Flow en deportistas universitarios mexicanos: su relación con aspectos intrínsecos y extrínsecos en la práctica deportiva / Flow in mexican university athletes: Their relationship with intrinsic and extrinsic aspects in sport practice

Resumen. Objetivo. Identificar los procesos que predicen un estado óptimo de Flow en deportistas universitarios. Método. En esta investigación se utilizó una muestra de 75 deportistas que participaron en la Universiada Estatal y Nacional con edades comprendidas entre 18 a 25 años (M = 21.26, DT = 1.89). Se aplicó la escala de ansiedad estado competitivo, de motivación en el deporte, de afectos y de estado de Flow. Resultados. Los deportistas con altos niveles en emociones positivas y de un estado óptimo de Flow presentaron bajos niveles de ansiedad somática y cognitiva. Así, la variable que predice en mayor medida un estado óptimo de Flow fueron los afectos positivos seguidos de los apoyos, las horas de entrenamiento y la motivación intrínseca.

Abstract. Objective. The aim of this study was to identify the processes that predict the optimal state of Flow in university athletes. Method. A sample of 75 athletes that participated in the State and National Universiada with ages between 18 and 25 years (M = 21.26, SD = 1.89) was selected in this research. The scale of Competitive State Anxiety, Sport Motivation, Affects and Flow State was administered. Results. Athletes that had higher levels of positive emotions accompanied with optimal state of Flow showed lower levels of somatic and cognitive anxiety. Thus, the variables that predicted an optimal state of Flow to a greater extent had a positive effect along support, hours of training and intrinsic motivation.

Comparativa entre Screening Cognitive Impairment in Psychiatry (SCIP-S) y Minimental State Examination (MMSE) en psiquiatría forense. Estudio piloto / Comparison between Screening Cognitive Impairment in Psychiatry (SCIP-S) and Minimental State Examination (MMSE) in Forensic Psychiatry. Pilot study

Objetivos: el objetivo es comparar MMSE y SCIP-S y determinar su utilidad en la valoración del estado cognitivo en los sujetos con patología psiquiátrica en el ámbito forense.Material y métodosestudio piloto de una serie de 33 casos procedentes de los Institutos de Medicina Legal de Catalunya y Andorra, cuyo criterio de inclusión fue la existencia de una enfermedad psiquiátrica categorizada en CIE-10. En todos los casos, además de la entrevista médico forense, se administró MMSE seguido de SCIP-S.Resultadosen MMSE, 31 de los 33 entrevistados obtuvieron una puntuación directa total ≥ 24 (rendimiento cognitivo normal). En SCIP-S, solo 5 de los 33 participantes se situaron en un percentil ≥ 15 (rendimiento cognitivo normal). La diferencia entre los resultados de ambas pruebas resultó estadísticamente significativa (p < 0,05).Conclusioneseste estudio sugiere una mayor utilidad del SCIP-S frente al MMSE en la detección de déficit cognitivos en los pacientes psiquiátricos. Por tanto, se recomienda el uso del primero en la práctica médico forense. (AU)

Objectives: The objective is to compare two brief cognitive screening tests, MMSE and SCIP-S, and determine their usefulness in assessing the cognitive status of subjects diagnosed with psychiatric pathology.Material and methodsPilot study of a series of 33 cases from the Institutes of Legal Medicine of Catalonia and Andorra, whose inclusion criterion was the existence of a psychiatric pathology categorized in ICD-10. In all cases, in addition, to the forensic medical interview, MMSE was administered followed by SCIP-S.ResultsIn MMSE, 31 of the 33 interviewees obtained a total direct score ≥ 24 (normal cognitive performance). In SCIP-S, only 5 of the 33 participants were in a percentile ≥15 (normal cognitive performance). The difference between the results of both tests was statistically significant (p<0.05).ConclusionsThis study suggests a greater usefulness of SCIP-S compared to MMSE in detecting cognitive deficits in psychiatric patients. Therefore, the use of the former is recommended in forensic medical practice. (AU)

[Hyponatremia as a presenting sign of metastatic disease in muscle invasive bladder cancer.] / Hiponatremia como signo de presentación de enfermedad metastásica en el cáncer vesical musculo infiltrante (CVMI).

OBJECTIVE: Bladder cancer is a commonly diagnosed malignancy in Europe, being 30% muscle-invasive at diagnosis. In these patients, metastases can develop both at diagnosis and after progression. Metastatic disease can manifest in a number of different ways, even as hydroelectrolytic alterations. In this work, we go through the causes of hyponatremia in patients suffering from bladder cancer and its relationship with disseminated disease. METHOD: We present two cases of patients with muscleinvasive bladder cancer with a common electrolytic misbalance, hyponatremia. RESULTS: As a result of the study, bone and cerebral metastases were revealed. CONCLUSIONS: The electrolytic alterations in the oncologic patient can have several causes: chemotherapy, urinary diversion, pain, or even to the tumor itself or its metastases. It is necessary to conduct an exhaustive study in order to discard the most important causes of hyponatremia and be able to decide an appropriate treatment.

