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1.
Radiologia (Engl Ed) ; 66(3): 236-247, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38908885

RESUMO

Preoperative localization of parathyroid pathology, generally a parathyroid adenoma, can be difficult in some cases due to the anatomical variants that these glands present. The objective of this review is to analyse the different imaging techniques used for preoperative localization of parathyroid pathology (scintigraphy, ultrasound, CT, MRI and PET). There is great variability between the different tests for the preoperative localization of parathyroid pathology. The importance of knowing the different diagnostic options lies in the need to choose the most suitable test at each moment and for each patient for an adequate management of primary hyperparathyroidism (PHP) with surgical criteria.


Assuntos
Neoplasias das Paratireoides , Humanos , Neoplasias das Paratireoides/diagnóstico por imagem , Ultrassonografia/métodos , Diagnóstico por Imagem/métodos , Hiperparatireoidismo Primário/diagnóstico por imagem , Glândulas Paratireoides/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Doenças das Paratireoides/diagnóstico por imagem
2.
Rev Clin Esp (Barc) ; 224(6): 337-345, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38697610

RESUMO

BACKGROUND AND OBJECTIVES: cardiovascular changes during pregnancy carry greater risk in heart disease. We analyze cardiovascular, obstetric and perinatal adverse effects associated with congenital and acquired heart disease during pregnancy and postpartum. MATERIALS AND METHODS: Cross-sectional and retrospective study, which included the 2017-2023 registry of pregnant or postpartum patients hospitalised with diagnosis of congenital or acquired heart disease. Adverse events (heart failure, stroke, acute pulmonary edema, maternal death, obstetric haemorrhage, prematurity and perinatal death) were compared with the clinical variables and the implemented treatment. RESULTS: 112 patients with a median age of 28 years (range 15-44) were included. Short circuits predominated 28 (25%). Thirty-six patients (32%) were classified in class IV of the modified WHO scale for maternal cardiovascular risk. Heart failure occurred in 39 (34.8%), acute lung edema 12 (10.7%), stroke 2 (1.8%), maternal death 5 (4.5%), obstetric haemorrhage 4 (3.6%), prematurity 50 (44.5%) and perinatal death 6 (5.4%). Shunts were associated with prematurity (adjusted odds ratio 4; 95% CI: 1.5-10, p = 0.006). Peripartum cardiomyopathy represented higher risk of pulmonary edema (adjusted OR 34; 95% CI: 6-194, p = 0.001) and heart failure (adjusted OR 16; 95% CI: 3-84, p = 0.001). An increased risk of obstetric haemorrhage was observed in patients with prosthetic valves (adjusted OR 30; 95% CI: 1.5-616, p = 0.025) and with the use of acetylsalicylic acid (adjusted OR 14; 95% CI: 1.2-16, p = 0.030). Furthermore, the latter was associated with perinatal death (adjusted OR 9; 95% CI: 1.4-68, p = 0.021). CONCLUSIONS: severe complications were found during pregnancy and postpartum in patients with heart disease, which is why preconception evaluation and close surveillance are vital.


Assuntos
Cardiopatias , Complicações Cardiovasculares na Gravidez , Transtornos Puerperais , Humanos , Feminino , Gravidez , Estudos Retrospectivos , Adulto , Estudos Transversais , Complicações Cardiovasculares na Gravidez/epidemiologia , Adulto Jovem , Adolescente , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/etiologia , Recém-Nascido , Edema Pulmonar/epidemiologia , Edema Pulmonar/etiologia , Período Pós-Parto
3.
Radiología (Madr., Ed. impr.) ; 66(2): 114-120, Mar.- Abr. 2024. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-231513

RESUMO

Objetivos: Valorar si la perfusión tumoral en el estudio diagnóstico inicial de RM es un marcador pronóstico para la supervivencia en pacientes diagnosticados de gliomas de alto grado. Analizar los factores de riesgo que influyen en la mortalidad por gliomas de alto grado para poder cuantificar la supervivencia global esperada del paciente. Pacientes y métodos: Se seleccionaron las RM de todos los pacientes diagnosticados de glioma de alto grado en un hospital de tercer nivel entre los años 2017 y 2019. Se recogieron variables clínicas y tumorales. Se usó el análisis de supervivencia para determinar la asociación entre la perfusión tumoral y el tiempo de supervivencia. Se estudió la relación entre las variables recogidas y la supervivencia mediante el estadístico de Wald, cuantificando esta relación mediante la regresión de Cox. Por último, se analizó el tipo de relación existente entre la perfusión tumoral y la supervivencia a través del estudio de regresión lineal. Estos análisis estadísticos se realizaron con el software SPSS v.17. Resultados: Se incluyeron 38 pacientes (media de edad 61,1años). La supervivencia media global fue de 20,6meses. Se observó asociación entre la perfusión tumoral en la RM diagnóstica y la supervivencia global, mostrando el grupo con valores intratumorales de volumen sanguíneo cerebral relativo (rVSC) >3,0 una disminución significativa en el tiempo medio de supervivencia respecto al grupo con valores <3,0 (14,6meses vs 22,8meses, p=0,046). También han demostrado influir significativamente en la supervivencia media variables como la escala de Karfnosky y el tiempo de recidiva desde la intervención. Conclusiones: Se ha evidenciado que la perfusión tumoral por RM tiene valor pronóstico en el estudio inicial de los gliomas de alto grado.(AU)


