Search

Objective To determine the prevalence of fatigue in our cohort as well as the factors to which it is associated, its relationship with demographic variables, vitamin D levels, treatment, systemic lupus erythematosus (SLE) symptoms and disease activity. Methods A cross-sectional study was carried out including 102 consecutive female patients with SLE (American College of Rheumatology 1997 criteria) who attended the Parc de Salut Mar between January 2012 and May 2014. Variables collected were: sociodemographic data, vitamin D supplementation, fatigue VAS, pharmacological treatment, main serological markers of SLE, and plasma levels of 25(OH)-vitD. The association between fatigue and the different variables was evaluated by the Spearman's Rho correlation coefficient for the continuous variables, the Mann–Whitney U test for the categorical and the Kruskal–Wallis test for the seasons of the year. Results The fatigue variable was evaluated through a fatigue VAS with a mean score of 52.84 (range 0–100), a median of 59 and a standard deviation of 29.86. A statistically significant relationship was found between fatigue and age, MHAQ, SLICC, summer and photosensitivity. As for the relationship between fatigue and vitamin D insufficiency (defined as 25-(OH)-vitD ≤ 30 levels), the sample was divided into patients receiving vitamin D supplements (n = 60) and patients without supplements (n = 40), finding a significant relationship in that last group. Conclusions A statistically significant association was found between the presence of fatigue and age, MHAQ, SLICC, photosensitivity, fibromyalgia and summer, and with vitamin D insufficiency in the group of patients without supplements (n = 40).

Fundamento Describir las caracteristicas clinicas y analiticas de los pacientes con enfermedadosea de Paget en el momento del diagnostico. Pacientes y metodo Estudio multicentrico y retrospectivo que ha incluido a 314 pacientes. Eldiagnostico se realizo mediante gammagrafia con polifosfato de 99Tc y radiografia simple. Seanalizaron los datos epidemiologicos, motivo del diagnostico, huesos afectados, grado de extensionmediante el indice de Coutris, complicaciones durante la evolucion y actividad de la enfermedadcon el indice de Renier. Los resultados se han analizado con el paquete estadisticoSPSS. Resultados Ciento cincuenta y nueve (50,5%) eran varones y la media (DE) de edad de 64,9(12,6) anos; en 288 (72,6%) el diagnostico fue casual y 201 (63,9%) presentaron una enfermedadpoliostotica; las localizaciones mas frecuentes fueron el hueso coxal, craneo y columnalumbar. La afectacion del sacro fue mas frecuente en el varon que en la mujer (p Conclusiones Aunque con frecuencia la enfermedad de Paget es asintomatica, en el momentodel diagnostico se presenta en muchas ocasiones de forma poliostotica y activa. El conocimientode la extension y la actividad de la enfermedad mediante una simple formula matematicason utiles para tomar una decision terapeutica.

Fundamento Determinar si la presencia de sofocos durante la menopausia se asocia a alteracionesen el metabolismo del oxido nitrico, actividad antioxidante total y otros parametros bioquimicos.Determinar el efecto del tratamiento hormonal sustitutivo (THS) sobre el metabolismodel oxido nitrico, actividad antioxidante total y otros parametros bioquimicos en mujeres menopausicascon sofocos y sin ellos. Pacientes y metodos Estudio experimental que incluye 29 mujeres menopausicas con sofocos(se les aplico THS a 12) y 20 sin sofocos (se les aplico THS a 6), sanas, de 45 a 55 anos deedad, con un periodo de menopausia de entre uno y 5 anos. Grupo control formado por 14 mujeresen edad fertil. Determinacion de estradiol, nitritos-nitratos, actividad antioxidante total yparametros generales, antes y 4-6 meses despues del THS. Resultados Previamente al THS la presencia de sofocos se asocio a un menor nivel de actividadantioxidante total (p Conclusiones La presencia de sofocos durante la menopausia indica un mayor grado de estresoxidativo y por tanto un mayor riesgo cardiovascular. El THS disminuye el grado de estres oxidativoy aumenta los metabolitos derivados del oxido nitrico en las mujeres menopausicas cono sin sofocos.

