A multidimensional approach to the resilience in older adults despite COVID-19.

Researchers have mainly focused on aging risk factors and COVID-19 consequences. However, older adults have proved their ability to overcome adversities along their life. Resilience is a protective variable that dampens the impact of stress. Based on MacLeod's et al. (2016) approach, we aimed to analyze the relationship between older adults' resilience and COVID-19 related-stressors as well as their physical, mental, and social characteristics. Eight hundred eighty-nine people aged 60 and over participated in this study. Older participants, women, having better perceived health and not losing a loved one because of the virus were associated with more resilience. Moreover, higher levels of gratitude, personal growth, life purpose and lower levels of depression were associated with greater scores in resilience. This study offers a change of perspective in which aging is perceived from a positive viewpoint by focusing on easily accessible resources that may help older adults to cope with adverse situations.

Psychological well-being among older adults during the COVID-19 outbreak: a comparative study of the young-old and the old-old adults.

The COVID-19 outbreak could be considered as an uncontrollable stressful life event. Lockdown measures have provoked a disruption of daily life with a great impact over older adults' health and well-being. Nevertheless, eudaimonic well-being plays a protective role in confronting adverse circumstances, such as the COVID-19 situation. This study aims to assess the association between age and psychological well-being (personal growth and purpose in life). Young-old (60-70 years) and old-old (71-80 years) community-dwelling Spaniards (N = 878) completed a survey and reported on their sociodemographic characteristics and their levels of health, COVID-19 stress-related, appraisal, and personal resources. Old-old did not evidence poorer psychological well-being than young-old. Age has only a negative impact on personal growth. The results also suggest that the nature of the COVID-19 impact (except for the loss of a loved one) may not be as relevant for the older adults' well-being as their appraisals and personal resources for managing COVID-related problems. In addition, these results suggest that some sociodemographic and health-related variables have an impact on older adults' well-being. Thus, perceived-health, family functioning, resilience, gratitude, and acceptance had significant associations with both personal growth and purpose in life. Efforts to address older adults' psychological well-being focusing on older adults' personal resources should be considered.

Development and assessment of the content validity of the professional good practices scale in nursing homes.

Recent approaches in the care of older people have led to a greater emphasis on good practices to prevent elder abuse. The instruments assessing good practices are very limited, and those focused on elder abuse have rarely considered subtle forms, especially in institutional settings. The aim of this study was to develop and assess the content validity of a good practices scale for professionals working in nursing homes. An extensive literature review of the tools assessing professionals' good-bad practices towards older people was conducted. A preliminary scale based on Kayser-Jones' (1990) [Old, Alone and Neglected: Care of the Aged in Scotland and the United States. Berkeley, CA: University of California Press] types of abuse was developed, including four subscales: Personalization, Humanization, Absence of Infantilization, and Absence of Victimization. Content validity was analyzed through a panel of eight experts. Rovinelli and Hambleton's index of item-objective congruence was used to analyze the items' inclusiveness in the assigned subscale to establish their representativeness. Items' relevance and clarity were analyzed using the paired comparison method. The final version of the scale included 56 items, with appropriate levels of item objective-congruence, relevance, and clarity. This instrument will allow professionals to detect and develop awareness and intervention programs that aim to promote good practices in nursing homes.

Trypanosoma cruzi induces apoptosis in ex vivo infected human chorionic villi.

Chagas' disease, produced by the haemoflagellated protozoan Trypanosoma cruzi (T. cruzi), is one of the most frequent endemic diseases in Latin America. In spite that in the past few years T. cruzi congenital transmission has become of epidemiological importance, studies about this mechanism of infection are scarce. The placental tissue undergoes apoptosis throughout gestation, as part of its normal turnover. On the other hand, it is known that T. cruzi induces, delays or inhibits apoptosis in other mammalian tissues. In order to determine the effect of parasite invasion on normal apoptosis in the placenta, explants of human chorionic villi were incubated with 105 trypomastigotes for 24 h. Effective infection was tested by visualizing T. cruzi antigens in histological preparations and by PCR. Upon infection, apoptotic cell death was determined by light and transmission electron microscopy, TUNEL analysis, measurement of caspase-3 like activity and immunohistochemical detection of caspase 3 cleaved cytokeratin 18. Our results clearly show that T. cruzi induces apoptosis in the chorionic villi and suggest that this is one of mechanisms used by the parasite to insure infection and invasion of human placenta and fetus.