Objectives: To evaluate if the tumour perfusion at the initial MRI scan is a marker of prognosis for survival in patients diagnosed with high grade gliomas (HGG). To analyse the risk factors which influence on the mortality from HGG to quantify the overall survival to be expected in patients. Patients and methods: The patients diagnosed with HGG through a MRI scan in a third-level hospital between 2017 and 2019 were selected. Clinical and tumour variables were collected. The survival analysis was used to determine the association between the tumour perfusion and the survival time. The relation between the collected variables and the survival period was assessed through Wald's statistical method, measuring the relationship via Cox's regression model. Finally, the type of relationship that exists between the tumour perfusion and the survival was analysed through the lineal regression method.Those statistical analysis were carried out using the software SPSS v.17. Results: Thirty-eight patients were included (average age: 61.1years old). The general average survival period was 20.6months. A relationship between the tumour perfusion at the MRI scan and the overall survival has been identified, in detail, a group with intratumor values of relative cerebral blood volume (rCBV) >3.0 has shown a significant decline in the average survival period with regard to the average survival period of the group with values <3.0 (14.6months vs. 22.8months, P=.046). It has also been proved that variables like Karnofsky's scale and the response time since the intervention significantly influence on the survival period. Conclusions: It has become evident that the tumour perfusion via MRI scan has a prognostic value in the initial analysis of HGG. The average survival period of patients with rCBV less than or equal to 3.0 is significantly higher than those patients whose values are higher, which allows to be more precise with the prognosis of each patient.(AU)


Assuntos
Humanos , Masculino , Feminino , Quimioterapia do Câncer por Perfusão Regional/métodos , Neoplasias Neuroepiteliomatosas/diagnóstico por imagem , Espectroscopia de Ressonância Magnética , Prognóstico , Sobrevivência , Radiologia , Espanha , Neoplasias Neuroepiteliomatosas/radioterapia
4.
Radiologia (Engl Ed) ; 66(2): 114-120, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38614528

RESUMO

OBJECTIVES: To evaluate if the tumour perfusion at the initial MRI scan is a marker of prognosis for survival in patients diagnosed with High Grade Gliomas (HGG). To analyse the risk factors which influence on the mortality from HGG to quantify the overall survival to be expected in patients. PATIENTS AND METHODS: The patients diagnosed with HGG through a MRI scan in a third-level hospital between 2017 and 2019 were selected. Clinical and tumour variables were collected. The survival analysis was used to determine the association between the tumour perfusion and the survival time. The relation between the collected variables and the survival period was assessed through Wald's statistical method, measuring the relationship via Cox's regression model. Finally, the type of relationship that exists between the tumour perfusion and the survival was analysed through the Lineal Regression method.Those statistical analysis were carried out using the software SPSS v.17. RESULTS: 38 patients were included (average age: 61.1 years old). The general average survival period was 20.6 months. A relationship between the tumour perfusion at the MRI scan and the overall survival has been identified, in detail, a group with intratumor values of relative cerebral blood volume (rCBV)>3.0 has shown a significant decline in the average survival period with regard to the average survival period of the group with values <3.0 (14.6 months vs. 22.8 months, p = 0.046). It has also been proved that variables like Karnofsky's scale and the response time since the intervention significantly influence on the survival period. CONCLUSIONS: It has become evident that the tumour perfusion via MRI scan has a prognostic value in the initial analysis of HGG. The average survival period of patients with rCBV less than or equal to 3.0 is significantly higher than those patients whose values are higher, which allows to be more precise with the prognosis of each patient.


Assuntos
Encéfalo , Glioma , Humanos , Pessoa de Meia-Idade , Prognóstico , Perfusão , Glioma/diagnóstico por imagem , Imageamento por Ressonância Magnética
5.
Neurologia (Engl Ed) ; 38(6): 379-386, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37120112

RESUMO

INTRODUCTION: Ataxia and hereditary spastic paraplegia are rare neurodegenerative syndromes. We aimed to determine the prevalence of these disorders in Spain in 2019. PATIENTS AND METHODS: We conducted a cross-sectional, multicentre, retrospective, descriptive study of patients with ataxia and hereditary spastic paraplegia in Spain between March 2018 and December 2019. RESULTS: We gathered data from a total of 1933 patients from 11 autonomous communities, provided by 47 neurologists or geneticists. Mean (SD) age in our sample was 53.64 (20.51) years; 938 patients were men (48.5%) and 995 were women (51.5%). The genetic defect was unidentified in 920 patients (47.6%). A total of 1371 patients (70.9%) had ataxia and 562 (29.1%) had hereditary spastic paraplegia. Prevalence rates for ataxia and hereditary spastic paraplegia were estimated at 5.48 and 2.24 cases per 100 000 population, respectively. The most frequent type of dominant ataxia in our sample was SCA3, and the most frequent recessive ataxia was Friedreich ataxia. The most frequent type of dominant hereditary spastic paraplegia in our sample was SPG4, and the most frequent recessive type was SPG7. CONCLUSIONS: In our sample, the estimated prevalence of ataxia and hereditary spastic paraplegia was 7.73 cases per 100 000 population. This rate is similar to those reported for other countries. Genetic diagnosis was not available in 47.6% of cases. Despite these limitations, our study provides useful data for estimating the necessary healthcare resources for these patients, raising awareness of these diseases, determining the most frequent causal mutations for local screening programmes, and promoting the development of clinical trials.