Hiponatremia como signo de presentación de enfermedad metastásica en el cáncer vesical musculo infiltrante (CVMI) / Hyponatremia as a presenting sign of metastatic disease in muscle invasive bladder cancer

OBJETIVO: El carcinoma vesical es una neoplasia de frecuente diagnóstico en Europa, siendo en un 30% de los casos musculo-infiltrante al diagnóstico. En estos pacientes la enfermedad metastásica puede presentarse al diagnóstico o con la progresión de la enfermedad. La presencia de metástasis puede manifestarse de diversas formas, incluso como alteraciones analíticas. En este trabajo realizamos un repaso de las causas de hiponatremia en los pacientes con carcinoma vesical y su relación con la enfermedad diseminada. MÉTODO: Presentamos 2 casos clínicos de pacientes con un carcinoma vesical infiltrante y con una alteración analítica en común, la hiponatremia. RESULTADO: A raíz del estudio de la hiponatremia, se evidencia la presencia de metástasis. CONCLUSIONES: Las alteraciones electrolíticas en el paciente oncológico pueden ser de causas diversas: tipo de derivación urinaria, quimioterápicos, dolor, o incluso la propia neoplasia ó sus metástasis. Se debe seguir un estudio exhaustivo para descartar las causas más importantes y poder realizar un correcto tratamiento de estos pacientes

OBJECTIVE: Bladder cancer is a commonly diagnosed malignancy in Europe, being 30% muscle-invasive at diagnosis. In these patients, metastases can develop both at diagnosis and after progression. Metastatic disease can manifest in a number of different ways, even as hydroelectrolytic alterations. In this work, we go through the causes of hyponatremia in patients suffering from bladder cancer and its relationship with disseminated disease. METHOD: We present two cases of patients with muscleinvasive bladder cancer with a common electrolytic misbalance, hyponatremia. RESULTS: As a result of the study, bone and cerebral metastases were revealed. CONCLUSIONS:The electrolytic alterations in the oncologic patient can have several causes: chemotherapy, urinary diversion, pain, or even to the tumor itself or its metastases. It is necessary to conduct an exhaustive study in order to discard the most important causes of hyponatremia and be able to decide an appropriate treatment

[Experience with third, fourth and fifth kidney transplants and their complications.] / Experiencia en terceros, cuartos y quintos trasplantes renales y sus complicaciones.

OBJECTIVES: Kidney transplant may be a good choice to treat chronic renal failure even in patients with two or more previous renal grafts. However, there might be several surgical complications and other difficulties we have to deal with. The aim of this report is to analyze the third, fourth and fifth transplants performed in our center focusing on the surgical complications and graft and patient survivals. METHODS: We performed a retrospective analysis of the 73 third, fourth and fifth kidney transplants performed in our center between February 1975 and December 2015. Statistical analysis has been performed with IBM SPSS 23.0 software. RESULTS: 62 patients received a third graft, 10 received a fourth one and one patient received a fifth graft. The median age of the recipients was 48 years, while for donors it was 50. Median cold ischemia time was 21 hours. Transplantectomy was not necessary in 49.31% of the cases. In 59.7% of the cases the graft vessels were anastomosed to the external iliac vessels. There were 21 cases of relevant postoperative complications (27.4% of the total grafts). Vascular thrombosis appeared in 5.5%. After 49 months of follow-up, the 1-, 3-, and 5-year graft survival were 64.3%, 56.16% and 50.69%, respectively. CONCLUSIONS: A new renal transplant in patients with two or more previous grafts is feasible, being necessary to individualize the cases. In spite of being more complex operations than previous transplants with a higher complication rate, we can obtain both acceptable graft and patient survival outcomes with an appropriate approach.

