Cognitive and clinical predictors of a long-term course in obsessive compulsive disorder: A machine learning approach in a prospective cohort study.

BACKGROUND: Obsessive compulsive disorder (OCD) is a disabling illness with a chronic course, yet data on long-term outcomes are scarce. This study aimed to examine the long-term course of OCD in patients treated with different approaches (drugs, psychotherapy, and psychosurgery) and to identify predictors of clinical outcome by machine learning. METHOD: We included outpatients with OCD treated at our referral unit. Demographic and neuropsychological data were collected at baseline using standardized instruments. Clinical data were collected at baseline, 12 weeks after starting pharmacological treatment prescribed at study inclusion, and after follow-up. RESULTS: Of the 60 outpatients included, with follow-up data available for 5-17 years (mean = 10.6 years), 40 (67.7 %) were considered non-responders to adequate treatment at the end of the study. The best machine learning model achieved a correlation of 0.63 for predicting the long-term Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score by adding clinical response (to the first pharmacological treatment) to the baseline clinical and neuropsychological characteristics. LIMITATIONS: Our main limitations were the sample size, modest in the context of traditional ML studies, and the sample composition, more representative of rather severe OCD cases than of patients from the general community. CONCLUSIONS: Many patients with OCD showed persistent and disabling symptoms at the end of follow-up despite comprehensive treatment that could include medication, psychotherapy, and psychosurgery. Machine learning algorithms can predict the long-term course of OCD using clinical and cognitive information to optimize treatment options.

The genomics of visuospatial neurocognition in obsessive-compulsive disorder: A preliminary GWAS.

BACKGROUND: The study of Obsessive-Compulsive Disorder (OCD) genomics has primarily been tackled by Genome-wide association studies (GWAS), which have encountered troubles in identifying replicable single nucleotide polymorphisms (SNPs). Endophenotypes have emerged as a promising avenue of study in trying to elucidate the genomic bases of complex traits such as OCD. METHODS: We analyzed the association of SNPs across the whole genome with the construction of visuospatial information and executive performance through four neurocognitive variables assessed by the Rey-Osterrieth Complex Figure Test (ROCFT) in a sample of 133 OCD probands. Analyses were performed at SNP- and gene-level. RESULTS: No SNP reached genome-wide significance, although there was one SNP almost reaching significant association with copy organization (rs60360940; P = 9.98E-08). Suggestive signals were found for the four variables at both SNP- (P < 1E-05) and gene-levels (P < 1E-04). Most of the suggestive signals pointed to genes and genomic regions previously associated with neurological function and neuropsychological traits. LIMITATIONS: Our main limitations were the sample size, which was limited to identify associated signals at a genome-wide level, and the composition of the sample, more representative of rather severe OCD cases than a population-based OCD sample with a broad severity spectrum. CONCLUSIONS: Our results suggest that studying neurocognitive variables in GWAS would be more informative on the genetic basis of OCD than the classical case/control GWAS, facilitating the genetic characterization of OCD and its different clinical profiles, the development of individualized treatment approaches, and the improvement of prognosis and treatment response.

Neuropsychological performance and predictors of pharmacological treatment response in obsessive compulsive disorder.

BACKGROUND: Obsessive Compulsive Disorder (OCD) is characterized by the presence of executive dysfunctions. As organizational strategies may play an important role as a possible endophenotype of the disorder, we decided to investigate non-verbal memory and organizational abilities in OCD. We also investigated how organization and non-verbal memory differ between responder and non-responder patients to pharmacological treatment, to test whether cognitive functions can predict the response to pharmacological treatment. METHODS: In Study 1, executive and clinical functioning measures were applied to 162 OCD and 95 controls. In Study 2, clinical, intelligence and executive functioning measures were applied to 72 OCD responders and 63 OCD non-responder patients. RESULTS: OCD patients and controls from Study 1 differed in copy organization (p < 0.01) and delayed recall (p = 0.048). In Study 2, the OCD responders displayed better copy organization (p = 0.013) and lower depressive, anxious and OCD symptoms (p < 0.01 in the three cases). Scores in the following instruments were found to predict the response to pharmacological treatment: HDRS, Y-BOCS, Raven progressive matrices, and Direct digit subtest from the Wechsler's scale (p < 0.01 in all four cases). LIMITATIONS: In Study 1, the imbalance of the sample can be considered a limitation, whilst in Study 2, some of the levels of pharmacological resistance were not represented. CONCLUSIONS: In this study, non-verbal memory and organization was affected in OCD. Responder patients also displayed better executive functioning and fluid intelligence. Organizational ability is a predictor of pharmacological response to SSRI monotherapy in a predictive model controlling for anxious symptoms.