Vitamin D deficiency in Spain: a population-based cohort study.

BACKGROUND: Vitamin D deficiency is common worldwide. No homogenous reference values have yet been established and no studies of values have been conducted in Spain involving a large number of participants. OBJECTIVE: To study the population concentrations of vitamin D in a representative sample of the Spanish population. SUBJECTS/METHODS: The study involved two cohorts from Spain, the Asturias study and the Pizarra study, which are two prospective, population-based studies involving 2260 participants. In 1262 subjects (age: 20-83 years) we studied 25-hydroxyvitamin D, intact parathyroid hormone (iPTH), calcium, phosphorus and creatinine. RESULTS: The median population values of 25-hydroxyvitamin D and iPTH were 22.46 ng/ml and 42.29 pg/ml, respectively. The values of 25-hydroxyvitamin D were significantly higher in summer and correlated with age (ß = -0.05 ± 0.01, P < 0.0001), creatinine (ß = 6.42 ± 1.17, P < 0.0001) and iPTH (-0.07 ± 0.01, P < 0.0001), but not with calcium, phosphorus or sex. The increase in iPTH with age was seen whatever the values of 25-hydroxyvitamin D, and was greater in the older persons. The concentration of iPTH rose continuously with effect from 25-hydroxyvitamin D values below ≈30 ng/ml. Values above ≈35 ng/ml were associated with a significantly lower concentration of iPTH. CONCLUSIONS: One-third (33.9%) of the Spanish population may be at risk for Vitamin D deficiency. The 25-hydroxyvitamin D values above 30 ng/ml can safely discard 'hyper PTH'. The increase in iPTH concentration is greater in older persons for similar values of 25-hydroxyvitamin D.

Trypanosoma cruzi induces tissue disorganization and destruction of chorionic villi in an ex vivo infection model of human placenta.

Congenital Chagas' disease, endemic in Latin America and also present with lower frequency in other countries, is associated with premature labor, miscarriage, and placentitis. The mechanism of tissue invasion and infection of human placenta by the parasite Trypanosoma cruzi (T. cruzi) remains unclear. In order to explore some morphological aspects of this infection in the placenta, we incubated chorionic villous explants from normal human placentae ex vivo with the parasite and studied the resulting effects by immunohistochemical and histochemical methods. Infection of the chorionic villi with the parasite was confirmed by immunofluoresence and PCR. T. cruzi induces syncytiotrophoblast destruction and detachment, selective disorganization of basal lamina and disorganization of collagen I in the connective tissue of villous stroma. These effects are a function of the number of parasites used for the infection. Our results suggest a participation of the proteolytic activity of the parasite on the placental basal lamina and connective tissue in the mechanism of infection of the fetus by T. cruzi.

Risk factors of elder abuse in a community dwelling Spanish sample.

We analyzed the discriminative capacity of several risk factors for elder abuse and neglect, in order to identify what characteristics distinguish between caregivers with a high or low risk of abuse and neglect. Forty-five caregivers of relatives with dementia participated. The combination of caregiving impact, frequency of aggressive behaviors by care-recipients, stress related to provocative and aggressive behaviors, the frequency of provocative behaviors, interpersonal burden, autoefficiency expectations, quantity of help received and depression classify correctly as risk factors in 90.9% of the cases. This study permits us to identify what characteristics distinguish between caregivers with a high or low risk of abuse and neglect and caregivers.