Fundamento Revision sistematica de la eficacia del calcio y la vitamina D en el tratamiento de la osteoporosis. Material y metodo Revision de la base de datos MEDLINE entre 1966 y mayo de 1998, mediante las palabras clave: osteoporosis, calcium, vitamin D (y terminos relacionados) y ensayo clinico alea-torizado. Revision de las ediciones electronicas de Best Evidence, Cochrane Library, resumenes de congresos y bibliografia de dos libros de texto. Revision ascendente de la bibliografia. Todas las revisiones se realizaron de forma independiente por dos de los autores. Tabulacion de los parametros de diseno y resultados principales de los ensayos identificados a partir de los articulos primarios. Calificacion metodologica de los estudios por parte de 2 observadores independientes. Tabulacion de los resultados y juicio evaluativo. Resultados Se han incluido 11 estudios sobre calcio, ocho sobre vitamina D y 12 sobre calcitriol y otros derivados de la hormona. Los estudios con calcio son fundamentalmente sobre poblacion no clinica y en tres se analiza eficacia sobre tasa de fracturas. Los resultados fueron positivos en poblaciones con ingestion basal baja y aporte elevado del farmaco. Los ensayos con vitamina D se realizaron sobre poblacion no clinica o ingresados en instituciones. Los ensayos con calcitriol se llevaron a cabo fundamentalmente en pacientes con fractura osteoporotica y tuvieron peores puntuaciones de validez metodologica. La heterogeneidad de los estudios impidio un metaanalisis de los diferentes tratamientos. En los estudios de calcio se observo de forma mas uniforme la efica-cia clinica. La concordancia entre observadores fue buena (? = 0,81) y no hubo correlacion significativa entre tamanos muestrales y efecto en los diferentes estudios. Conclusiones El tratamiento con calcio es eficaz en poblacion con una ingestion baja de calcio que recibe aportes importantes. La vitamina D es eficaz fundamentalmente, asociada a calcio, en poblacion deficitaria. El calcitriol y otros derivados de la hormona tienen una eficacia mas controvertida.

Objetivo determinar los factores de riesgo de nueva fractura tras vertebroplastia. Pacientes y metodo estudio prospectivo no controlado. Criterios de inclusion: pacientes con vertebroplastia por fracturas osteoporoticas. Visita previa (dia 0), se incluyen datos clinicos y densitometricos. Visitas a los 30, 90 y 180 dias, se recogen variables clinicas y efectos adversos, como extravasacion de cemento y nuevas fracturas vertebrales. Para determinar factores de riesgo de nueva fractura se evaluaron las diferencias entre el grupo con nuevas fracturas (R1) y el grupo que no tenia fracturas (R0). Resultados se realizo vertebroplastia a 43 pacientes (82 vertebras). En 11 (11,5%) casos se evidencio extravasacion de cemento a disco y 9 pacientes presentaron 12 nuevas fracturas vertebrales (20,9%). Entre los grupos R1 y R0 no se observaron diferencias estadisticamente significativas en las variables: sexo, edad, T-score, vitamina D, grado de cifosis, osteoporosis primaria/secundaria, fracturas previas, numero de vertebras cementadas y cantidad de cemento inyectado. Se establecio una relacion positiva entre extravasacion de cemento a disco y aparicion de fracturas adyacentes (p

Objetivo Examinar las actitudes de los medicos en relacion al cuidado de su salud, tanto en el campo de las medidas preventivas como en caso de enfermedad. Participantes y metodo Se envio un cuestionario postal estructurado a una muestra representativa de los medicos colegiados en la provincia de Barcelona seleccionada aleatoriamente por grupos de edad, genero, residencia y forma de ejercicio (n = 795). Resultados Contesto la encuesta el 34% de los medicos seleccionados. La mitad de los encuestados (49%) reconoce no tener medico de cabecera y solo el 33% utiliza el que le corresponde en la Seguridad Social. El 48% carece de historia clinica. Es frecuente (52%) consultar a distintos companeros ante cualquier problema de salud. Solo el 48% sigue las indicaciones del medico que ha consultado y el 82% se automedica de modo habitual. En relacion con las actitudes preventivas, el 47% no efectua los examenes de salud que ofrece el centro de trabajo y el 19,5% de los que si se someten a ellos no sigue las recomendaciones propuestas. Conclusiones Una elevada proporcion de medicos adopta actitudes inadecuadas en relacion con el cuidado de su salud, lo que hace recomendable una reflexion en la propia profesion sobre la necesidad de cambiar estos comportamientos.