Assuntos
Ataxia Cerebelar , Paraplegia Espástica Hereditária , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Paraplegia Espástica Hereditária/epidemiologia , Paraplegia Espástica Hereditária/genética , Estudos Transversais , Estudos Retrospectivos , Espanha/epidemiologia
6.
Clin. transl. oncol. (Print) ; 23(10): 2046-2056, oct. 2021. tab, graf
Artigo em Inglês | IBECS | ID: ibc-223375

RESUMO

Purpose To report healthcare resource use and associated costs in controlled versus uncontrolled carcinoid syndrome (CS) in patients with neuroendocrine tumours. Methods A cross-sectional, non-interventional multicentre study was conducted with retrospective data analysis. Resource use was compared between two patient groups: those with controlled CS (> 12 months with no uncontrolled CS episodes) and uncontrolled CS (< 12 months since last uncontrolled episode). Patients were matched for age, sex, and origin and grade of tumour. When no matching patients were available, data from deceased patients were used. Information on healthcare resource use came from review of medical records, patient history and physician reports. Working capacity was assessed using the Work Productivity and Activity Impairment General Health questionnaire. Results Twenty-six university hospitals in Spain participated, between July 2017 and April 2018. 137 patients were enrolled; 104 were analysed (2 groups of 52). Patients with uncontrolled CS had 10 times more emergency department (ED) visits (mean 1.0 vs 0.10 visits; P = 0.0167), were more likely to have a hospital admission (40.4% vs 19.2%; P = 0.0116) and had longer hospital stays (mean 7.87 vs 2.10 days; P = 0.0178) than those with controlled CS. This corresponded to higher annual hospitalisation costs (mean €5511.59 vs €1457.22; P = 0.028) and ED costs (€161.25 vs €14.85; P = 0.0236). The mean annual total healthcare costs were 60.0% higher in patients with uncontrolled than controlled CS (P = NS). Conclusion This study quantifies higher health resource use, and higher hospitalisation and ED costs in patients with uncontrolled CS. Better control of CS may result 3in lower medical costs (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Custos de Cuidados de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/economia , Síndrome do Carcinoide Maligno/economia , Síndrome do Carcinoide Maligno/terapia , Tumores Neuroendócrinos/economia , Tumores Neuroendócrinos/terapia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Custos Diretos de Serviços , Hospitalização/estatística & dados numéricos , Estudos Retrospectivos , Estudos Transversais , Hospitalização/economia
7.
Clin Transl Oncol ; 23(10): 2046-2056, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34109562

RESUMO

PURPOSE: To report healthcare resource use and associated costs in controlled versus uncontrolled carcinoid syndrome (CS) in patients with neuroendocrine tumours. METHODS: A cross-sectional, non-interventional multicentre study was conducted with retrospective data analysis. Resource use was compared between two patient groups: those with controlled CS (> 12 months with no uncontrolled CS episodes) and uncontrolled CS (< 12 months since last uncontrolled episode). Patients were matched for age, sex, and origin and grade of tumour. When no matching patients were available, data from deceased patients were used. Information on healthcare resource use came from review of medical records, patient history and physician reports. Working capacity was assessed using the Work Productivity and Activity Impairment General Health questionnaire. RESULTS: Twenty-six university hospitals in Spain participated, between July 2017 and April 2018. 137 patients were enrolled; 104 were analysed (2 groups of 52). Patients with uncontrolled CS had 10 times more emergency department (ED) visits (mean 1.0 vs 0.10 visits; P = 0.0167), were more likely to have a hospital admission (40.4% vs 19.2%; P = 0.0116) and had longer hospital stays (mean 7.87 vs 2.10 days; P = 0.0178) than those with controlled CS. This corresponded to higher annual hospitalisation costs (mean €5511.59 vs €1457.22; P = 0.028) and ED costs (€161.25 vs €14.85; P = 0.0236). The mean annual total healthcare costs were 60.0% higher in patients with uncontrolled than controlled CS (P = NS). CONCLUSION: This study quantifies higher health resource use, and higher hospitalisation and ED costs in patients with uncontrolled CS. Better control of CS may result 3in lower medical costs.


Assuntos
Custos de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde/economia , Síndrome do Carcinoide Maligno/economia , Absenteísmo , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Custos Diretos de Serviços , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Síndrome do Carcinoide Maligno/patologia , Síndrome do Carcinoide Maligno/terapia , Pessoa de Meia-Idade , Tumores Neuroendócrinos/economia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/terapia , Presenteísmo/estatística & dados numéricos , Estudos Retrospectivos , Espanha , Trabalho/estatística & dados numéricos
8.
Cir Pediatr ; 34(2): 79-84, 2021 Apr 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33826260

RESUMO

INTRODUCTION: CT-scan is the method of choice for major trauma assessment. However, it significantly increases radiation exposure in the pediatric population. The objective of this study was to analyze differences in clinical outcomes according to the preoperative use of CT-scan. MATERIALS AND METHODS: A retrospective observational study of pediatric patients admitted for trauma and requiring surgery was carried out. Patients were classified according to the previous use of CT-scan. ICU stay, re-admissions, and deaths were assessed. RESULTS: From 2011 to 2017, 737 patients under 18 years of age with external lesions were treated, 174 of whom required surgery. 48 patients (27.6%) underwent CT-scan prior to the procedure (Group 1), while the remaining 126 patients (72.4%) were directly scheduled for surgery (Group 2). Penetrating trauma occurred in 81% of patients, the proportion being significantly higher in Group 2 (p= 0.001). Median age was 15 years (interquartile range: 12-17), with no differences between groups. No significant differences were found in terms of hemodynamic instability at admission between groups (p= 0.596). At surgery, 3 out of 48 patients (6.3%) had no evident lesion. No significant differences were found in terms of re-admissions (p= 0.476), mortality (0.994), and ICU stay (0.466). CONCLUSION: The use of CT-scan as a diagnostic tool in pediatric trauma does not reduce mortality, ICU stay, or number of re-admissions. The use of tools such as ultrasound examination and simple X-ray should be protocolized to avoid unnecessary exposure to higher radiation doses. Prospective studies confirming this hypothesis are required.