Terapia Ocupacional en el tratamiento de las adicciones / Occupational therapy in treatment of addictive disorders

Objetivo. La Terapia Ocupacional esuna disciplina presente en los equipos de tratamientode personas con problemas asociados al consumode drogas desde los inicios de la respuesta institucionalal fenómeno. Sin embargo, su figura profesionales poco conocida y, en ocasiones, malinterpretada.Amenudo el encargo que recibe el profesional esel de «mantener ocupados» a los pacientes. La TerapiaOcupacional se basa en el estudio de la ocupaciónhumana y la utiliza como instrumento de intervenciónpara el logro de sus objetivos, siendo elbásico y fundamental conseguir la independencia dela persona.Material y métodos. Se revisan los aspectos relativosa la Terapia Ocupacional dentro de las adicciones.Resultados. En el presente trabajo se exponenmodelos científicos, instrumentos de evaluaciónpropios y enfoques específicos aplicables a la adicción,sustentados en la investigación científica.Conclusiones. Finalmente, se pone de manifiestoel papel que la Terapia Ocupacional puede desarrollaral hilo de los más recientes modelos neuropsicológicosde la adicción

Objectives. Occupational Therapy is adiscipline present in professional staff of peoplewith problems associated to drug use treatment,from the beginnings of the institutional reply to thephenomenon. Nevertheless, its professional profileis hardly known and, sometimes, misunderstood. Inmany occasions the order that professional receivesis «to maintain occupied» the patients. OccupationalTherapy is based on the study of human occupationand uses this one as intervention tool for theprofit of its objectives, being it basic and fundamentalobjective to obtaining person’s independence.Material and methods. The Occupational Therapyin the treatment of addictive disorders is reviewed.Results. In the present work, scientific models,own assessment instruments and specific approachespotentially applicable to the addiction are exposed,sustained in the scientific research.Discussion. Finally, it is describes the role thatOccupational Therapy can play following the mostrecent neuropsychological addiction models

Modification of dysfunctional thoughts about caregiving in dementia family caregivers: description and outcomes of an intervention programme.

UNLABELLED: Among the diverse group of interventions developed to help dementia family caregivers cognitive-behavioural approaches show especially promising results. OBJECTIVES: This study describes a cognitive-behavioural group intervention aimed principally at the modification of dysfunctional thoughts associated with caregiving (MDTC). The efficacy of the MDTC intervention in reducing caregivers' depressive symptomatology, together with the frequency and appraisal of problem behaviours, is compared to that of a waiting-list control group (WL). Furthermore, the potential mediating role of the dysfunctional thoughts in the relationship between this intervention and caregivers' depressive symptomatology is analyzed. Of the 74 dementia caregivers who were randomized to one of two conditions (MDTC and WL), 39 completed the post-intervention assessment. Statistical analyses were performed on an intention-to-treat basis, using last observation carried forward. The results reveal that the MDTC intervention is successful in reducing caregivers' level of depressive symptomatology and dysfunctional thoughts about caregiving, as well as in modifying their appraisal of their relative's problem behaviours. Furthermore, a mediating role for dysfunctional thoughts was found in the relationship between the MDTC intervention and levels of depressive symptomatology. The relevance of addressing dysfunctional thoughts and cognitive distortions in group interventions with caregivers is highlighted.

Tratamiento psicológico del miedo a las caídas: un estudio de caso / Psycological treatment of the fear of falling: A case study

Objetivo: el miedo a las caídas es la complicación más común entre las personas mayores que han presentado una caída de la que no se ha derivado lesión física importante. Material y método: se presentan los resultados de una intervención conductual llevada a cabo con una mujer de 69 años que, durante un período de 1 año, había presentado diversas caídas sin causa física que, según informe médico, las justificara. Esta persona había reducido drásticamente su actividad, y se desplazaba tan sólo apoyada en muebles o en otra persona. La intervención consistió en una fase educativa acerca del problema y la explicación de éste en términos conductuales; el aprendizaje de estrategias para minimizar la ansiedad ante la realización de actividades y reanudar de forma gradual las actividades temidas (exposición en vivo, respiración profunda, autoinstrucciones, parada de pensamiento y aserción encubierta), así como correciones ambientales y eliminación de factores de riesgo. Resultados y discusión: los resultados del programa, tras 8 sesiones de intervención, evaluados con distintas técnicas de autoinforme y tests situacionales, indican que se ha reducido de una forma notable la ansiedad global para andar y mantenerse de pie, así como que ha aumentado significativamente el número de conductas de movilidad en solitario —especialmente, en el ámbito del hogar— y de actividades de la vida diaria realizadas de forma independiente, cuya realización se había suprimido desde la primera caída (AU)

