. Limitations of the study include the small numbers of participants and the fact that it is restricted to one region of Spain.

Infección quirúrgica en un hospital de tercer nivel. Estudio de vigilancia prospectivo (2001–2004) / Surgical site infection in a tertiary hospital. A prospective surveillance study (2001–2004)

Introducción: La infección de localización quirúrgica (ILQ), superficial y profunda, es un problema muy frecuente dentro de la infección hospitalaria. Supone un riesgo para la seguridad del paciente y, por tanto, su reducción es una prioridad para los sistemas sanitarios. El objetivo del estudio fue analizar la incidencia de ILQ en los servicios quirúrgicos de un hospital de tercer nivel. Material y métodos: Estudio de cohortes prospectivo sobre 14.455 pacientes ingresados desde enero de 2001 hasta diciembre de 2004. Se calcularon la incidencia acumulada (IA), cruda y ajustada por el índice del National Nosocomial Infection Surveillance (NNIS) y densidad de incidencia (DI) de ILQ. Resultados: La IA de pacientes con ILQ fue 3,4% (IC95%: 3,0–3,7%), la IA de ILQ 3,5% (IC95%: 3,2–3,8%) y la DI 0,28/100 pacientes intervenidos-día. Las unidades con IA más elevadas fueron cirugía maxilofacial (6%), digestiva (5,3%) y cardiovascular (5,1%). Ajustando por la estancia, urología y cirugía pediátrica registraron las mayores tasas de incidencia, mientras que oftalmología y neurocirugía obtuvieron las menores. La cirugía de colon y recto tuvieron los parámetros más elevados (IA=10%; DI=0,57), seguido de la revascularización miocárdica y la prótesis de cadera. En el conjunto de las unidades y en los procedimientos investigados, la IA de ILQ aumentó con el índice NNIS. Conclusiones: La IA y la DI de ILQ fueron similares a las obtenidas en los proyectos de vigilancia europeos e inferiores a las registradas en 1994 en este mismo hospital, reflejo de una mayor intensidad en la vigilancia y de una mayor concienciación en la aplicación de sus medidas de control (AU)

Introduction: Surgical site infection (SSI) is a very common problem in hospital infection control. It represents a risk for the safety of the patient and therefore its reduction is a priority in Health Services. The aim of the study is to analyse the incidence of SSI in the surgical departments of a tertiary hospital. Material and methods: A prospective cohort study was conducted on 14,455 patients admitted from January 2001 to December 2004. The cumulative incidence (CI) crude and adjusted for the National Nosocomial Infection Surveillance (NNIS) index and the incidence density (ID) of SSI were calculated. Results: The CI of patients with SSI was 3.4% (95% CI: 3.0–3.7%), the CI of SSI was 3.5% and the observed ID was 0.28/100 surgical patients/day. Surgical units with the highest CI were maxillofacial (6%), gastrointestinal (5.3%) and cardiovascular (5.1%). Adjusting for length of stay, urology and paediatric surgery recorded the highest incidence rates, while ophthalmology and neurosurgery had the least. Colorectal surgery had the highest parameters (CI=10%; ID=0.57), followed by myocardial revascularisation and hip prosthesis. Among the surgical units and operative procedures assessed, the CI of SSI increased with the NNIS index. Conclusions: The CI and ID of SSI observed in this study were similar to those obtained in previous European surveillance projects, and lower than those recorded in our hospital in 1994 which reflects a higher level of vigilance and a higher awareness in applying control measure (AU)

[Surgical site infection in a tertiary hospital. A prospective surveillance study (2001-2004)]. / Infección quirúrgica en un hospital de tercer nivel. Estudio de vigilancia prospectivo (2001-2004).

INTRODUCTION: Surgical site infection (SSI) is a very common problem in hospital infection control. It represents a risk for the safety of the patient and therefore its reduction is a priority in Health Services. The aim of the study is to analyse the incidence of SSI in the surgical departments of a tertiary hospital. MATERIAL AND METHODS: A prospective cohort study was conducted on 14,455 patients admitted from January 2001 to December 2004. The cumulative incidence (CI) crude and adjusted for the National Nosocomial Infection Surveillance (NNIS) index and the incidence density (ID) of SSI were calculated. RESULTS: The CI of patients with SSI was 3.4% (95% CI: 3.0-3.7%), the CI of SSI was 3.5% and the observed ID was 0.28/100 surgical patients/day. Surgical units with the highest CI were maxillofacial (6%), gastrointestinal (5.3%) and cardiovascular (5.1%). Adjusting for length of stay, urology and paediatric surgery recorded the highest incidence rates, while ophthalmology and neurosurgery had the least. Colorectal surgery had the highest parameters (CI=10%; ID=0.57), followed by myocardial revascularisation and hip prosthesis. Among the surgical units and operative procedures assessed, the CI of SSI increased with the NNIS index. CONCLUSIONS: The CI and ID of SSI observed in this study were similar to those obtained in previous European surveillance projects, and lower than those recorded in our hospital in 1994 which reflects a higher level of vigilance and a higher awareness in applying control measures.