INTRODUCCION: La tomografía axial computarizada (TAC) es el método de elección en la evaluación del trauma mayor, sin embargo, aumenta significativamente la exposición a radiación en la población pediátrica. El objetivo de este estudio es determinar diferencias en los desenlaces clínicos de acuerdo con el uso preoperatorio de la TAC. METODOS: Estudio observacional retrospectivo. Se incluyeron pacientes pediátricos ingresados por trauma que necesitaron manejo quirúrgico, y se clasificaron de acuerdo con el uso previo de TAC. Se evaluó tiempo en Unidad de Cuidados Intensivos (UCI), readmisiones, y muerte. RESULTADOS: Durante 2011 a 2017, 737 pacientes menores de 18 años consultaron por lesiones de causa externa, 174 requirieron intervención quirúrgica. A 48 (27,6%) se les realizó TAC previo al manejo quirúrgico (Grupo 1); los restantes 126 pacientes (72,4%) fueron llevados directamente a cirugía (Grupo 2). El trauma penetrante se presentó en un 81% de los pacientes, siendo significativamente mayor en el grupo 2 (p= 0,001). La mediana de edad fue 15 años (rango intercuartílico 12-17) sin diferencia entre los grupos. No hubo diferencias significativas en inestabilidad hemodinámica al ingreso entre los grupos (p= 0,596). Al momento de la cirugía, tres de 48 pacientes (6,3%) no presentaron ninguna lesión evidente. No hubo diferencias significativas en las readmisiones (p= 0,476), la mortalidad (0.994) y estancia en UCI (0,466). CONCLUSION: El uso de TAC como herramienta diagnóstica en trauma pediátrico no disminuye la mortalidad, días de estancia en UCI, ni el número de readmisiones. Debe protocolizarse el uso de herramientas como la ecografía y radiografía simple para evitar exposición innecesaria a dosis más altas de radiación. Se requieren estudios prospectivos que confirmen esta hipótesis.


Assuntos
Traumatismos Abdominais , Centros de Traumatologia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Adolescente , Criança , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Estados Unidos
9.
Cir. pediátr ; 34(2): 79-84, Abr. 2021. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-216655

RESUMO

Introducción: La tomografía axial computarizada (TAC) es el método de elección en la evaluación del trauma mayor, sin embargo, aumentasignificativamente la exposición a radiación en la población pediátrica.El objetivo de este estudio es determinar diferencias en los desenlacesclínicos de acuerdo con el uso preoperatorio de la TAC. Métodos: Estudio observacional retrospectivo. Se incluyeron pacientes pediátricos ingresados por trauma que necesitaron manejo quirúrgico, y se clasificaron de acuerdo con el uso previo de TAC. Se evaluótiempo en Unidad de Cuidados Intensivos (UCI), readmisiones, y muerte.Resultados: Durante 2011 a 2017, 737 pacientes menores de 18años consultaron por lesiones de causa externa, 174 requirieron intervención quirúrgica. A 48 (27,6%) se les realizó TAC previo al manejoquirúrgico (Grupo 1); los restantes 126 pacientes (72,4%) fueron llevadosdirectamente a cirugía (Grupo 2). El trauma penetrante se presentó enun 81% de los pacientes, siendo significativamente mayor en el grupo2 (p= 0,001). La mediana de edad fue 15 años (rango intercuartílico 12-17) sin diferencia entre los grupos. No hubo diferencias significativasen inestabilidad hemodinámica al ingreso entre los grupos (p= 0,596).Al momento de la cirugía, tres de 48 pacientes (6,3%) no presentaronninguna lesión evidente. No hubo diferencias significativas en las read-misiones (p= 0,476), la mortalidad (0,994) y estancia en UCI (0,466). Conclusión: El uso de TAC como herramienta diagnóstica en trau-ma pediátrico no disminuye la mortalidad, días de estancia en UCI, niel número de readmisiones. Debe protocolizarse el uso de herramientascomo la ecografía y radiografía simple para evitar exposición innecesariaa dosis más altas de radiación. Se requieren estudios prospectivos queconfirmen esta hipótesis.(AU)


Introduction: CT-scan is the method of choice for major traumaassessment. However, it significantly increases radiation exposure in thepediatric population. The objective of this study was to analyze differ-ences in clinical outcomes according to the preoperative use of CT-scan. Materials and methods: A retrospective observational study ofpediatric patients admitted for trauma and requiring surgery was carriedout. Patients were classified according to the previous use of CT-scan.ICU stay, re-admissions, and deaths were assessed. Results: From 2011 to 2017, 737 patients under 18 years of agewith external lesions were treated, 174 of whom required surgery. 48patients (27.6%) underwent CT-scan prior to the procedure (Group 1),while the remaining 126 patients (72.4%) were directly scheduled forsurgery (Group 2). Penetrating trauma occurred in 81% of patients, theproportion being significantly higher in Group 2 (p= 0.001). Median agewas 15 years (interquartile range: 12-17), with no differences betweengroups. No significant differences were found in terms of hemodynamicinstability at admission between groups (p= 0.596). At surgery, 3 outof 48 patients (6.3%) had no evident lesion. No significant differenceswere found in terms of re-admissions (p= 0.476), mortality (0.994),and ICU stay (0.466). Conclusion: The use of CT-scan as a diagnostic tool in pediatrictrauma does not reduce mortality, ICU stay, or number of re-admissions.The use of tools such as ultrasound examination and simple X-ray shouldbe protocolized to avoid unnecessary exposure to higher radiation doses.Prospective studies confirming this hypothesis are required.(AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Unidades de Terapia Intensiva Pediátrica , Ferimentos e Lesões , Tomografia Computadorizada de Emissão , Traumatismos Torácicos , Diagnóstico , Estudos Retrospectivos , Pediatria , Cirurgia Geral
10.
Neurologia (Engl Ed) ; 2021 Mar 25.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33775475