How is COVID-19 affecting patients with obsessive-compulsive disorder? A longitudinal study on the initial phase of the pandemic in a Spanish cohort.

BACKGROUND: Although the consequences of the COVID-19 pandemic on emotional health are evident, little is known about its impact on patients with obsessive-compulsive disorder (OCD). METHODS: One hundred and twenty-seven patients with OCD who attended a specialist OCD Clinic in Barcelona, Spain, were assessed by phone from April 27 to May 25, 2020, during the early phase of the pandemic, using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and a structured interview that collected clinical and sociodemographic information. Results were compared with those for 237 healthy controls from the same geographic area who completed an online survey. RESULTS: Although 65.3% of the patients with OCD described a worsening of their symptoms, only 31.4% had Y-BOCS scores that increased >25%. The risk of getting infected by SARS-CoV2 was reported as a new obsession by 44.8%, but this only became the main obsessive concern in approximately 10% of the patients. Suicide-related thoughts were more frequent among the OCD cohort than among healthy controls. The presence of prepandemic depression, higher Y-BOCS scores, contamination/washing symptoms, and lower perceived social support all predicted a significantly increased risk of OCD worsening. CONCLUSIONS: Most patients with OCD appear to be capable of coping with the emotional stress of the COVID-19 outbreak and its consequences during the initial phase of the pandemic. Nevertheless, the current crisis constitutes a risk factor for a significant worsening of symptoms and suicidal ideation. Action is needed to ensure effective and individualized follow-up care for patients with OCD in the COVID-19 era.

[Initial situation and approach to the care of migraine in neurology services in Spain: the PRIMERA study]. / Situacion de partida y abordaje asistencial de la migrana en las consultas de neurologia de Espana. Estudio PRIMERA.

INTRODUCTION: Despite the high degree of disability it entails, many patients with migraine have never visited their doctor for this reason. It is necessary to conduct a study to examine the characteristics of first-time visits as a step that must be carried out prior to establishing specific intervention measures for this group of patients. AIM: To determine the profile of the patients with migraine who visit a neurology service for the first time, together with the diagnostic and therapeutic attitudes that neurologists display towards them. PATIENTS AND METHODS: We conducted a cross-sectional, multi-centre study of neurology services across the country. The research included 168 neurologists who recruited 851 patients (74.6% females; mean age: 34.0 ± 10.7 years). Disability was assessed by means of the specific migraine questionnaire (Headache Impact Test) and the generic disability questionnaire (Sheehan Disability Scale). RESULTS: A third (66.5%) of the patients went for consultation following their doctor's advice, while the remaining 33.5% went on their own accord. Only 55.9% had been previously diagnosed with migraine. The main reasons for visiting were ineffective symptomatic treatment (25%) and an increase in the frequency or intensity of the attacks (23.4%). Although 70.3% of the patients had high disability scores on the Headache Impact Test, only 17.4% used specific treatment and only 13.3% were on preventive treatment. CONCLUSIONS: The PRIMERA study confirms, once again, that migraine is an under-diagnosed and under-treated condition in our setting, which means that specific educational interventions and training are still required for this pathology.

[Personality factors, degree of disability and therapeutic management of patients with migraine visiting a neurology unit for the first time (Psicomig study)]. / Factores de personalidad, grado de discapacidad y abordaje terapeutico de los pacientes con migrana atendidos en primera consulta en neurologia (estudio Psicomig).

INTRODUCTION: Migraine has recently been associated to certain personality profiles and styles of coping. AIM: To explore the association between personality factors, disability and the therapeutic management of migraine. PATIENTS AND METHODS: We conducted an epidemiological, cross-sectional, multi-centre study with patients with migraine visiting a neurology unit for the first time. Socio-demographic and clinical data were collected about the patients. The NEO-FFI (Neuroticism-Extraversion-Openness Five-Factor Inventory) was used to evaluate personality factors; the degree of disability was evaluated using the Headache Impact Test (HIT-6) and the number of lost workday equivalents (LWDE) was measured. Bivariate logistic regression analyses were also performed. RESULTS: A total of 736 patients were recruited, of whom 700 were suitable for inclusion in the analysis (75.6% females; mean age: 35.5 ± 11.5 years). In all, 68.9% presented migraine without aura, 1-4 seizures/month (66.7%) and of moderate intensity (58.1%). A total of 76.1% of patients had severe disability according to the HIT-6. Of the 554 active patients, the mean number of lost workday equivalents in the previous three months was 6.8 ± 8.2. Patients showed greater emotional instability than the general population and they scored lower on extraversion, openness, agreeableness and conscientiousness. All the patients were being treated for their migraine: 47.3% by means of stepped treatment between seizures; 39.9% intra-seizures, and stratified in only 12.9%. CONCLUSIONS: This study confirms the impact of migraine in terms of disability and in terms of loss of labour output, together with its association with personality factors.