Objective: fear of falling is the most common complication in elderly people who have suffered a fall without sustaining serious physical injury. Material and methods: we present the results of a behavioural intervention carried out in a 69-year-old woman who had had various falls over a period of 1 year, with no cause, according to her medical report, that would explain these falls. The patient had drastically reduced her activity and moved about only by supporting herself on items of furniture or on other people. The intervention consisted of an education phase about the problem and its explanation in behavioural terms. The patient learned behavioural strategies to minimise anxiety in the face of activities, and gradual recommencement of the feared activities (exposure in vivo, deep breathing, self-instructions, thought stopping and covert assertion), in addition to environmental changes and elimination of risk factors. Results and discussion: the results of the intervention programme after eight sessions, assessed with various self-report techniques and situational tests, indicate a notable reduction in the patient’s overall anxiety about walking and remaining on her feet, and a significant increase in the number of unaided mobility behaviours -especially in the home environment- and of independently carried out everyday activities, which had been ceased since the first fall (AU)

Protocolo para el estudio de trastornos debidos a la deficiencia nutricional de yodo / Protocol for the study of iodine deficiency disorders

El protocolo aquí presentado es el desarrollo de la ponencia del mismo título expuesta en la mesa redonda sobre yodo deficiencia del congreso de la Sociedad Española de Endocrinología (SEEN) celebrado en Cáceres. En él se recogen las experiencias de protocolización previas que se han producido en España para el estudio de los trastornos por déficit de yodo, que han sido de gran utilidad para sistematizar los estudios realizados en los últimos años. Con este protocolo se pretende actualizar la sistemática del estudio de los trastornos por déficit de yodo en el contexto de los nuevos conocimientos y de los importantes cambios sociosanitarios que se han producido en los últimos años (AU)

The protocol presented here in is anextension of the communication with the same title delivered during the round table on iodine deficiency at the meeting of the Spanish Society of Endocrinology and Nutrition in Caceres. The protocol collates the experience gained from previous protocols for the study of iodine deficiency disorders (IDD) in Spain, which have proved highly useful for the systematic study of these disorders in recent years. This new protocol aims to update the systematic study of IDD in the context of new knowledge and the considerable social and healthcare changes that have taken place in recent years (AU)

[Differential efficacy of two psychoeducational interventions for dementia family caregivers]. / Eficacia diferencial de dos intervenciones psicoeducativas para cuidadores de familiares con demencia.

INTRODUCTION AND OBJECTIVES: The aim of this work is to compare the effectiveness of two psychoeducational interventions for dementia caregivers: a cognitive behavioral one (PCC), aimed at the modification of dysfunctional thoughts about caregiving, and another one consisting in problem solving skills training (PSP) for caregivers, with the aim of modifying the behavioral problems of their relative. SUBJECTS AND METHODS: Seventy five caregivers were asked to participate in an intervention program, of whom 31 finally completed the study. Both group interventions are compared with a control group (CG). The caregiver groups were randomly assigned to each experimental condition. Pre, post intervention, and follow up assessments of the following variables have been made: depression, perceived stress, frequency of behavioral problems, perceived stress associated with the behavioral problems and dysfunctional thoughts about caregiving. RESULTS: Following the intervention, caregivers in the PCC program show significantly less perceived stress than the other two groups. In the same direction, a trend exists to a significant reduction of the stress associated with the behavioral problems. In the follow up assessment, caregivers of the PCC program significantly report less relative's behavioral problems than the other two groups. Caregivers of the PCC program have less dysfunctional thoughts than the other two groups, differences almost reaching significance. CONCLUSIONS: Benefits of a psychoeducational intervention vary as a function of the contents it includes. The importance of intervening on the caregiver dysfunctional thoughts for an adequate coping with caregiving is highlighted.