RESUMO

INTRODUCTION: Ataxia and hereditary spastic paraplegia are rare neurodegenerative syndromes. We aimed to determine the prevalence of these disorders in Spain in 2019. PATIENTS AND METHODS: We conducted a cross-sectional, multicentre, retrospective, descriptive study of patients with ataxia and hereditary spastic paraplegia in Spain between March 2018 and December 2019. RESULTS: We gathered data from a total of 1.809 patients from 11 autonomous communities, provided by 47 neurologists or geneticists. Mean (SD) age in our sample was 53.64 (20.51) years; 920 patients were men (50.8%) and 889 were women (49.2%). The genetic defect was unidentified in 920 patients (47.6%). A total of 1371 patients (70.9%) had ataxia and 562 (29.1%) had hereditary spastic paraplegia. Prevalence rates for ataxia and hereditary spastic paraplegia were estimated at 5.48 and 2.24 cases per 100 000 population, respectively. The most frequent type of dominant ataxia in our sample was SCA3, and the most frequent recessive ataxia was Friedreich ataxia. The most frequent type of dominant hereditary spastic paraplegia in our sample was SPG4, and the most frequent recessive type was SPG7. CONCLUSIONS: In our sample, the estimated prevalence of ataxia and hereditary spastic paraplegia was 7.73 cases per 100 000 population. This rate is similar to those reported for other countries. Genetic diagnosis was not available in 47.6% of cases. Despite these limitations, our study provides useful data for estimating the necessary healthcare resources for these patients, raising awareness of these diseases, determining the most frequent causal mutations for local screening programmes, and promoting the development of clinical trials.

11.
Med. leg. Costa Rica ; 36(2): 17-27, sep.-dic. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1040442

RESUMO

Resumen Introducción: El envejecimiento poblacional ha impulsado a que su abordaje se convierta en un tema prioritario a nivel mundial, sobre la cual aún existen mitos y discriminación, siendo las personas adultas mayores en privación de libertad en un sistema penitenciario, una población con mayores riesgos de exclusión y que cuentan con características neuropsicológicas que ameritan su atención. Por lo tanto, se realizó en Costa Rica un primer abordaje en el Centro de Atención Institucional Adulto Mayor desde la neuropsicología forense, para mejorar los protocolos disponibles de evaluación de la población adulta mayor. Procedimiento: Se llevó a cabo un trabajo final de graduación en formato de práctica dirigida durante 858 horas tanto de forma presencial como a distancia, en el período de abril del 2017 a abril del 2018, participando de los procesos de evaluación neuropsicológica forense, elaboración de un protocolo de evaluación neuropsicológica forense y participación en procesos psicoeducativos sobre consumo de sustancias y violencia sexual. Resultados: En total se atendieron 40 personas hombres, entre 58 y 85 años de edad. Con variables sociodemográficas y de salud como una baja escolaridad (45%), con antecedentes de trauma craneoencefálico (67%) y en su mayoría cometieron abuso sexual (55%). Se elaboró un protocolo de evaluación neuropsicológica que incluye un módulo de entrevista y observación, evaluación del estado de ánimo y evaluación del funcionamiento cognitivo.


Abstract Introduction: Population ageing has become a priority between the attention and care systems but still deals with myths and discrimination, being the older adults incarcerated in the prison system a population with a greater risk of exclusion and that have neuropsychological characteristics that need attention. Therefore, a first approach was carried out in Costa Rica in the Institutional Adult Care Center from the forensic neuropsychology, to improve the available protocols for the evaluation of the older adult population. Method: A final graduation work was carried out in a guided practice format for 858 hours both in person and remotely, in the period from April 2017 to April 2018, participating in the processes of forensic neuropsychological evaluation, preparation of a protocol of forensic neuropsychological evaluation and participation in psychoeducational processes on substance use and sexual violence. Results: In total 40 male people, between 58 and 85 years of age, were attended. With sociodemographic and health variables such as low schooling (45%), with a history of cranioencephalic trauma (67%) and most of them committed sexual abuse (55%). A neuropsychological evaluation protocol was elaborated that includes an interview and observation module, evaluation of mood and evaluation of cognitive functioning module.