Our goal was to assess expectations, preferences and treatment satisfaction in patients suffering from rheumatoid arthritis (RA) treated with infliximab and their relationship with health related quality of life in real clinical practice.198 patients with AR participated in the study who started medication with infliximab at the beginning of the survey. Evaluation of expectations, preferences, satisfaction, health related quality of life, clinic evolution of patients and safety were made 2, 6, and 14 weeks after, coinciding with infliximab transfusions.More than 85% of the patients preferred to be treated in the hospital. They valued positively to be in contact with other patients, nurses and doctors in order to speak about their illness. Between 70% and 80% of the patients were satisfied with the infliximab treatment. After 2 weeks patients had reduced tender joint count by 70% and swollen joint count by 75%. At the end of the 14th week, 56.6% of the patients matched criteria ACR20, 31.5% ACR50 and 11.3% ACR70. 33.8% of patients had adverse events. The results in the EuroQol-5D indicated that patients improved their punctuations getting closer to those of the general population. Functional capacity of 50% of the patients improved significantly after the first 2 weeks of treatment and after 14 weeks this percentage reached the 70%.The results demonstrate that patients preferred to be treated in the hospital rather than in their houses. Also, patients reported a high level of satisfaction with infliximab.

A retrospective analysis of a registration database was used to assess the efficacy and tolerability of anagrelide for treating essential thrombocythemia (ET). The study was conducted by analysing information on response to treatment, time to response and tolerability.A total of 411 patients with ET from 54 centres in Spain were included in a retrospective chart review. Patients who had started treatment with anagrelide as a first- or second-line therapy before December 31, 2004 were included.Of 411 patients, anagrelide was given as a first-line therapy in 110 patients, following hydroxyurea in 280 patients, and following other drugs in 21 patients. Overall response (OR) with anagrelide was 81.2% (77,0-84,9; p=0,05). Complete response (platelets400x10(9)/L) was observed in 53.6% (48,6-58,5; p=0,05) and partial response (600x10(9)/L) in 27.6% (23,4-32,2; p=0,05) of patients. There was no significant correlation of previous treatment with OR rate (p=0.103) despite a higher OR for previously untreated patients (86.4%) than for previously treated patients (79.3%). The most frequent treatment-related adverse reactions were headache (13.1%), palpitations (10.2%) and tachycardia (7.5%).The observed response rates and tolerability profile are similar to those reported previously. Anagrelide is well tolerated and effective in reducing platelets to target levels in patients with ET.

To evaluate the risk factors of new fractures after vertebroplasty (VP).Prospective, non-randomized study including patients with acute osteoporotic fractures treated with VP. Baseline visit included clinical and densitometric data. At 30, 90 and 180 days, changes in clinical data and side effects (cement leakage and new fractures) were recorded. To establish the predictive factors of a new fracture, differences between the group of patients with new fractures (R1) and those without fractures (R0) were evaluated.Vertebroplasty was performed in 43 patients (82 vertebrae). Cement leakage into a disc appeared in 11 cases (11,5%) and 12 new fractures occurred in 9 patients. No statistical differences were detected between groups R1 and R0 in the following variables: sex, age, vitamin D levels, T-score, kyphosis angle, primary/secondary osteoporosis, preexisting fractures, number of treated vertebrae and amount of cement injected. A positive, statistical significant correlation, was established between cement leakage into a disk and incidence of adjacent new fractures (p0.001).Cement leakage into a disc increases the risk of adjacent new fractures after vertebroplasty.