Eficacia diferencial de dos intervenciones psicoeducativas para cuidadores de familiares con demencia / Differential efficacy of two psychoeducational interventions for dementia family caregivers

Introducción y objetivo. A través de este trabajo se comparan dos intervenciones psicoeducativas con cuidadores de personas con demencia, un programa cognitivoconductual (PCC) dirigido a la modificación de pensamientos disfuncionales para el cuidado y otro programa de solución de problemas (PSP) dirigido a entrenar a los cuidadores en el manejo de los comportamientos problemáticos de su familiar. Sujetos y métodos. Se ofreció la posibilidad de participar en un programa de intervención a 75 cuidadores, de los cuales completaron el estudio 31. Las dos intervenciones grupales se comparan, a su vez, con un grupo control. Cada grupo de cuidadores se asignó aleatoriamente a cada una de las condiciones experimentales. Se realizaron evaluaciones antes y después de la intervención y otra de seguimiento de las siguientes variables: depresión, estrés percibido, frecuencia de comportamientos problemáticos, estrés asociado a los comportamientos y pensamientos disfun cionales sobre el cuidado. Resultados. Tras la intervención, los cuidadores que participaron en la intervención PCC tenían significativamente menos estrés percibido que los otros dos grupos, así como una tendencia a la significación en el mismo sentido cuando se analizaba el estrés asociado a los comportamientos problemáticos. En la fase de seguimiento, los cuidadores que participaron en la intervención PCC informaron de una frecuencia significativamente menor de comportamientos problemáticos que los otros dos grupos, y de menos pensamientos disfuncionales que los otros dos grupos, diferencias que rozan la significación estadística. Conclusiones. Los beneficios de una intervención psicoeducativa varían en función de los contenidos que incluya. Se destaca la importancia de intervenir sobre pensamientos poco adaptativos para un adecuado afrontamiento del cuidado (AU)

Introduction and objectives. The aim of this work is to compare the effectiveness of two psychoeducational interventions for dementia caregivers: a cognitive-behavioral one (PCC), aimed at the modification of dysfunctional thoughts about caregiving, and another one consisting in problem-solving skills training (PSP) for caregivers, with the aim of modifying the behavioral problems of their relative. Subjects and methods. Seventy-five caregivers were asked to participate in an intervention program, of whom 31 finally completed the study. Both group interventions are compared with a control group (CG). The caregiver groups were randomly assigned to each experimental condition. Pre, post-intervention, and follow-up assessments of the following variables have been made: depression, perceived stress, frequency of behavioral problems, perceived stress associated with the behavioral problems and dysfunctional thoughts about caregiving. Results. Following the intervention, caregivers in the PCC program show significantly less perceived stress than the other two groups. In the same direction, a trend exists to a significant reduction of the stress associated with the behavioral problems. In the follow-up assessment, caregivers of the PCC program significantly report less relative’s behavioral problems than the other two groups. Caregivers of the PCC program have less dysfunctional thoughts than the other two groups, differences almost reaching significance. Conclusions. Benefits of a psychoeducational intervention vary as a function of the contents it includes. The importance of intervening on the caregiver dysfunctional thoughts for an adequate coping with caregiving is highlighted (AU)

Evaluación toxicológica en ratas Sprague-Dawley de Interleuquina-2 y del candidato vacunal FPCR3, terapia combinada en pacientes con SIDA / Toxicological evaluation of Interleukin-2 and FPCR3 vaccine candidate in Sprague-Dawley rats, combined therapy in AIDS-patients