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Prisões , Prisioneiros , Idoso , Nível de Saúde , Costa Rica , Psicologia Forense , Neuropsicologia
12.
J Intellect Disabil Res ; 62(11): 923-930, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29961996

RESUMO

BACKGROUND: Few studies have looked at the prevalence of substance use disorders (SUD) in people with intellectual disability (ID). The results range between 1% and 6.4% and go up to 20% in people with ID and psychiatric disorders, probably underestimating real prevalence due to several limitations in these studies. ID confers risk for the development of SUD, which in turn will involve negative psychosocial and clinical consequences. We aimed to study the prevalence of SUD in a sample of patients with ID admitted to a brief hospitalisation psychiatric unit, describing them by type and severity and analysing their relationship with clinical, prognostic and access to treatment variables. METHODS: We undertook a descriptive, cross-sectional and retrospective study by means of a review of clinical histories of all patients with a diagnosis of ID, admitted in a period of 10 years. RESULTS: Among the final sample of patients included, 52.3% had a mild ID, 40.9% an unspecified ID, 3.4% a moderate ID and another 3.4% a severe ID. More than one third of the sample met criteria for a SUD. The main SUD was cannabis use disorder (25%), followed by alcohol use disorder (22.7%) and cocaine use disorder (13.6%). The use of more than one substance was the most frequent pattern. Cannabis use disorder and cocaine use disorder were overrepresented in the group with mild ID. A greater number of psychiatric admissions was observed for the group with SUD. Specialised mental health services for ID and specialised addiction network facilities were much less involved in the care of these patients that could be expected according to good clinical practice recommendations. CONCLUSIONS: Substance use disorder in patients with ID and mental health disorders admitted to psychiatric hospitalisation are prevalent, which makes this issue an area of interest for future improvements in case identification, proper referring to specialised treatment resources and an increasing research focusing on specific therapeutic approaches.


Assuntos
Hospitalização/estatística & dados numéricos , Deficiência Intelectual/epidemiologia , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Comorbidade , Estudos Transversais , Feminino , Humanos , Deficiência Intelectual/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto Jovem
13.
Rev Neurol ; 66(S01): S115-S120, 2018 Mar 01.
Artigo em Espanhol | MEDLINE | ID: mdl-29516463

RESUMO

INTRODUCTION: There are few studies about preschool attention deficit hyperactivity disorder (ADHD) prevalence. AIM: To study the prevalence of ADHD in preschoolers using an specific scale (ADHD-RS-IV-P-Es) developed for this age range. SUBJECTS AND METHODS: We evaluated the prevalence of possible ADHD in a representative sample of preschoolers in Navarra and La Rioja, Spain. RESULTS: We find a range of prevalence between 2.5-4.1% depending on the criteria that was used (more or less strict). CONCLUSIONS: There are specific tools that can be use in preschool ADHD study. The prevalence of preschool ADHD in Spain is similar than in other countries. The frequency of symptoms in this age range is similar to the found in school age children.


TITLE: Trastorno por deficit de atencion/hiperactividad en niños en edad preescolar. Prevalencia epidemiologica en Navarra y La Rioja, España.Introduccion. La prevalencia del trastorno por deficit de atencion/hiperactividad (TDAH) esta en constante estudio, y hay pocas publicaciones sobre la prevalencia en niños preescolares. Objetivo. Estudiar la prevalencia de sintomas de TDAH en niños preescolares usando una escala especifica (ADHD Rating Scale-IV, version preescolar, validada para España) desarrollada para esta franja de edad. Sujetos y metodos. Se evalua la prevalencia de posible TDAH en una muestra representativa de preescolares en Navarra y La Rioja usando diferentes puntos de corte. Resultados. Se encuentra un rango de prevalencia de sintomas de TDAH del 2,5-4,1% segun el criterio usado (mas o menos estricto). Conclusiones. Existen herramientas especificas que pueden usarse para evaluar el TDAH en preescolares. La prevalencia de posible TDAH en preescolares en España es similar a la encontrada en otros paises. La frecuencia de sintomas en esta franja de edad no es mas alta que en otras edades, por lo que no es cierto que los sintomas de TDAH sean muy prevalentes en la poblacion general de niños preescolares.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Prevalência , Estudos de Amostragem , Espanha/epidemiologia , Avaliação de Sintomas
14.
J Neuroendocrinol ; 29(8)2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28718206

RESUMO

With the aim of studying delta-like protein 1 (DLK1) with respect to the relationship between adipocyte leptin and adenohypophyseal hormones, we carried out an immunohistochemical study analysing the presence of receptors for these hormones in the pituitary and adipose cells of male wild-type (WT) mice (Dlk1+/+ ) compared to knockout (KO) mice (Dlk1-/- ). The mRNA expression of these molecules was also determined using the reverse transcriptase-polymerase chain reaction. The results obtained showed that, in WT adipose cells, all of the adenohypophyseal hormone receptors were present, with a higher mRNA expression for growth hormone (GH) receptor and thyroid-stimulating hormone (TSH) receptor. Of the total cells in the anterior pituitary lobe, 17.09±0.9% were leptin receptor (LEPR) immunoreactive (-IR), mainly in GH-IR and prolactin (PRL)-IR cells (41.5±3.8%; 13.5±1.7%, respectively). In Dlk1-/- mice, adipocyte cells showed a significant increase in the TSH receptor mRNA expression level. Moreover, the percentage of LEPR-IR GH cells showed a statistically significant increase compared to controls, from 41.5±3.8% to 53.1±4.0%. By contrast, only 3.0±0.6% of LEP-IR anterior pituitary cells were detected in Dlk1 KO mice, as opposed to 6.8±1.1% observed in WT mice. The results suggest that relationships exist between adipocytes and pituitary GH, PRL and TSH cells, in addition to an influence with respect to the synthesis and release of pituitary leptin, particularly in PRL cells.