Alzheimer's disease and coffee: a quantitative review.

PURPOSE: To estimate the pooled risk of coffee consumption for Alzheimer's disease (AD). MATERIAL AND METHODS: We have reviewed all observational studies that evaluated the association between AD risk and coffee consumption. Four studies were identified: two case-control studies and two cohorts. These studies were carried out between 1990 and 2002. RESULTS: There was an obvious protective effect of coffee consumption in the pooled estimate [risk estimate: 0.73 (95% confidence interval: 0.58-0.92)]. However, the homogeneity test was highly significant (p<0.01), indicating heterogeneity across the pooled studies. Pooled analysis applying the random effect model was 0.79 with 95% confidence interval overlapping unity (95% confidence interval: 0.46-1.36). Three studies assessed coffee consumption by interview questionnaire. The risk of AD in coffee consumers versus non-consumers in studies that used interview questionnaire had a pooled risk estimate of 0.70 with 95% confidence interval 0.55-0.90. CONCLUSION: Although our pooled estimates show that coffee consumption is inversely associated with the risk of AD, the four studies had heterogeneous methodologies and results. Further prospective studies evaluating the association between coffee consumption and AD are strongly needed.

Smoking and Parkinson's disease: systematic review of prospective studies.

We estimated the pooled risk of tobacco smoking for Parkinson's disease (PD). Inclusion criteria included systematic searches of MedLine, PsycLIT, Embase, Current Contents, previously published reviews, examination of cited reference sources, and personal contact and discussion with several investigators expert in the field. Published prospective studies on PD and cigarette smoking. When two or more studies were based on an identical study, the study that principally investigated the relationship or the study that was published last was used. Seven prospective studies were carried out between 1959 and 1997, of which six reported risk estimates. Four cohorts were based on standardised mortality rates, which were exclusively of male. Only one study included risk estimates for both males and females separately. The risk of ever smoker was 0.51 (95% confidence interval, 0.43 to 0.61). There was an obvious protective effect of current smoking in the pooled estimate (relative risk, 0.35; 95% CI, 0.26-0.47). Former smokers had lower risk compared with never smokers (relative risk, 0.66; 95% CI, 0.49-0.88). Although our pooled estimates show that smoking is inversely associated with the risk of PD, the four prospective studies that were based on follow-up of mortality of smokers had many limitations. Further studies evaluating the association between smoking and PD in women are strongly needed.

Parkinson's disease protects against smoking?

Our aim was to estimate the pooled risk of current and former smoking for Parkinson's disease (PD). We have reviewed all observational studies that evaluated the association between PD risk and smoking habit. Twenty six studies were identified: 21 case-control, 4 cohort and 1 cross-sectional. The cross-sectional study did not compare former with never smokers. These studies were carried out between 1968 and 2000. There was an obvious protective effect of current smoking in the pooled estimate [risk estimate 0.37 (95% confidence interval 0.33 to 0.41)]. Former versus never smokers had pooled risk estimate of 0.84 (95% confidence interval 0.76 to 0.92). Current and former smoking do not, therefore, exert the same protective effect against PD so that it is unnecessary to postulate a biological mechanism through which smoking protects against PD. The results show that the reverse direction of causation is a more probable explanation, i.e. movement disorders of PD protect against smoking. Another explanation is that failure to develop strong smoking habits in early adult life might be a prodromal symptom of the disease and could perhaps be its first clinical manifestation.

Smoking and Parkinson's disease: explanatory hypothesis.

A systematic review was conducted to estimate the pooled risk of smoking for Parkinson's disease in Chinese populations. The four identified case-control studies had odds ratios with 95% confidence intervals nearly or overlapping unity. Pooled odds ratio of these studies was 0.77 with 95% confidence interval 0.60 to 0.97. It was suggested that smoking induces debrisoquine 4-hydroxylase, which is responsible for the metabolism of antipsychotic drugs and the detoxification of certain environmental toxins known to cause dopaminergic neural damage. This could be the explanation of these contradictory results as cytochrome P-450 CYP2D6 debrisoquine hydroxylase gene polymorphism is known to be much lower in Chinese than in Caucasian people. This systematic review raises concerns about generalization of the conclusion previously settled by many cohort and case-control studies.

