[Study of sociodemographic and psychopathological risk factors in suicide attempts. 2008-2010]. / Análisis de los intentos de autolisis en un área de salud. 2008-2010.

OBJECTIVE: The aim of this study is to determine the sociodemographic and psychopathological features and risk factors associated with suicide attempts. DESIGN: A descriptive cross-sectional study based on medical records. Emergency Primary Care Centres (Jumilla, Yecla) and Hospital Emergency Departments (Yecla, Murcia, Spain). RESULTS: The suicide attempt rate increases in younger people (average of 36.4 years old). Suicide attempts are higher among women (67%). In terms of psychopathological data, suicide attempts were characterised by a higher prevalence of depression and anxiety disorder (30%), and substance abuse (13%). The percentage of patients who had made a previous suicide attempt was 37%. Self-poisoning was the most recurrent method of suicide attempt, present in at least 80% of the cases. Gender was a significant factor in the cause of suicide attempt (P=.042) and psychopathology (P=.011). The geographic origin of the patient is significantly associated with the suicide method used (P=.000). CONCLUSIONS: Suicide treatment protocols and suicide prevention programs must be developed, as well as recording the risk factors in the patient history.

Análisis de los intentos de autolisis en un área de salud. 2008-2010 / Study of sociodemographic and psychopathological risk factors in suicide attempts. 2008-2010

Objetivo. Se trata de estudiar el porcentaje de pacientes con intentos de autolisis valorados en un área de salud sin psiquiatra de guardia y analizar las características de los mismos. Material y métodos. Estudio descriptivo, transversal. Se han estudiado el total de las consultas atendidas por intento de autolisis durante los años 2008, 2009 y 2010, en el área V-Región de Murcia. Los criterios de exclusión han sido los intentos de autolisis con consecuencia de fallecimiento. Resultados. La edad media de los pacientes que consultaron por intento de autolisis fue 36,4 años. El 67% de los pacientes fueron mujeres. Los antecedentes psiquiátricos más prevalentes fueron, síndrome ansioso-depresivo (30%), abuso de drogas (13%) y patología dual (10%). El 37% de los pacientes que realizó un intento de autolisis tenía antecedentes de intentos previos. El 80% de los intentos de autolisis fue por consumo de fármacos o la combinación de fármacos, alcohol y drogas ilegales. El sexo se relaciona significativamente con el desencadenante del intento de autolisis (p 0,042) y con el diagnóstico psiquiátrico previo (p 0,011). La procedencia geográfica se relaciona significativamente con el método de autolisis (p 0,000). Conclusiones. A la hora de elaborar la historia clínica debe mejorarse la cumplimentación de los factores de riesgo de suicidio. Deben establecerse protocolos asistenciales multidisciplinares no solo para el tratamiento médico sino para la valoración urgente por el psiquiatra en nuestro centro de referencia (AU)

Objective. The aim of this study is to determine the sociodemographic and psychopathological features and risk factors associated with suicide attempts. Design. A descriptive cross-sectional study based on medical records. Emergency Primary Care Centres (Jumilla, Yecla) and Hospital Emergency Departments (Yecla, Murcia, Spain). Results. The suicide attempt rate increases in younger people (average of 36.4 years old). Suicide attempts are higher among women (67%). In terms of psychopathological data, suicide attempts were characterised by a higher prevalence of depression and anxiety disorder (30%), and substance abuse (13%). The percentage of patients who had made a previous suicide attempt was 37%. Self-poisoning was the most recurrent method of suicide attempt, present in at least 80% of the cases. Gender was a significant factor in the cause of suicide attempt (P=.042) and psychopathology (P=.011). The geographic origin of the patient is significantly associated with the suicide method used (P=.000). Conclusions. Suicide treatment protocols and suicide prevention programs must be developed, as well as recording the risk factors in the patient history (AU)

[Severe isolated pulmonary hypertension as main manifestation of Crest syndrome]. / Hipertensión pulmonar aislada severa como manifestación principal del síndrome Crest.

Interstitial pulmonary fibrosis is the leading cause of secondary pulmonary hypertension in systemic sclerosis, and it occurs in either limited or diffuse cutaneous scleroderma subset. Isolated pulmonary hypertension, without pulmonary disease, occurs primarily in patients with limited cutaneous scleroderma (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia [CREST] variant) although it is an unusual feature in this subset, with a worse prognosis in the short term. We present a previously undiagnosed patient with the CREST syndrome, with severe isolated pulmonary hypertension and secondary respiratory failure as major feature of its connective tissue disease. Clinical, prognostic and therapeutical aspects are commented.

Hipertensión pulmonar aislada severa como manifestación principal del síndrome Crest / Severe isolated pulmonary hypertension as major feature of the crest syndrome

La fibrosis pulmonar intersticial es la causa más frecuente de hipertensión pulmonar secundaria en la esclerosis sistémica, tanto en el subgrupo de escleroderma cutánea difusa como en el de escleroderma cutánea limitada. La hipertensión pulmonar aislada, no asociada a enfermedad pulmonar, aunque ocurre primariamente en pacientes con escleroderma cutánea limitada y su variante el síndrome CREST (calcinosis, fenómeno de Raynaud, dismotilidad esofágica, esclerodactilia y telangiectasias) constituye un hallazgo infrecuente en este subgrupo, implicando un mal pronóstico a corto plazo. Comunicamos el caso de una paciente con síndrome CREST, no diagnosticada previamente, con hipertensión pulmonar aislada severa e insuficiencia respiratoria secundaria como manifestación principal de su conectivopatía. Se comentan aspectos relacionados con la clínica, pronóstico y manejo terapéutico de estos pacientes (AU)

Esophageal candidiasis in HIV-negative patients.

UNLABELLED: Candida esophagitis is the most frequent esophageal infection in HIV seropositive as well as in seronegative patients. AIM: this retrospective study was designed to determine the characteristics of this disease in HIV negative patients in a general hospital. DESIGN: clinical records of all HIV negative patients with Candida esophagitis, which was endoscopically diagnosed and microscopically confirmed (biopsy and/or cytology of esophageal mucosa), were studied. RESULTS: thirty-one patients (23 men, 8 women, mean age: 65.4 +/- 14.3 years, median 71) fulfilled the criteria (0.56% of the diagnostic esophagogastroduodenal endoscopies). The most common clinical symptoms were dysphagia with or without odynophagia and pain (retrosternal, epigastric or xiphoid). Fourteen patients (45%) had no esophageal signs; in nine of them (29%) the disease was diagnosed in the course of an endoscopic exam to investigate the sources of acute or chronic anaemia. The most frequent predisposing factors were diabetes mellitus, oral or aerosolized corticotherapy, malignancies, treatment with broad-spectrum antibiotics and liver cirrhosis. Nine patients (29%) presented no known predisposing factors. The most common endoscopic appearance was grade II (51%). Sixty-one per cent of the patients exhibited at least one other esophagogastroduodenal endoscopic lesion associated with the mycosis. Three patients died of their underlying diseases within one week of the diagnosis of the candidiasis. Only one patient presented persistence of candidiasis one week after initiating treatment with oral nystatine. CONCLUSIONS: esophageal candidiasis is infrequent and does not always present with suspicious symptoms or known predisposing factors. Aerosolized corticotherapy may be a risk factor for the development of esophageal candidiasis.