Assuntos
Tecido Adiposo/metabolismo , Peptídeos e Proteínas de Sinalização Intracelular/metabolismo , Proteínas de Membrana/metabolismo , Hipófise/metabolismo , Animais , Peptídeos e Proteínas de Sinalização Intracelular/genética , Masculino , Proteínas de Membrana/genética , Camundongos , Camundongos Knockout , Hormônios Adeno-Hipofisários/metabolismo , Prolactina/metabolismo , RNA Mensageiro/metabolismo , Receptores para Leptina/metabolismo , Receptores da Somatotropina/metabolismo , Receptores da Tireotropina/metabolismo
15.
Neurologia ; 32(8): 487-493, 2017 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27091681

RESUMO

INTRODUCTION: ADHD symptoms begin to appear at preschool age. ADHD may have a significant negative impact on academic performance. In Spain, there are no standardized tools for detecting ADHD at preschool age, nor is there data about the incidence of this disorder. OBJECTIVE: To evaluate developmental factors and learning difficulties associated with probable ADHD and to assess the impact of ADHD in school performance. METHODS: We conducted a population-based study with a stratified multistage proportional cluster sample design. RESULTS: We found significant differences between probable ADHD and parents' perception of difficulties in expressive language, comprehension, and fine motor skills, as well as in emotions, concentration, behaviour, and relationships. Around 34% of preschool children with probable ADHD showed global learning difficulties, mainly in patients with the inattentive type. According to the multivariate analysis, learning difficulties were significantly associated with both delayed psychomotor development during the first 3 years of life (OR: 5.57) as assessed by parents, and probable ADHD (OR: 2.34) CONCLUSIONS: There is a connection between probable ADHD in preschool children and parents' perception of difficulties in several dimensions of development and learning. Early detection of ADHD at preschool ages is necessary to start prompt and effective clinical and educational interventions.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Deficiências da Aprendizagem , Desempenho Psicomotor/fisiologia , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Desenvolvimento Infantil , Pré-Escolar , Feminino , Humanos , Masculino , Pais/psicologia , Espanha , Inquéritos e Questionários
16.
Acta Neurochir (Wien) ; 158(10): 1837-43, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27520361

RESUMO

BACKGROUND: Evidence for the effectiveness of linezolid in neurosurgical infections (NSIs) is growing. The comfortable oral dosage and tolerance of linezolid opens the possibility for sequential antimicrobial treatment (SAT) in stable patients after a period of intravenous treatment. METHODS: To evaluate the efficacy and safety of SAT with oral linezolid in patients with NSI and to analyse the cost implications, an observational, non-comparative, prospective cohort study was conducted on clinically stable consecutive adult patients at the Neurosurgical Service. Following intravenous treatment, patients were discharged with SAT with oral linezolid. RESULTS: A total of 77 patients were included. The most common NSIs were: 41 surgical wound infections, 20 subdural empyemas, 18 epidural abscesses, and 16 brain abscesses. Forty-four percent of patients presented two or more concomitant NSIs. Aetiological agents commonly isolated were: Propionibacterium acnes (36 %), Staphylococcus aureus (23 %), Staphylococcus epidermidis (21 %) and Streptococcus spp. (13 %). The median duration of the SAT was 15 days (range, 3-42). The SAT was interrupted in five cases due to adverse events. The remainder of the patients were cured at the end of the SAT. A total of 1,163 days of hospitalisation were saved. An overall cost reduction of €516,188 was attributed to the SAT. Eight patients with device infections did not require removal of the device, with an additional cost reduction of €190,595. The mean cost saving per patient was €9,179. CONCLUSIONS: SAT with linezolid was safe and effective for the treatment of NSI. SAT reduces hospitalisation times, which means significant savings of health and economic resources.


Assuntos
Antibacterianos/efeitos adversos , Custos e Análise de Custo , Linezolida/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos , Infecções Estafilocócicas/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/economia , Feminino , Humanos , Linezolida/administração & dosagem , Linezolida/economia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/etiologia , Infecção da Ferida Cirúrgica/tratamento farmacológico
17.
Talanta ; 151: 224-233, 2016 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-26946031

RESUMO

Phthalates and bisphenol A (BPA) have received special attention in recent years due to their frequent use in consumer products and potential for adverse effects on human health. BPA is being replaced with a number of alternatives, including bisphenol S, bisphenol B, bisphenol F and bisphenol AF. These bisphenol analogues have similar potential for adverse health effects, but studies on human exposure are limited. Accurate measurement of multiple contaminants is important for estimating exposure. This paper describes a sensitive and automated method for the simultaneous determination of 14 phthalate metabolites, BPA and four bisphenol analogues in urine using online solid phase extraction coupled with high-performance liquid chromatography/tandem mass spectrometry using a hybrid triple-quadrupole linear ion trap mass spectrometer (LC-QTRAP-MS/MS), requiring very little sample volume (50µL). Quantification was performed under selected reaction monitoring (SRM) mode with negative electrospray ionization. The use of SRM combined with an enhanced product ion scan within the same analysis was examined. Unequivocal identification was provided by the acquisition of three SRM transitions per compound and isotope dilution. The analytical performance of the method was evaluated in synthetic and human urine. Linearity of response over three orders of magnitude was demonstrated for all of the compounds (R(2)>0.99), with method detection limits of 0.01-0.5ng/mL and limits of reporting of 0.07-3.1ng/mL. Accuracy ranged from 93% to 113% and inter- and intra-day precision were <22%. Finally, the validated method has been successfully applied to a cohort of pregnant women to measure biomarker concentrations of phthalates and bisphenols, with median concentrations ranging from 0.3ng/mL (bisphenol S) to 18.5ng/mL (monoethyl phthalate).