Estudio de 13 casos de anisakiasis en la provincia de Córdoba / Study of 13 cases of anisakiasis in the province of Córdoba, Spain

La anisakiasis o anisakidosis es una zoonosis parasitaria provocada por la infestación de nematodos de la familia Anisakidae, principalmente la especie Anisakis simplex (AS). Su distribución es mundial, aunque su aparición es reciente en España (1991) habiéndose descrito 19 casos previos a este estudio. Presentamos 13 casos diagnosticados en distintos centros hospitalarios de la provincia de Córdoba desde septiembre de 1994 hasta julio de 1998, lo que representa la mayor serie de casos descrita en España por el momento. Todos los pacientes comenzaron clínicamente como un cuadro de abdomen agudo por lo que se trataron mediante a cirugía precoz en la que se observó un segmento intestinal inflamado y estenótico que fue resecado. El estudio histológico de la pieza reveló un importante infiltrado eosinófilo en la mucosa. En un caso se detectaron fragmentos del parásito en la mucosa intestinal y en los 12 restantes el diagnóstico fue inmunológico mediante la determinación de IgE específica anti-Anisakis simplex y la detección de antígenos del nematodo mediante anticuerpos monoclonales. Como antecedente epidemiológico de interés cabe resaltar que todos los pacientes referían ser comedores habituales de pescado crudo (principalmente boquerones en vinagre) que actúa como huésped de larvas terciarias del parásito (AU)

Abnormally wide confidence intervals in logistic regression: interpretation of statistical program results

This study describes the behavior of eight statistical programs (BMDP, EGRET,IMP, SAS, SPSS, STATA, STATISTIX and SYSTAT) when performing a logistic regression with a simulated data set that contains a numerical problem created by the presence of a cell value equal to zero. The programs respond in different ways to this problem. Most of them give a warning, although many simultaneously present incorrect results, among which are confidence intervals that tend toward infinity. Such results can mislead the user. Various guidelines are offered for detecting these problems in actual analyses, and users are reminded of the importance of critical interpretation of the results of statistical programs

Abnormally wide confidence intervals in logistic regression: interpretation of statistical program results / Intervalos de confianza anormalmente amplios en regresión logística: interpretación de resultados de programas estadísticos

This study describes the behavior of eight statistical programs (BMDP, EGRET,IMP, SAS, SPSS, STATA, STATISTIX and SYSTAT) when performing a logistic regression with a simulated data set that contains a numerical problem created by the presence of a cell value equal to zero. The programs respond in different ways to this problem. Most of them give a warning, although many simultaneously present incorrect results, among which are confidence intervals that tend toward infinity. Such results can mislead the user. Various guidelines are offered for detecting these problems in actual analyses, and users are reminded of the importance of critical interpretation of the results of statistical programs

Este estudio describe el comportamiento de ocho programas estadísticos (BMDP, EGRET,JMP, SAS, SPSS, STATA, STATISTIX y SYSTAT), al realizar una regresión logística con una base de datos simulados en la cual existe un problema numérico creado por la presencia de una celda con frecuencia igual a 0. Los programas responden de manera heterogénea a este problema. La mayor parte de ellos ofrecen señales de alarma, aunque muchos presentan, simultáneamente, resultados incorrectos entre los cuales destacan los intervalos de confianza que tienden al infinito. Estos resultados pueden desorientar al usuario. Se describen diferentes criterios orientativos para detectar estos problemas en situaciones de análisis reales y se recuerda la importancia de la interpretación crítica de los resultados de programas estadísticos

Intervalos de confianza normalmente amplios en regresión logística: intepretación de resultados de programas estadísticos / Abnormally broad confidence intervals in logistic regression: interpretation of results from statistical programs

This study describes the behavior of eight statistical programs (BMDP, EGRET, JMP, SAS,SPSS, STATA, STATISTIX, and SYSTAT) when performing a logistic regression with a simulated data set that contains a numerical problem created by the presence of a cell valueequal to zero. The programs respond in different ways to this problem. Most of them give a warning, although many simultaneously present incorrect results, among which are confidence intervals that tend toward infinity. Such results can mislead the user. Various guidelines are offered for detecting these problems in actual analyses, and users are reminded of the importance of critical interpretation of the results of statistical programs

Este estudio describe el comportamiento de ocho programas estadísticos (BMDP, EGRET, JMP, SAS, SPSS, STATA, STATISTIX y SYSTAT), al realizar una regresión logística con una base de datos simulados en la cual existe un problema numérico creado por la presencia de una celda con frecuencia igual a 0. Los programas responden de manera heterogénea a este problema. La mayor parte de ellos ofrecen señales de alarma, aunque muchos presentan, simultáneamente, resultados incorrectos entre los cuales destacan los intervalos de confianza que tienden al infinito. Estos resultados pueden desorientar al usuario. Se describen diferentes criterios orientativos para detectar estos problemas en situaciones de análisis reales y se recuerda la importancia de la interpretación crítica de los resultados de programas estadísticos