Experiencia en terceros, cuartos y quintos trasplantes renales y sus complicaciones / Experience with third, fourth and fifth kidney transplants and their complications

Objetivos: El trasplante renal puede ser una buena opción terapéutica en la insuficiencia renal terminal, incluso en los pacientes con dos o más injertos previos. Sin embargo, pueden existir una serie de dificultades y complicaciones quirúrgicas a las cuales el equipo de trasplante debe enfrentarse. El objetivo de este artículo es revisar los terceros, cuartos y quintos trasplantes realizados en el Hospital Universitario Marqués de Valdecilla (HUMV) analizando las dificultades quirúrgicas, sus complicaciones y la supervivencia de injertos y pacientes. Método: Revisión retrospectiva desde Febrero de 1975 hasta Diciembre de 2015 que incluye 73 trasplantes (3º,4º y 5º) realizados en el HUMV. El estudio estadístico ha sido realizado con el programa informático IBM SPSS versión 23.0. Resultados: 62 pacientes han recibido un tercer trasplante, 10 de ellos posteriormente han recibido un cuarto y 1 única paciente ha recibido un quinto. La mediana de edad de los receptores fue 48 años y la de los donantes 50. La mediana de isquemia fría fue de 21 horas. No fue necesaria la trasplantectomía de los injertos previos en un 49,31 % de los casos. En un 59,7% de los casos se pudieron anastomosar los vasos del injerto a los vasos iliacos externos del receptor. Se registraron un 27,4% de complicaciones postquirúrgicas relevantes, con un 5,5% de trombosis en los vasos de los injertos. Tras una mediana de seguimiento global de 49 meses la supervivencia del injerto a 1, 3 y 5 años fue del 64,3%, 56,16% y 50,69% respectivamente. Conclusión: A pesar de ser necesario individualizar los casos, un nuevo trasplante en pacientes con dos o más injertos renales previos, sigue siendo una opción terapéutica a considerar. Aunque pueden ser cirugías complejas y de alto riesgo de complicaciones, con un manejo óptimo y cirujanos expertos se pueden obtener cifras de supervivencia de injerto aceptables (AU)

Objectives: Kidney transplant may be a good choice to treat chronic renal failure even in patients with two or more previous renal grafts. However, there might be several surgical complications and other difficulties we have to deal with. The aim of this report is to analyze the third, fourth and fifth transplants performed in our center focusing on the surgical complications and graft and patient survivals. Methods: We performed a retrospective analysis of the 73 third, fourth and fifth kidney transplants performed in our center between February 1975 and December 2015. Statistical analysis has been performed with IBM SPSS 23.0 software. Results: 62 patients received a third graft, 10 received a fourth one and one patient received a fifth graft. The median age of the recipients was 48 years, while for donors it was 50. Median cold ischemia time was 21 hours. Transplantectomy was not necessary in 49.31% of the cases. In 59.7% of the cases the graft vessels were anastomosed to the external iliac vessels. There were 21 cases of relevant postoperative complications (27.4% of the total grafts). Vascular thrombosis appea-red in 5.5%. After 49 months of follow-up, the 1-, 3-, and 5-year graft survival were 64.3%, 56.16% and 50.69%, respectively. Conclusions: A new renal transplant in patients with two or more previous grafts is feasible, being necessary to individualize the cases. In spite of being more complex operations than previous transplants with a higher complication rate, we can obtain both acceptable graft and patient survival outcomes with an appropriate approach (AU)

Molecular and clinical profile of von Willebrand disease in Spain (PCM-EVW-ES): comprehensive genetic analysis by next-generation sequencing of 480 patients.

Molecular diagnosis of patients with von Willebrand disease is pending in most populations due to the complexity and high cost of conventional molecular analyses. The need for molecular and clinical characterization of von Willebrand disease in Spain prompted the creation of a multicenter project (PCM-EVW-ES) that resulted in the largest prospective cohort study of patients with all types of von Willebrand disease. Molecular analysis of relevant regions of the VWF, including intronic and promoter regions, was achieved in the 556 individuals recruited via the development of a simple, innovative, relatively low-cost protocol based on microfluidic technology and next-generation sequencing. A total of 704 variants (237 different) were identified along VWF, 155 of which had not been previously recorded in the international mutation database. The potential pathogenic effect of these variants was assessed by in silico analysis. Furthermore, four short tandem repeats were analyzed in order to evaluate the ancestral origin of recurrent mutations. The outcome of genetic analysis allowed for the reclassification of 110 patients, identification of 37 asymptomatic carriers (important for genetic counseling) and re-inclusion of 43 patients previously excluded by phenotyping results. In total, 480 patients were definitively diagnosed. Candidate mutations were identified in all patients except 13 type 1 von Willebrand disease, yielding a high genotype-phenotype correlation. Our data reinforce the capital importance and usefulness of genetics in von Willebrand disease diagnostics. The progressive implementation of molecular study as the first-line test for routine diagnosis of this condition will lead to increasingly more personalized and effective care for this patient population.

[Adolescent pregnancy: its causes and repercussions in the dyad]. / Embarazo adolescente: sus causas y repercusiones en la diada.