En busca de nuevas fórmulas terapéuticas para combatir la infección por el virus de inmunodeficiencia humana se han desarrollado diferentes tipos de vacunas, entre las que se encuentran las que estimulan la respuesta de linfocitos T citotóxicos contra antígenos del VIH. A partir de la obtención en el Centro de Ingeniería Genética y Biotecnología (La Habana, Cuba) de un candidato vacunal que utiliza como vector el virus de la viruela aviar modificado con genes que expresan proteínas anti-VIH, se ha diseñado un estudio clinico que combina la aplicación de este producto (FPCR3) con la terapia antirretroviral de alta eficiencia y dosis bajas de Interleuquina-2 humana recombinante (IL-2hr). Antes de ensayar estos productos biotecnológicos en pacientes con el síndrome de inmunodeficiencia adquirida se hizo necesario realizar pruebas toxicológicas para evaluar su seguridad, para lo cual se diseñaron 2 estudios de toxicidad aguda en los que se evaluó la respuesta sistémica y local de ratas Sprague-Dawley a dosis superiores a la que se administrará en los pacientes incluidos en el estudio clínico piloto. Se utilizaron 50 ratas de la sublínea Cenp: SPRD (Sprague-Dawley) en el estudio de toxicidad aguda de Interleuquina-2hr y 70 animales de esta misma especie y sublínea para el realizado al candidato vacunal FPCR3. Los productos Se administraron por vía subcutánea e intramuscular respectivamente a niveles de 30, 60 y 90 veces la dosis terapéutica. En el estudio realizado al candidato vacunal FPCR3 se incluyeron 3 grupos en los que se realizaron administraciones repetidas, a fin de evaluar de forma preliminar la tolerancia local de este producto. En ambos estudios se incluyó un grupo control inoculado con el placebo de las formulaciones. Se realizó Observación clínica diaria y se llevó a cabo el estudio histopatológico de los órganos diana y del sitio de administración. No se evidenciaron signos de toxicidad ni efectos adversos en los animales inoculados con el candidato vacunal FPCR3 é IL-2. No se reportaron muertes durante los estudios y los animales manifestaron adecuada respuesta ante estímulos, así como incremento progresivo de peso. El estudio histopatológico mostró ligera reacción local caracterizada por secuestro del inóculo y presencia de tejido de granulación en animales administrados con Interleuquina-2 hr. En los que recibieron diferentes dosis del candidato vacunal FPCR3 se reportaron granulomas macrofágicos de diversa intensidad en el sitio de administración. No se reportó en ningún caso signos de toxicidad en los órganos estudiados. Aún cuando se precisan otros estudios toxicológicos, estos resultados sugieren que la aplicación del candidato vacunal FPCR3 contra el virus de la inmunodeficiencia humana -y de Interleuquina-2hr es segura y bien tolerada en el espectro de dosis estudiadas, garantizando un marco de segur¡dad adecuado para su aplicación en los pacientes infectados con el síndrome de la inmunodeficiencia adquirida incluidos en el estudio clínico piloto (AU)

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Replication of African swine fever virus DNA in infected cells.

We have examined the ultrastructural localization of African swine fever virus DNA in thin-sections of infected cells by in situ hybridization and autoradiography. Virus-specific DNA sequences were found in the nucleus of infected Vero cells at early times in the synthesis of the viral DNA, forming dense foci localized in proximity to the nuclear membrane. At later times, the viral DNA was found exclusively in the cytoplasm. Electron microscopic autoradiography of African swine fever virus-infected macrophages showed that the nucleus is also a site of viral DNA replication at early times. These results provide further evidence of the existence of nuclear and cytoplasmic stages in the synthesis of African swine fever virus DNA. On the other hand, alkaline sucrose sedimentation analysis of the replicative intermediates synthesized in the nucleus and cytoplasm of infected macrophages showed that small DNA fragments ( approximately 6-12S) were synthesized in the nucleus at an early time, whereas at later times, larger fragments of approximately 37-49S were labeled in the cytoplasm. Pulse-chase experiments demonstrated that these fragments are precursors of the mature cross-linked viral DNA. The formation of dimeric concatemers, which are predominantly head-to-head linked, was observed by pulsed-field electrophoresis and restriction enzyme analysis at intermediate and late times in the replication of African swine fever virus DNA. Our findings suggest that the replication of African swine fever virus DNA proceeds by a de novo start mechanism with the synthesis of small DNA fragments, which are then converted into larger size molecules. Ligation or further elongation of these molecules would originate a two-unit concatemer with dimeric ends that could be resolved to generate the genomic DNA by site-specific nicking, rearrangement, and ligation as has been proposed in the de novo start model of Baroudy et al. (B. M. Baroudy, S. Venkatesam, and B. Moss, 1982, Cold Spring Harbor Symp. Quant. Biol. 47, 723-729) for the replication of vaccinia virus DNA.

