Characterization of Burnout Among Spanish Family Physicians Treating Fibromyalgia Patients: The EPIFFAC Study.

OBJECTIVE: Burnout among physicians has increased, affecting not only doctors but also the quality of patient care. Treating challenging disorders, such as fibromyalgia, may increase the risk of feeling burned out. Health care of fibromyalgia patients is increasingly being assigned to family physicians. Therefore, we described the demographic characteristics, work contexts, component burnout scores (exhaustion, depersonalization, and personal accomplishment), and perceptions of fibromyalgia care of Spanish family medicine physicians with high and low levels of burnout. We then evaluated which of these variables were associated with having high or low levels of burnout. METHOD: This cross-sectional study assessed 506 family physicians recruited from the Spanish Society of Family Physicians and randomly selected from Primary Health Care Centers. The subgrouping of family physicians based on their burnout scores was assessed by cluster analysis. Variables showing statistically significant differences between clusters and significance below 0.25 in univariate logistic regressions were assessed by multivariate logistic regression analysis. RESULTS: Family physicians reporting higher burnout scores (25%) felt that fibromyalgia patients on sick leave increased their workload, reported no support from nurses in the treatment of fibromyalgia patients, and had a more negative impression of fibromyalgia patients. CONCLUSIONS: One-quarter of family physicians reported feeling exhausted, detached from fibromyalgia patients, or less professionally accomplished. Several personal characteristics and contextual variables increased burnout. Several interventions to modify these variables and, thus, protect family physicians treating fibromyalgia from burnout are suggested.

Predictive risk model for the diagnosis of diabetes mellitus type 2 in a follow-up study 15 years on: PRODI2 Study.

Background: The prevalence and mortality related to diabetes mellitus type 2 (DM2) have increased consistently for decades. Identifying adults at high risk of diabetes incidence is important for the execution of intervention. Methods: The participants in the PRODI2 study (n=273), who come from the southeast of Spain and did not have diabetes at the start of the study, were followed for 15 years (1999-2014), and their risk parameters were measured, from which a predictive model was obtained which indicates the level of influence of each factor in the development of DM2. The expected risk of diabetes was calculated by binary logistic regression. Results: Those participants whose father has suffered an acute myocardial infarction are 3.9 times more likely to develop DM2 (confidence interval 95%: 1.498, 10.339); those with at least one parent who has a history of diabetes are 2.7 times more at risk (confidence interval 95%: 1.224, 6.101); the risk of being diabetic was 1.13 times higher for every extra unit on the waist-hip ratio (confidence interval 95%: 1.073, 1.195), and for the hip perimeter an OR of 0.93 was obtained (confidence interval 95%: 0.876, 0.982). Statistically significant differences were observed in all cases (P<0.05). Conclusion: This study shows that the risk of being diabetic rises in patients whose father has suffered an acute myocardial infarction, in those whose mother or father is diabetic and in patients with a high waist perimeter.

Characterization of Escherichia coli clinical isolates causing urinary tract infections in the community of Chilpancingo, Mexico

Escherichia coli is the main cause of urinary tract infections (UTI) in ambulatory patients, especially strains belonging to the B2 phylogenetic group and ST131 clonal group. Antibiotic treatment is usually administered empirically; however, it is not always effective due to bacterial multidrug resistance and the production of extended spectrum β-lactamases (ESBLs). The aim of this study was to characterize E. coli clinical isolates from patients with UTI in a community of the State of Guerrero, Mexico. From January to August 2014, 134 clinical isolates of E. coli were recovered. Strain identification and antibiotic susceptibility were performed using the Vitek automated system. Phylogenetic and O25b-ST13 groups were determined by multiple PCR. Identification of the blaCTX-M, blaTEM, and blaSHV genes was performed by conventional PCR. We found that over 50% of the isolates were resistant to betalactams and quinolones, while 0 to 33% were resistant to aminoglycosides and nitrofurans, and 56.49% of the strains were ESBL producers. B2 phylogenetic group was the most predominant (43%) compared to the other groups. The prevalence of bla genes was: blaCTX-M 64.3%, blaSHV 41.4%, and blaTEM 54.3%. These results show a high percentage (55%) of multidrug-resistant strains isolated from UTI patients from the community in the city of Chilpancingo, Guerrero, Mexico (AU)

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Characterization of Escherichia coli clinical isolates causing urinary tract infections in the community of Chilpancingo, Mexico.

Escherichia coli is the main cause of urinary tract infections (UTI) in ambulatory patients, especially strains belonging to the B2 phylogenetic group and ST131 clonal group. Antibiotic treatment is usually administered empirically; however, it is not always effective due to bacterial multidrug resistance and the production of extended spectrum ß-lactamases (ESBLs). The aim of this study was to characterize E. coli clinical isolates from patients with UTI in a community of the State of Guerrero, Mexico. From January to August 2014, 134 clinical isolates of E. coli were recovered. Strain identification and antibiotic susceptibility were performed using the Vitek automated system. Phylogenetic and O25b-ST13 groups were determined by multiple PCR. Identification of the blaCTX-M, blaTEM, and blaSHV genes was performed by conventional PCR. We found that over 50% of the isolates were resistant to betalactams and quinolones, while 0 to 33% were resistant to aminoglycosides and nitrofurans, and 56.49% of the strains were ESBL producers. B2 phylogenetic group was the most predominant (43%) compared to the other groups. The prevalence of bla genes was: blaCTX-M 64.3%, blaSHV 41.4%, and blaTEM 54.3%. These results show a high percentage (55%) of multidrug-resistant strains isolated from UTI patients from the community in the city of Chilpancingo, Guerrero, Mexico. [Int Microbiol 19(4): 209-215 (2016)].

Severe symptomatic hyponatremia during citalopram therapy--a case report.

BACKGROUND: Hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone is an uncommon complication of treatment with the new class of antidepressant agents, the selective serotonin reuptake inhibitors. The risk of hyponatremia seems to be highest during the first weeks of treatment particularly, in elderly females and in patients with a lower body weight. CASE PRESENTATION: A 61-year-old diabetic male was admitted to the hospital because of malaise, progressive confusion, and a tonic/clonic seizure two weeks after starting citalopram, 20 mg/day. On physical examination the patient was euvolemic and had no evidence of malignancy, cardiac, renal, hepatic, adrenal or thyroid disease. Laboratory tests results revealed hyponatremia, serum hypoosmolality, urine hyperosmolarity, and an elevated urine sodium concentration, leading to the diagnosis of inappropriate secretion of antidiuretic hormone. Citalopram was discontinued and fluid restriction was instituted. The patient was discharged after serum sodium increased from 124 mmol/L to 134 mmol/L. Two weeks after discharge the patient denied any new seizures, confusion or malaise. At that time his serum sodium was 135 mmol/L. CONCLUSIONS: Because the use of serotonin reuptake inhibitors is becoming more popular among elderly depressed patients the present paper and other reported cases emphasize the need of greater awareness of the development of this serious complication and suggest that sodium serum levels should be monitored closely in elderly patients during treatment with citalopram.