Eficacia y tolerabilidad de irbesartán en pacientes con hipertensión arterial y diabetes mellitus tipo 2 / Effectiveness and tolerability of irbesartan in patients with arterial hypertension and type 2 diabetes mellitus

Fundamento. La coexistencia de hipertensión arterial (HTA) y diabetes tipo 2 constituye una combinación de incidencia creciente y de elevado riesgo cardiovascular. El bloqueo del sistema renina angiotensina con inhibidores de la enzima convertidora (IECA) o con antagonistas de los receptores de angiotensina confiere a los pacientes con HTA y diabetes una mayor protección frente a la enfermedad cardiovascular (ECV) y renal (ER). El presente estudio tiene como objetivo evaluar la eficacia y la tolerabilidad del antagonista de los receptores de angiotensina irbesartán en una cohorte de pacientes con HTA y diabetes mellitus tipo 2.Diseño y métodos. Estudio prospectivo observacional en una cohorte de 1.184 pacientes diagnosticados de diabetes mellitus tipo 2, con cifras de tensión arterial (TA)>= 130 y/o 85 mmHg. El tratamiento antihipertensivo se realizó con irbesartán a dosis entre 75 y 300 mg añadiendo posteriormente hidroclorotiazida 12,5 mg/día si no se había alcanzado el objetivo de reducir la TA a un nivel inferior a 130/85 mmHg. El seguimiento clínico fue de 12 semanas. La eficacia del fármaco se evaluó mediante la disminución de la TA determinada por un sistema de medida oscilométrico semiautomático. Las variables de seguridad fueron los niveles de creatinina y de potasio séricos, así como la aparición de reacciones adversas. Resultados. El tratamiento con irbesartán produjo un descenso significativo (p = 0,0001), tanto de la TA sistólica (TAS) (de 157,6 ñ 17,1 a 141,8 ñ 18,8 mmHg) como de la TA diastólica (TAD) (de 90,5 ñ 10,2 a 81,0 ñ 9,9 mmHg). El porcentaje de pacientes controlados a las 12 semanas fue del 70,4 por ciento para la TAD (< 85 mmHg) y del 17 por ciento para la TAS (< 130 mmHg). No se verificaron cambios significativos en los valores medios de creatinina (de 0,97 ñ 0,19 a 0,98 ñ 0,19 mg/dl) ni en las cifras de potasio sérico (de 4,34 ñ 0,46 a 4,34 ñ 0,48 mmol/l). Igualmente, la tasa de reacciones adversas fue mínima, pues sólo el 3,1 por ciento de los pacientes presentaron alguna reacción adversa. Conclusiones. El irbesartán es un fármaco eficaz, seguro y bien tolerado para el tratamiento de la HTA en pacientes con diabetes tipo 2. Produce descensos significativos de la TA con una tasa muy baja de reacciones adversas (AU)

Sarcoidosis e hipotiroidismo por tiroiditis autoinmune

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Surgical management of hand contractures and pseudosyndactyly in dystrophic epidermolysis bullosa.

The term epidermolysis bullosa refers to a group of disorders characterized by skin blistering following minor trauma. The hands, because of constant use during normal daily activity, are especially exposed to blistering, with secondary scarring leading to pseudosyndactyly, adduction contracture of the thumb, and flexion or extension contracture of the fingers. The standard surgical approach for the correction of these deformities is based on the incisional release of pseudosyndactyly and contractures, and split skin grafting of the secondary wounds. A simplified approach without skin grafting is presented in this paper. Four children (8 hands) underwent 25 operations over two decades. The results, in terms of postoperative healing and recurrence, were comparable with those of the standard approach involving skin grafting.

Blood loss and hematological recovery following reduction mammaplasty and dermolipectomy: a prospective study.