Migration of mitochondria to viral assembly sites in African swine fever virus-infected cells.

An examination by electron microscopy of the viral assembly sites in Vero cells infected with African swine fever virus showed the presence of large clusters of mitochondria located in their proximity. These clusters surround viral factories that contain assembling particles but not factories where only precursor membranes are seen. Immunofluorescence microscopy revealed that these accumulations of mitochondria are originated by a massive migration of the organelle to the virus assembly sites. Virus infection also promoted the induction of the mitochondrial stress-responsive proteins p74 and cpn 60 together with a dramatic shift in the ultrastructural morphology of the mitochondria toward that characteristic of actively respiring organelles. The clustering of mitochondria around the viral factory was blocked in the presence of the microtubule-disassembling drug nocodazole, indicating that these filaments are implicated in the transport of the mitochondria to the virus assembly sites. The results presented are consistent with a role for the mitochondria in supplying the energy that the virus morphogenetic processes may require and make of the African swine fever virus-infected cell a paradigm to investigate the mechanisms involved in the sorting of mitochondria within the cell.

PSA excess in the differential diagnosis of prostate carcinoma.

OBJECTIVE: To evaluate the efficiency of PSA excess in distinguishing prostate cancer (PC) in its early stages from benign prostatic hypertrophy (BPH) and compare it with the efficiency of serum PSA. METHODS: A cross-sectional study was carried out on 27 patients with PC and 46 with BPH, whose serum PSA and prostatic volume were determined. PSA excess was calculated as the difference between serum PSA and predicted PSA according to the gland volume, calculating the latter as the prostatic volume multiplied by factor 0.3 ng/ml/g. RESULTS: PSA excess values were significantly higher in patients with PC, while serum PSA levels were not different between the two populations studied. Receiver operating curves (ROC plots) showed a higher diagnostic utility for PSA excess, with a maximum efficiency of 73% at a cut-off point of -13 ng/ml. The predictive value of a positive result is slightly higher for serum PSA, but PSA excess showed a predictive value of a negative result superior to that of PSA.

Usefulness of PSA density and PSA excess in the differential diagnosis between prostate cancer and benign prostatic hypertrophy.

The usefulness of PSA density (PSAD) was evaluated in relation to the volume of the transitional zone (PSAT) and PSA excess. With this purpose we conducted a study including 27 patients diagnosed as having prostatic cancer (PC) and 46 patients with benign prostatic hypertrophy (BPH). In all of them, the PSA concentration in the serum was determined as well as the total prostatic volume and the transitional zone volume; digital rectal examination (DRE) was also performed. The major diagnostic efficacy was obtained with the excess of PSA (73%, cutoff = -13 ng/ml), followed by DRE (68%), PSAT (64%, cutoff = 0.5), PSAD (64%, cutoff = 0.2), and lastly PSA and ultrasonography (60%). Multivariate analysis (logistic regression) demonstrated PSA excess and DRE to be the best predictors. The model obtained by regression shows the best positive predictive value, and PSA excess the best negative predictive value. Consequently, PSA excess could be relevant in prostate cancer diagnosis.