Assuntos
Compostos Benzidrílicos/urina , Cromatografia Líquida de Alta Pressão/métodos , Fenóis/urina , Ácidos Ftálicos/urina , Extração em Fase Sólida/métodos , Espectrometria de Massas em Tandem/métodos , Compostos Benzidrílicos/química , Compostos Benzidrílicos/isolamento & purificação , Estudos de Coortes , Feminino , Humanos , Íons/química , Fenóis/química , Fenóis/isolamento & purificação , Ácidos Ftálicos/química , Ácidos Ftálicos/isolamento & purificação , Ácidos Ftálicos/metabolismo , Gravidez , Valores de Referência , Reprodutibilidade dos Testes , Espectrometria de Massas por Ionização por Electrospray
19.
Rev Calid Asist ; 30(5): 256-64, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-26346581

RESUMO

OBJECTIVE: The aim of this study was to quantify and describe the prescription profile, as well as to assess the adequacy of treatment with non-steroidal anti-inflammatory drugs (NSAIDs) in the diabetic population of a health district. MATERIAL AND METHODS: This is a descriptive, cross-sectional study aimed at a target population of 2,795 diabetic patients. Data were collected from the computerised clinical records of a sample of 380 individuals. The adequacy of treatment was assessed using the recommendations proposed by the Spanish societies of Rheumatology, Cardiology and Gastroenterology. RESULTS: More than one-quarter (28%) of the diabetic patients received treatment with NSAIDs. The most commonly used ones were ibuprofen, naproxen, and dexketoprofen, with a defined daily dose per 1,000 inhabitants per day of 35.3, 17.2, and 13.2, respectively. In patients with a history of chronic kidney disease and cardiovascular high risk, fewer NSAIDs were prescribed, while they were used most frequently in patients with a risk for gastrointestinal adverse events. The prescription was considered adequate in 46.5% of diabetic patients. The main causes of inappropriate use were the inadequate prescription of NSAIDs (25.2%), and the use of any NSAID other than naproxen (20.6%). CONCLUSIONS: The most prescribed NSAIDs were those showing a low cardiovascular risk profile. Treatment with NSAIDs was inadequate in more than half of the patients. Risk factors for cardiovascular, and especially gastrointestinal, events must be considered in order to avoid its use when not indicated, as well as the use of any NSAIDs other than naproxen.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Prescrições/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/efeitos adversos , Doenças Cardiovasculares/induzido quimicamente , Comorbidade , Estudos Transversais , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/sangue , Revisão de Uso de Medicamentos , Registros Eletrônicos de Saúde , Feminino , Gastroenteropatias/induzido quimicamente , Hemoglobinas Glicadas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Polimedicação , Guias de Prática Clínica como Assunto
20.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. impr.) ; 41(5): 254-260, jul.-ago. 2015. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-138459

RESUMO

Objetivo. El estudio del funcionamiento de la asistencia en un dispositivo ambulatorio de Psicología clínica de Atención Primaria en su primer año de puesta en marcha. Material y método. Estudio descriptivo-prospectivo, en el que se analiza la demanda y labor asistencial del dispositivo, con el que colaboraron 36 médicos de familia (33% del total de profesionales del área), pertenecientes a 6 centros de salud, durante un año, al que fueron enviados 171 pacientes, de 15 años y mayores con trastornos psicológicos leves (> 61 en la escala de evaluación global, APA, 2002). Resultados. Ciento once pacientes recibieron tratamiento, fundamentalmente con diagnósticos de: trastorno de adaptación, afectivo y ansiedad, el 54,82% alcanzaron el alta y al año de la intervención se había producido una disminución global en cuanto al uso de medicación de un 25,19%. Conclusiones. El dispositivo de Psicología clínica de Atención Primaria es una unidad intermedia entre los médicos de Atención Primaria y las unidades especializadas por lo que se atiende sintomatología menos grave y menos definida que en las Unidades de Salud Mental y que supone un apoyo y una descarga importante para estos. Para los pacientes supone una intervención temprana que evita la cronificación de sus síntomas así como un menor consumo de psicofármacos, a un año vista. Pese a la moderada concordancia entre los diagnósticos de los médicos y del dispositivo, se ha establecido una vía de comunicación y trabajo interdisciplinar directo e inmediato, que será necesario implementar y que supone un ahorro de recursos y sufrimiento (AU)


Objective. Our aim is to present the first year of operation of a Clinical Psychology service in a Primary Care setting. Material and method. A descriptive study was performed by analysing the requests and the care intervention of the Psychology Service, in collaboration with 36 general practitioners (33% of the staff), belonging to 6 health centres. Within the one year period, 171 outpatients from 15 years and older were referred with mild psychological disorders (> 61 in the global assessment functioning scale, APA, 2002). Results. A total of 111 outpatients received psychological care. The main diagnoses were adaptation disorder, affective disorder, and anxiety. More than half (54.82%) of them achieved a full recovery. After a year follow up, a drop of 25.19% was observed in medicines use. Conclusions. The Primary Care Psychology team is a halfway unit between Primary Care practitioners and specialised units in order to deal with mild mental symptomatology which otherwise could be undertreated. It represents an important support for practitioners. Secondly, the early intervention can prevent mental problems becoming chronic, as shown by the drop in medication use. In spite of the not very high agreement between the practitioner's diagnoses and those made by the Psychology unit, it has set up an important means of communication and with direct and immediate interdisciplinary action. This should eventually lead to savings in economic resources and human suffering (AU)


Assuntos
Feminino , Humanos , Masculino , Psicologia Clínica/métodos , Psicologia Clínica/organização & administração , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Transtornos Psicóticos Afetivos/psicologia , /organização & administração , /normas , Estudos Prospectivos , Testes Psicológicos/normas , Transtornos de Ansiedade/psicologia
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