Neurobiological and psychopathological variables related to emotional instability: a study of their capability to discriminate patients with bulimia nervosa from healthy controls.

OBJECTIVE: To analyze the capability of a set of neurobiological and psychopathological variables to discriminate bulimia nervosa (BN) patients from healthy controls. METHOD: Seventy-five female patients with purging BN and 30 healthy controls were compared for psychopathology (impulsivity, borderline personality traits, depressive symptoms and self-defeating personality traits) and neurobiological parameters reflecting hypothalamic-pituitary-adrenal axis activity (morning serum cortisol before and after dexamethasone) and monoamine activity (24-hour urinary excretion of norepinephrine, serotonin, dopamine, and their main metabolites: 3-methoxy-4-hydroxyphenylglycol, 5-hydroxyindoleacetic acid, and homovanillic acid). Furthermore, the relationships between the 2 sets of variables were compared in the 2 samples. RESULTS: BN patients displayed higher impulsivity, more severe depressive features, and more borderline and self-defeating personality traits than controls. The 4 psychopathological variables were strongly interrelated in patients, whereas only depressive features correlated with self-defeating personality traits in controls. Patients had lower 24-hour excretion of serotonin and dopamine than controls, as well as lower ability to suppress cortisol. The relations between the biochemical and the psychopathological variables were only significant in the BN patients, but not in the control group. When discriminant analysis methods were applied, patients and controls differed for psychopathology (impulsive behaviors and borderline personality traits) and biological parameters (baseline cortisol and dopamine excretion), but when the variables were analyzed together, the differences in neurobiological parameters appeared as mediated by the psychopathological status. DISCUSSION: Our results suggest that hypothalamic-pituitary-adrenal axis activity, dopamine activity and other biological parameters are worthy of further study as potential dimensional markers of BN, although they seem to depend on the psychopathological status of the patients, in such a way that the psychopathological items associated with emotional instability (impulsivity and borderline personality traits) seem to be more reliable as clinical markers at the time being.

Psychopathology and lymphocyte subsets in patients with bulimia nervosa.

The association between lymphocyte subsets and several psychopathological variables which had proved to be able to affect immune cell count in other conditions was investigated in bulimia nervosa patients. Sixty-seven female bulimia nervosa patients and 29 female healthy controls were assessed for nutritional status (weight, blood cells, lymphocyte subsets, biochemical parameters and hormones) and psychopathology (anxiety, depression, hostility, impulsivity and borderline personality traits). A negative correlation between impulsivity and helper T-cells (CD4(+)) was found in controls. In the bulimia nervosa group, the patients with higher anxiety had the lower lymphocyte count, and anxiety and hostility were negatively related to CD4(+) count. In addition, helper/cytotoxic T-cell ratio negatively correlated in this group with impulsivity, hostility and depression. In the light of these results, the potential influence of psychopathology on lymphocyte subset counts seems to be specific in bulimia nervosa patients, and more relevant than in healthy controls.

Clinical comparative study of dose-volume and equivalent uniform dose based predictions in post radiotherapy acute complications.

BACKGROUND: Single points placed on Dose-Volume Histograms (DVHs) for treatment plan acceptance are still widely used compared to the Equivalent Uniform Dose (EUD). The aim of this work is to retrospectively measure and compare the ability of both criteria in correctly predicting two clinical outcomes, RTOG grade 2 acute gastrointestinal (GI) and genitourinary (GU) complications in 137 patients treated for prostate cancer. MATERIAL AND METHODS: For both complications,the best predictions have been achieved by fitting the EUD parameter and a tolerance dose (for a varying DVH point) by maximization of the Area Under the Receiver Operating Curve (AUROC). A complementary likelihood fitting of the Lyman's Normal Tissue Complication Probability (NTCP) allowed a graphical comparison between expected and observed frequencies, and to derive the associated parameters. RESULTS AND DISCUSSION: No significant differences were found in the AUROC values obtained by using dose-volume or EUD criteria, but all the results highlighted the role of high doses. Limiting V65 (for grade 2 GI) or V73 (for grade 2 GU) was as predictive as limiting EUD value, with n equal to 0.09 or 0.06 respectively, but in all cases AUROC values were low (< 0.7). Likelihood fitting gave m = 0.195 and TD50=72.5 Gy (fixing n=0.06 for acute GU) and m=0.19 and TD50=66 Gy (fixing n=0.09 for acute GI). Both AUROC and likelihood values revealed a better fit for acute GI than for acute GU. The use of a fractionation correction, new clinical contours or previous risk factors could improve these values.

Hypertension in the very old; prevalence, awareness, treatment and control: a cross-sectional population-based study in a Spanish municipality.

BACKGROUND: Information on hypertension in the very elderly is sparse. Until recently evidence of benefits from pharmacological treatment was inconclusive. We estimated the prevalence of hypertension in subjects aged 80 or more, the proportion of awareness, treatment and control. Explanatory variables associated with good control were also studied. METHODS: Cross sectional, population-based study, conducted in Martorell, an urban Spanish municipality, in 2005. By simple random sampling from the census, 323 subjects aged 80 or more were included. Patients were visited at home or in the geriatric institution and after giving informed consent, the study variables were collected. These included: supine and standing blood pressure and information about diagnosis and treatment of hypertension. The estimation and 95% confidence interval were obtained and a logistic regression model was used to study explanatory variables associated with blood pressure below 140/90 mm Hg. RESULTS: The prevalence of hypertension was 72.8% (95%CI: 69.5-76.6%) and 93% of the patients were aware of this condition, of whom 96.3% (95%CI: 93.65-97.9%) had been prescribed pharmacological treatment and 30.7% (95%CI: 25.8 - 36.1%) had blood pressure below 140/90 mm Hg. Some of the patients (43%) had one antihypertensive drug and 39.5% had two in combination. Explanatory variables associated with blood pressure below 140/90 mm Hg included prescription of a diuretic, OR: 0.31 (95%CI: 0.14-0.66), and history of ischemic heart disease, OR: 0.21 (95%CI: 0.1-0.47). CONCLUSION: The prevalence of hypertension in population aged 80 or more was over 70%. Most patients were aware of this condition and they had antihypertensive medication prescribed. Approximately one third of treated patients had blood pressure below 140/90 mm Hg. Patients with heart disease and with diuretics had more frequently blood pressure below this value.

Impacto de una intervención educativa simple en el retraso diagnóstico de los pacientes hospitalizados con tuberculosis pulmonar / Impact of a simple educational intervention in the late diagnosis of hospitalized patients with lung tuberculosis

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