Teen pregnancy (TP) is a global public health problem that affects the physical and emotional health, educational and economic status of prospective parents and often also affects the product of gestation. In most cases, the TP is an unplanned event, and often difficult to accept by the couple. But it is more complicated for the future mother who suddenly finds herself without the protection of the couple, her family and her school companions. The risks to which the young mothers are exposed are diverse, but include: submitting to a clandestine abortion, falling into drug addiction, prostitution and crime; Also, it should be noted that with so many adversities, she can develop child maltreatment and frequently, she may be attacked at home, at school or in society giving rise to the twin phenomena of child abuse. To address this problem, it is necessary to develop preventive strategies aimed at risk of early pregnancy or acquiring sexually transmitted diseases by implementing educational programs for personal, family or schools for this age group range. It stresses the need for these programs to be consistent and persistent, as a basic strategy to reduce the consequent risks to unplanned or accepted sex life.

El embarazo en adolescentes (EA) es un problema de salud pública mundial que altera la salud física, emocional, la condición educativa y económica de los futuros padres; asimismo, frecuentemente se afecta también al producto de la gestación. El EA habitualmente no es un evento planeado o deseado y, frecuentemente, difícil de aceptar por la pareja, aunque quizá sea más marcado en la futura madre, quien bruscamente se puede encontrar sin protección. Ello se agrava cuando su condición económica no le permite atender sus propias necesidades y las de su hijo. Los riesgos a los que se expone la joven son diversos, pero destacan: someterse a un aborto clandestino, caer en adicciones, prostitución y delincuencia. Para hacer frente a este problema es necesario desarrollar estrategias preventivas orientadas al riesgo de embarazo temprano o la adquisición de enfermedades por transmisión sexual, mediante la implementación de programas educativos de alcance personal, familiar o escolar para este grupo etario. Se insiste en la necesidad de que dichos programas sean constantes y persistentes, como una estrategia básica que permita disminuir los riesgos consecuentes a una vida sexual no planeada o aceptada.

Intramyocardial dissecting hematoma of the right ventricle secondary to acute myocardial infarction. Case report / Hematoma intramiocárdico disecante del ventrículo derecho secundario a infarto agudo de miocardio. Reporte de caso

Abstract: Background: Intramyocardial dissecting haematoma is a rare form of cardiac rupture that can occur as a complication following acute myocardial infarction or during the remodelling process, with very scarce reports in medical literature. Usually caused by a haemorrhagic dissection among the spiral myocardial fibres. Case report: Here we report the case of a 60-year-old man with a previous infarction in the inferior wall extended to the right ventricle, in whom a dissecting intramyocardial haematoma in the free wall of the right ventricle was identified using transthoracic and contrast echocardiography, corroborated with cardiac magnetic resonance. Results: By this imaging modalities, it was possible to see the various acoustic densities of the progressive clotting of the hematoma, its extension through the haemorrhagic dissection, as well as its independency in relation to ventricular cavities and extracardiac space by confirming intact epicardial and endocardial layers. Conclusion: The patient presented a gradual improvement and hemodynamic stability, and basing on the existent medical literature, it was decided the medical treatment as the therapeutic option, maintaining asymptomatic after three months of follow-up.

Resumen: Antecedentes: El hematoma intramiocárdico disecante es una forma rara de ruptura cardiaca que puede ocurrir como una complicación posterior al infarto agudo de miocardio o durante el proceso de remodelación del mismo, con informes muy escasos en la literatura médica. Generalmente causada por una disección hemorrágica entre las fibras espirales del miocardio. Caso clínico: Se presenta el caso de un hombre de 60 años con infarto previo en la pared inferior extendido al ventrículo derecho, en el que se identificó un hematoma intramiocárdico disecante en la pared libre del ventrículo derecho mediante ecocardiografía transtorácica y contrastada, corroborado con resonancia magnética cardiaca. Resultados: Por medio de estas modalidades de imagen se pudieron observar las distintas densidades acústicas de la coagulación progresiva del hematoma, su extensión a través de la disección hemorrágica, así como su independencia en relación con las cavidades ventriculares y el espacio extracardiaco, confirmando las capas epicárdicas y endocárdicas indemnes. Conclusión: El paciente presentó una mejoría gradual y estabilidad hemodinámica, y basándose en la literatura médica existente, se decidió el tratamiento médico como opción terapéutica, manteniéndose asintomático después de tres meses de seguimiento.

Molecular and clinical profile of von Willebrand disease in Spain (PCM-EVW-ES): Proposal for a new diagnostic paradigm.

