[Analysis and predictor of delays in the suspicion and treatment among hospitalized patients with pulmonary tuberculosis]. / Análisis y factores predictores del retraso en la sospecha diagnóstica y tratamiento de los pacientes hospitalizados con tuberculosis pulmonar.

BACKGROUND AND OBJECTIVES: Sometimes tuberculosis diagnosis is missed at hospital admission. Delayed diagnosis of active pulmonary tuberculosis among hospitalized patients could to contribute to nosocomial transmission. The objective of this study was to define the occurrence and associated patient risk factors among hospitalized patients with delayed diagnosis of respiratory tuberculosis. METHODS AND PATIENTS: A retrospective chart review was undertaken between 1995 and 2002 on all patients with pulmonary tuberculosis. Time intervals between admission, diagnosis and treatment of tuberculosis were determined. Epidemiological and clinical features were evaluated for their effect on these time intervals. RESULTS: Among 149 patients newly diagnosed to have active pulmonary TB, the diagnosis was initially missed in 102 (68% [95% CI, 61 to 75%]) of all hospitalized patients, of whom 66 (65% [95% CI, 56 to 74%]) were smear positive. Treatment was initiated after a week or more in 62 (42% [95% CI, 34% to 50%]) of all patients, of whom 34 (55% [95% CI, 43 to 67%])) were smear positive. Age >or= 60 years (OR 3.17 [95% CI; 1.27 to 7.87]; p = 0.013), presence of chronic lung disease (OR 2.99 [95% CI; 1.21 to 7.38]; p = 0.017), negative sputum AFB smear (OR 4.51 [95% CI; 1.34 to 15.16]; p = 0.015) and absence of hemoptysis or melanoptysis (OR 2.96 [95% CI; 1.18 a 7.41]; p = 0.020), were independently associated with delays. CONCLUSIONS: The diagnosis and treatment of hospitalized patients with pulmonary tuberculosis is often delayed because absence of clinic suspicion owing to old age, chronic lung disease or atypical presentations and slow confirmation by culture. Improved clinical acumen, development of rapid diagnostic tests, and the institution of early empiric therapy are desirable objectives to improve the tuberculosis control.

El reumatólogo consultor: enlace entre la medicina primaria y la hospitalaria. Organización de la Unidad Consultora de Reumatología-Atención Primaria (UCRAP). Experiencia del primer año de funcionamiento / The rheumatology consultant: a link between hospital and primary care. Organization of a rheumatology unit in primary care. First year experience

Fundamento: Comunicamos la creación de una unidad consultora de reumatología para atención primaria y analizamos la experiencia del primer año de funcionamiento, así como la valoración que de ella hacen los médicos de atención primaria y los pacientes atendidos. Material y método: Hemos registrado los datos de cada paciente y la actividad generada a través de una hoja de registro. La valoración por médicos y pacientes se ha realizado mediante cuestionarios diseñados para tal fin. Resultados: Se ha atendido a 17.602 consultas ordinarias y 45 consultas urgentes. La demanda ha sido creciente. Se han recibido 532 llamadas telefónicas y 36 correos electrónicos. Se han realizado 269 artrocentesis y 1.993 infiltraciones. El 3,2 por ciento de los pacientes se remitió al servicio hospitalario de reumatología. La artrosis, los reumatismos de partes blandas y las raquialgias encabezan los diagnósticos más frecuentes. Se han diagnosticado 52 nuevos casos de enfermedad inflamatoria. Todos los aspectos de la actividad del reumatólogo consultor fueron evaluados muy positivamente por los médicos de asistencia primaria. La evaluación de los pacientes es también muy satisfactoria. Discusión: La atención combinada en el hospital y en la asistencia primaria por el mismo especialista supone una posibilidad óptima de acercar a la atención primaria una especialidad hasta ahora exclusivamente hospitalaria. La experiencia es considerada muy positiva por reumatólogos, médicos de atención primaria y pacientes. (AU)

[Psychopathology of bulimia nervosa: a multidimensional model]. / Psicopatología de la bulimia nerviosa: un modelo multidimensional1

INTRODUCTION: In recent years, a number of studies have been carried out with the intention of isolating clinical dimensions in the psychopathology of bulimia nervosa. Although borderline personality has been considered a core element of the bulimic psychopathology by most of the authors, it has not been incorporated into any of these models. In this context, the present study was aimed at testing the consistence of the more complex model proposed until now, including in the analysis borderline personality as a clinical variable. SAMPLE AND METHODS: A group of 66 female patients fulfilling DSM-IV criteria for bulimia nervosa were assessed using a set of clinical instruments. The isolated items were processed using factor analysis techniques. RESULTS: Five basic dimensions of bulimia nervosa were obtained: 1. body disatisfaction; 2. restrictive eating behaviors; 3. purging behaviors; 4. emotional instability; and 5. disocial behavior. CONCLUSIONS: Our results support the idea that bulimia nervosa is a multidimensional condition. In our model, the dimension emotional instability incorporated borderline features, which tended to be strongly associated to self-defeating behaviors and depressive symptoms.