A study was made to assess the impact of surgery on the hematological status and postoperative hematological recovery of 75 consecutive patients undergoing either reduction mammaplasty or dermolipectomy. Blood losses were estimated the morning after surgery, measuring decreases in hemoglobin level and hematocrit, while postoperative recovery was evaluated in terms of hemoglobin level and hematocrit at 10 weeks. The postoperative hemoglobin decrease was 2.69 g%, and the hematocrit dropped 7.25%. By 10 weeks, however, the patients had recovered their preoperative values. We found no significant differences in the evolution of hemoglobin level and hematocrit during the study between reduction mammaplasty and dermolipectomy patients. A significant positive correlation between surgical piece weight and postoperative reduction in hemoglobin concentration and hematocrit was observed. Conversely, at 10 weeks, a significant but negative correlation between surgical specimen weight and hemoglobin concentration and hematocrit was recorded. The anticipated weight of the surgical piece could thus be used as a predictor of intraoperative blood loss and of the speed of postoperative recovery. Since patients with surgical resection of > 3 kg remained anemic at 10 weeks, oral iron supplements could benefit this subset of patients.

Squamous cell carcinoma of the tongue in a patient with Rothmund-Thomson syndrome.

Rothmund-Thomson syndrome is a rare autosomal recessive genodermatosis characterised by poikilodermatous skin changes that appear in childhood. Patients exhibit variable additional features including juvenile cataracts, skeletal abnormalities and a higher than expected incidence of malignancies. We report a case of squamous cell carcinoma of the tongue in a 37-year-old Rothmund-Thomson syndrome patient and review the natural history of this rare disease, given that the patient was diagnosed with Rothmund-Thomson syndrome at the age of 8 years and was first reported in 1975.

A controlled, randomized, double-blind study of ketorolac for postoperative analgesia after plastic surgery.

The present study was designed to evaluate the efficacy and safety of ketorolac compared with metamizol (Nolotil) in the control of pain after plastic surgery. Almost no literature exists on postoperative pain control in this specialty. A multiple-dose, randomized, double-blind study of parallel design was carried out. One hundred patients received either ketorolac 30 mg intramuscularly (IM) every 8 hours or metamizol 2 g IM every 8 hours for postoperative analgesia during the first 48 postoperative hours. Pain severity was assessed using a visual analog scale. Adverse events were recorded. There were no significant differences between the groups in terms of pain scores or frequency of adverse events throughout the study. Two postoperative hemorrhages were recorded in the ketorolac group. Ketorolac and metamizol were found to be equally safe and effective in reducing postoperative pain after plastic surgery. It should be noted that 52% of patients in the ketorolac group and 48% in the metamizol group considered their postoperative analgesia to be very good. Nevertheless, for surgical procedures or for patients in whom postoperative hematoma formation is a particular concern, ketorolac probably should not be used.

Does double gloving protect surgical staff from skin contamination during plastic surgery?

In a randomized study, the effectiveness of double gloving in maintaining an intact barrier between the patient and the hands of the surgical staff during plastic surgery operations was tested. For 2 months, the surgical staff of a plastic surgery unit randomly wore single or double gloves during all elective surgical procedures. At the end of the operations, the gloves were tested by the water filling test. A total of 1092 gloves were examined. Twelve accidental injuries were noticed during the operations, and 67 unnoticed perforations occurred. The data suggest that the risk of perforation and exposure increases with the length and complexity of the procedures. It was concluded that double gloving is effective in plastic surgery, inasmuch as the barrier protection was maintained by the inner glove in two of three cases in which the outer glove was perforated inadvertently. Plastic surgeons must balance the improved security of double gloving with the possible discomfort or reduced sensitivity.

Nevus comedonicus: report of a case with genital involvement.

We report the case of a 6-year-old girl with a nevus comedonicus involving the left perineal region and ipsilateral labium majus. This lesion constitutes a rare hamartomatous malformation of the pilosebaceous apparatus, most frequently located on the face or trunk. Genital involvement has only very rarely been reported.

Mondor's disease and aesthetic breast surgery: report of case secondary to mastopexy with augmentation.

Although the etiology of Mondor's disease remains obscure, trauma of some form is the most commonly cited cause. Surgical trauma has frequently been quoted, but references in the literature specifically implicating aesthetic breast surgery are scarce. In this article, we report a case of Mondor's disease secondary to mastopexy with concomitant augmentation mammaplasty.