The diagnosis of von Willebrand disease (VWD) remains difficult in a significant proportion of patients. A Spanish multicentre study investigated a cohort of 556 patients from 330 families who were analysed centrally. VWD was confirmed in 480. Next generation sequencing (NGS) of the whole coding VWF was carried out in all recruited patients, compared with the phenotype, and a final diagnosis established. A total of 238 different VWF mutations were found, 154 were not included in the Leiden Open Variation Database (LOVD). Of the patients, 463 were found to have VWF mutation/s. A good phenotypic/genotypic association was estimated in 96.5% of the patients. One hundred seventy-four patients had two or more mutations. Occasionally a predominant phenotype masked the presence of a second abnormality. One hundred sixteen patients presented with mutations that had previously been associated with increased von Willebrand factor (VWF) clearance. RIPA unavailability, central phenotypic results disagreement and difficult distinction between severe type 1 and type 3 VWD prevented a clear diagnosis in 70 patients. The NGS study facilitated an appropriate classification in 63 of them. The remaining seven patients presented with a VWF novel mutation pending further investigation. In five patients with a type 3 and two with a type 2A or 2B phenotype with no mutation, an acquired von Willebrand syndrome (AVWS) was suspected/confirmed. These data seem to support NGS as a first line efficient and faster paradigm in VWD diagnosis.

Validación de la escala de ansiedad en la interacción social en estudiantes universitarios mexicanos / Validation of the Social Interaction Anxiety Scale among Mexican College Students / Validação da Escada de Ansiedade na Interação Social em estudantes universitários mexicanos

Objetivo. El propósito de esta investigación fue validar la escala de ansiedad en la interacción social (Social Interaction Anxiety Scale [SIAS-20] de Mattick y Clarke, 1998) en una población de estudiantes universitarios mexicanos. Concretamente, se buscó validar la estructura unidimensional del SIAS-20, calcular su consistencia interna, describir su distribución, comparar diferencias de medias entre géneros, comprobar su validez criterial con el factor de fobia social del inventario de ansiedad y fobia social (Social Phobia and Anxiety Inventory [SPAI] de Turner, Beidel, Dancu y Stanley, 1989) y su validez convergente con la escala de autoverbalizaciones al hablar en público (Self-Statements during Public Speaking Scale [SSPS] de Hofmann y DiBartolo, 2000) así como estudiar su relación con un inventario de deseabilidad social (Balanced Inventory of Desirable Responding [BIDR] de Paulhus, 1998). Método. Para ello, se empleó una muestra probabilística de estudiantes universitarios, estratificada por géneros. Resultados. Descartados los tres ítems inversos del SIAS-20, el modelo unidimensional tuvo buen ajuste. Además, la consistencia interna del SIAS-17 fue alta y su distribución asimétrica positiva. Los promedios fueron estadísticamente equivalentes entre ambos géneros. La escala mostró validez criterial con el SPAI y convergente con el SSPS. La correlación con deseabilidad social fue baja. Conclusión. Se encontró que la escala es válida para emplearla con población estudiantil universitaria mexicana. Futuros estudios deben concentrarse en su estandarización por percentiles, tanto en población mexicana, como en países hispanoparlantes.

Objective. The purpose of this research was to validate the Social Interaction Anxiety Scale (SIAS-20; Mattick & Clarke, 1998) with a student population of a Mexican university. In particular, the intention was to validate the unidimensional structure of the SIAS-20, calculate its internal consistency, describe its distribution, compare differences in averages between genders, prove its criterion validity with the social phobia factor of the anxiety and social phobia inventory ([SPAI] of Turner, Beidel, Dancu & Stanley, 1989) and its convergent validity with the Self-Statements During Public Speaking Scale ([SSPS] of Hofmann & DiBartolo, 2000), as well as studying its relationship with a social desirability inventory (Balanced Inventory of Desirable Responding [BIDR]; Paulhus, 1998). Method. A probabilistic sample of college students stratified by sex was collected. Results. Excluding the three negatively-keyed items of the SIAS-20, the single-factor model showed a good fit. Also, the internal consistency of the SIAS-17 was high, and its distribution was positively skewed. The averages were statistically equivalent between men and women. The scale showed criterion validity with the SPAI and convergent validity with the SSPS. The correlation with social desirability was low. Conclusion. In conclusion, the scale is valid for use with the Mexican university student population. It is recommend that future studies focus on its standardization by percentiles in Mexico, as well as in other Spanish-speaking countries.

Escopo. O proposto de esta pesquisa foi validar a escada de ansiedade na interação social (Social Interaction Anxiety Scale [SIAS-20] de Mattick y Clarke, 1998) na população de estudantes universitários mexicanos. Concretamente, procurou-se validar a estrutura unidimensional do SIAS-20, calcular sua consistência interna, descrever sua distribuição, comparar diferencias de médias entre géneros, comprovar sua validez criterial com o fator de fobia social do inventário de ansiedade e fobia social (Social Phobia and Anxiety Inventory [SPAI] de Turner, Beidel, Dancu y Stanley, 1989) e sua validez convergente com a escada de auto-verbalização ao falar em público (Self-Statements during Public Speaking Scale [SSPS] de Hofmann y DiBartolo, 2000), assim como estudar sua relação com um inventário de desejabilidade social(Balanced Inventory of Desirable Responding [BIDR] de Paulhus, 1998). Metodologia. Para isto foi empregada uma amostra probabilística de estudantes universitários estratificada por géneros. Resultados. Descartados os três itens inversos do SIAS-20, o modelo unidimensional teve um bom ajuste. Além a consistência interna do SIAS-17 foi alta e sua distribuição assimétrica positiva. As médias foram estatisticamente equivalentes entre ambos géneros. A escada mostrou validez criterial com o SPAI e convergente com o SSPS. A correlação com desejabilidade social foi baixa. Conclusão. Foi achado que a escada é válida para ser empregada com população estudantil universitária mexicana. Futuros estudos devem enfocar-se em sua estandardização por percentis, tanto em população mexicana, como em países hispano-falantes.

Adaptación transcultural de un tratamiento para la fobia social: un estudio piloto / Transcultural adaptation of a treatment for social phobia: A pilot study

The adaptation and application of a Spanish social phobia treatment were carried out in other important cultural context, the Mexican. The participants, 27 Mexican students who suffered generalized social phobia were randomly assigned to the treatment (n= 14) or a waiting list control group (n= 13). We carried out two assessments using the ADIS-IV clinical interview and scales commonly used in the assessment of social anxiety and social phobia. Results show that the group which received treatment significantly reduced the existence of the disorder, and its scores on social phobia, showed more confidence in a public speaking task and had a higher level of adjustment in relation to the control group. The efficacy of this protocol, adjusted and applied for the first time to a Mexican sample, was confirmed in this pilot study. The results kept their efficacy in a two years follow-up study (AU)

Efectuamos la adaptación y aplicación de un tratamiento para la fobia social originalmente diseñado en España a otro marco cultural de referencia, el Mexicano. Contamos con una muestra de 27 estudiantes Mexicanos que presentaban fobia social generalizada, quienes fueron asignados aleatoriamente al tratamiento (n= 14) o a un grupo control de lista de espera de cuatro meses (n= 13). Se empleó la entrevista clínica ADIS-IV y escalas comúnmente utilizadas en la evaluación de la ansiedad y fobia social. El grupo que recibió tratamiento presentó una reducción significativa en las puntuaciones de ansiedad social, sintió más seguridad ante una tarea de discurso y reflejó un menor grado de inadaptación que el grupo control. El protocolo de tratamiento adaptado y aplicado por primera vez a una muestra de jóvenes adultos mexicanos se mostró eficaz en este estudio piloto. Los resultados se mantuvieron en un seguimiento efectuado a los dos años (AU)

Psychobiology of borderline personality traits related to subtypes of eating disorders: a study of platelet MAO activity.

Increased and decreased levers of platelet monoamine oxidase (MAO) activity have been reported in patients with eating disorders, indicating abnormalities of the serotonin turnover. However, whether these findings are related to eating disorders or are rather reflecting the pathophysiology of borderline personality traits in these patients is still unknown. Platelet MAO activity and comorbid personality disorders were investigated in 72 patients with different subtypes of eating disorders (ED) and in a group of 28 healthy controls. ED patients comprised the following subtypes: 25 anorexia nervosa (AN) restrictive, 14 AN binge eating-purging (AN b-p), 3 anorexia nervosa not otherwise specified (AN NOS) and 30 bulimia nervosa (BN). Personality disorders and traits were assessed with the Structured Interview for Personality Disorders (SCID-II), the Zanarini Rating Scale for Borderline Personality Disorder, and the Barrat Impulsiveness Scale. Platelet MAO activity was significantly lower in ED patients with comorbid borderline personality disorder (BPD) than in ED without Borderline personality disorder (BDP). Platelet MAO activity was significantly and inversely correlated with the number and severity of BPD clinical features. In the subsample of patients with binge eating-purging symptoms (AN b-p, AN NOS and BN), platelet MAO activity was significantly lower in binge-purge patients with comorbid BPD than in binge-purge patients without BPD. The whole group of eating disorders had a significantly reduced lever of platelet MAO activity compared with the control group. The results suggest that low platelet MAO activity might characterize eating disorders with comorbid borderline personality traits, reflecting greater serotonin dysfunction in these patients. The role of decreased platelet MAO as an endophenotype with specific clinical manifestations should be explored in future studies.

Association of anaemia and mortality in patients with acute pulmonary embolism.

This study aimed to evaluate the relationship between anaemia and pulmonary embolism (PE) prognosis. We analysed a cohort of 764 patients with acute PE referred to a single center for diagnosis and management. Patients were divided into groups by quartiles of haemoglobin (Hb): Hb < 11.7 g/dl; Hb 11.7 to 12.9 g/dl; Hb 13.0 to 14.1 g/dl; Hb > 14.1 g/dl. Patients had a mean Hb of 12.9 g/dl, and values ranged from to 4.3 to 19.5 g/dl. Lower Hb was associated with recent bleeding, an impaired haemodynamic profile and higher creatinine. Patients in the lower Hb quartiles more commonly had female gender (p < 0.001), a diagnosis of cancer (p < 0.001), and an indication for an inferior vena cava (IVC) filter (p < 0.002), compared to patients in the higher Hb quartiles. Patients in higher Hb quartiles had higher survival at three months (75%, 86%, 90% and 91% for lowest to highest quartiles, respectively). On multivariate analysis, adjusting for known PE prognostic factors, low Hb proved to be an independent predictor of mortality (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.05 to 1.28 for each decrease of 1 g/dl). Hb level remained an independent predictor of all-cause mortality when cancer patients were excluded from the analysis (adjusted HR 0.81; 95% CI, 0.66 to 0.99; p = 0.04). Moreover, patients with anaemia showed a higher risk of fatal PE (unadjusted HR 1.19, 95% CI 1.04 to 1.37). In conclusion, in patients with acute symptomatic PE, anaemia severity is associated with worsened survival.

Survival and function of transfused platelets. Studies in two patients with congenital deficiencies of platelet membrane glycoproteins.

Platelets of patients suffering from Glanzmann's thrombasthenia (GT) and Bernard Soulier Syndrome (BSS) are defective in different membrane glycoproteins. Since these integrins can be identified by monoclonal antibodies, normal infused platelets could be distinguished from defective platelets and followed by using flow cytometry (FC). We studied this aspect in two recipients suffering, one from GT and the other one, who underwent splenectomy, from BSS. One hour after transfusion, normal platelets comprised 17% of the total platelet population in the patient with GT. Aggregation tests detected a measurable response to collagen (increase of 15% of transmittance). The presence of transfused platelets decreased progressively to 0.8% on day 4, which corresponded with a half-life of 2.6 days. Studies performed in the patient suffering from BSS found that 1 hour after transfusion, 53% of the platelet population corresponded to normal platelets. There was a progressive decay until day 6, which corresponded to a half-life of 4.6 days. Aggregation tests also detected a platelet response to ristocetin from 1 hour after transfusion (47% increase of transmittance) to day 3. FC is useful to measure platelet lifespan in these kinds of patients. We also report the first studies of platelet aggregation after platelet transfusion.

[Anti-factor Xa activity of enoxaparin for thromboprophylaxis in nonsurgical patients is dependent on body mass]. / La actividad anti-Xa depende del peso en pacientes médicos que reciben tromboprofilaxis con enoxaparina.

OBJECTIVE: Thromboprophylaxis with a fixed dose of low-molecular-weight heparin is recommended for hospitalized acutely ill medical patients. The purpose of this study was to assess whether the anti-factor Xa (anti-Xa) activity of enoxaparin prescribed for venous thromboembolism prophylaxis depends on body mass index (BMI) in patients hospitalized for an acute respiratory disease. PATIENTS AND METHODS: All patients admitted to the respiratory medicine department (January-December 2006) for an acute respiratory disease, and for whom pharmacologic thromboprophylaxis was indicated, were included in the study. Anti-Xa activity was measured 4 hours after administration of enoxaparin on the third day of hospitalization. The primary outcome was anti-Xa activity in relation to BMI. RESULTS: One hundred twelve patients were enrolled. Mean anti-Xa activity decreased with each BMI quartile (0.28, 0.23, 0.15, and 0.13 U/mL for quartiles 1, 2, 3, and 4, respectively). In the multivariate analysis, BMI was the only predictor of inadequate anti-Xa activity (odds ratio, 1.14; 95% confidence interval, 10.5-1.24; P< .002) after adjustment for age, sex, and serum creatinine levels. Two episodes of symptomatic proximal deep vein thrombosis were diagnosed in the month after hospitalization; both occurred in patients who had inadequate anti-Xa activity. CONCLUSIONS: Anti-Xa activity is dependent on BMI in hospitalized acute medical patients receiving enoxaparin for thromboprophylaxis.

Tratamiento anticoagulante oral. Estudio coste/beneficio / Oral anticoagulation: cost/benefit study

El tratamiento anticoagulante oral (TAO) se aplica a más del 1% de la población y experimenta un crecimientosuperior al 10% anual. La demanda de recursos clínicos y analíticos que precisa el control de este tratamiento obliga adestinar importantes medios económicos y de logística sanitaria para su atención. De las múltiples estrategias paraafrontarlo (asistencia hospitalaria, atención primaria o autocontrol) deben establecerse estudios comparativos que reflejenno solo los costes de su actuación sino también sus resultados clínicos, medidos como mortalidad y la morbilidad delos episodios tromboticos y hemorrágicos ocurridos y evitados.En 4 unidades de anticoagulacion de grandes hospitales nacionales, que dan cobertura sanitaria a 1.641.914 habitantes,se hizo el seguimiento de 20.347 pacientes en TAO, durante el año 2003. Se registraron los episodios trombóticos ohemorrágicos aparecidos y se calcularon los mismos eventos que a tenor de sus patologías se deberían de haber producido.Las complicaciones tromboembolicas aparecidas fueron 299, que generaron 129 ingresos hospitalarios y ocurrieron11 exitus. Las complicaciones hemorrágicas graves generaron 181 ingresos hospitalarios y produjeron 20 exitus.Los costes del TAO en esta población atendida (medicación y su control clínico/analítico fueron estimados en 2.749.813 €.Los gastos sanitarios ocasionados (calculados según los GRD de las patologías) de las complicaciones clínicas aparecidasfueros estimados en 1.068.259 €.Las complicaciones evitadas fueron calculadas en más de 100 exitus y en 1.044 accidentes vasculares cerebrales y583 recidivas tromboticas con unos costes estimativos, sólo en la fase aguda intrahospitalaria, superiores a los 5.000.000 €

More than 1% of the population are on oral anticoagulant treatment (OAT), a figure which is growing by over 10%annually.The demand for the clinical and analytical services necessary for monitoring this treatment requires the assignmentof significant economical and healthcare logistic resources. Comparative studies of the multiple control strategies(attending hospital, primary care or self-monitoring) should be set up, and should reflect not only the costs of their performancebut also their clinical results, measures such as mortality and morbidity of thrombotic and haemorrhagic episodesthat have occurred and been avoided.During 2003, 20,347 patients on OAT were monitored in 4 anticoagulation units of large national hospitals providinghealthcare cover to 1,641,914 inhabitants. Thrombotic or haemorrhagic episodes were recorded and the same eventsthat should have occurred, according to their pathologies, were calculated.Two hundred and ninety-nine thromboembolic complications occurred which led to 129 hospital admissions and therewere 11 deaths. Serious haemorrhagic complications resulted in 181 hospital admissions and caused 20 deaths.The costs of OAT in the population attended (medication and their clinical/analytical monitoring) were estimated at€2,749,813. The healthcare costs (calculated according to the DRG of the pathologies) of the clinical complicationswhich occurred were estimated at €1,068,259.The complications avoided were calculated at more than 100 deaths, 1,044 cerebrovascular accidents and 583thrombotic recurrences with estimated costs, in the acute intrahospital phase only, of greater than €5,000,000

[Morbidity and mortality in patients treated with oral anticoagulants]. / Morbilidad y mortalidad en pacientes con tratamiento anticoagulante oral.

INTRODUCTION AND OBJECTIVES: The number of patients receiving oral anticoagulant therapy has increased markedly in recent years, with the consequence that monitoring must be decentralized. The aim of this study was to provide reference values for the quality of care in patients receiving oral anticoagulants at large specialized Spanish centers for use in future comparative analyses. METHODS: The records of 20,347 outpatients who were receiving oral anticoagulants between January and December 2003 at four large Spanish centers were assessed. Databases at the four hospitals were searched for severe adverse events. RESULTS: In total, 211,987 regular check-ups were carried out, 72.7% of which gave international normalized ratios (INRs) within the range 2-4. Overall, 2369 hemorrhagic events were observed, 190 (8%) of which were severe, with 20 deaths (0.1 per 100 patient-years). In addition, there were 299 thromboembolic events, with 11 deaths (0.05 per 100 patient-years). The frequency of these events was greater in patients with a cardiac prosthesis, who required more intense anticoagulation. The incidence of death with different diagnoses was also greater in anticoagulated patients with a cardiac prosthesis, and the highest probability of death (1 in 3) was associated with episodes of cerebral hemorrhage. The incidence of hemorrhage increased as the INR increased. In contrast, thrombotic events occurred principally when the INR was below 2, and were not observed with INRs over 6. CONCLUSIONS: The incidence of adverse events in patients receiving oral anticoagulant therapy at large Spanish centers was similar to that observed in other European countries.