Low-trauma non-spinal fractures are a growing source of morbidity and mortality in the elderly. We aimed to evaluate the overall incidence of low-trauma non-spinal fractures and of the main skeletal sites in a cohort of women from Spain.A total of 5,201 women, aged 65 or older, were enrolled in a 3-year cohort study by non-probabilistic sampling of consecutive cases in 58 primary care centers in Spain, with 6-month visits. All radiological or surgically confirmed low trauma non-spinal fractures were collected.311 women (6.0%) sustained a total of 363 fractures after a 3.01-year median follow-up, and 14,999 women-year. The incidence rate of overall non-spinal fractures was 2,420 cases per 100,000 women-year. The incidence rates of hip, forearm and humeral fractures were 887,369 and 333 cases/100,000 women-year respectively.Low-trauma non-spinal fractures are highly incident in Spain in women aged 65 years or older, similar to other western countries.

To study the risk factors for the development and persistence of asymptomatic bacteriuria (AB) in type 2 diabetes mellitus (DM) patients from our health zone.Observational and laboratory prospective cohort study.women and men with type 2 DM from the 2 health centers of Petrer (Alicante).questionnaire including particular and epidemiological data. Laboratory values: biochemistry, glycosylated hemoglobin A1C, microalbuminuria, urinary sediment and urine culture.A total of 457 patients with type 2 DM were included; 63.2% women and 36.8% men. The prevalence of AB at baseline was 19.9% (25.6% in women vs 10.1% in men). 78.02% had persistence of AB after the twelve months of follow-up; 21.7% developed symptomatic urinary tract infection (UTI) and 35.2% were treated with antimicrobial agents for any reason different from UTI during the follow-up period. The persistence of AB at the end of the study was 15.5%. Female sex (p = 0.04), leukocyturia (p = 0.008), urinary incontinence (p = 0.04) and elevated C reactive protein concentration (p = 0.009) remained significant risk factors for the presence and the persistence of AB when the multivariate logistical regression analysis was done. The presence of UTI within one year before the study started (p= 0.024) and previous antibiotic treatments (p = 0.04) were also independent significant factors associated with persistent AB. 84.5% of diabetic patients with persistent AB had the same infective organism in the urine culture as those found during the initial AB.In patients with type 2 diabetes, female sex, urinary incontinence, leukocyturia, and elevated C reactive protein concentration were associated with development of AB. The same occurred with obesity in women and prostatic syndrome in men. The persistence of AB with the same species of isolated microorganisms as those found in AB at study entry is frequent, but it remains to be known if eradication of pathogens is more difficult in diabetic patients or, alternatively, if AB episodes are transient.

To describe the clinical and laboratory features of Paget's disease of bone at the time of diagnosis.This multicenter and retrospective study included 314 patients. Diagnosis was performed by means of characteristic radiological findings and typical bone scintigraphy. The variables analyzed included: epidemiological variables, cause of diagnosis, bone involvement, disease extension (Coutris index), complications, alkaline phosphate (AP) levels and disease activity (Renier index).There were 159 (50.5%) males and the mean age was 64.9 years (SD 12.6). Diagnosis was casual in 228 (72.6%) patients. Polyostotic involvement was detected in 201 (63.9%) patients. More common locations were pelvis, skull and lumbar spine. Sacrum was more frequently involved in men than in women (p0.05), whereas skull involvement was more common in women (p0.05). The number of bones involved was 3.1 SD 3 and the percentage of skeletal involvement was 8.7 % (SD 6.5). One hundred ninety eigth (63%) patients had complications. The disease was active in 242 (77%) patients with a mean AP value of 377 IU/L (SD 493); the activity of the disease measured by the Renier index was 34 (SD 46); the activity was greater in the skull and the humerus.Paget's disease of bone is usually asymptomatic. Polyostotic involvement and activity are common at the time of diagnosis. Knowledge of the extension and activity by means of a mathematical model may aid to make therapeutical decisions.

The goal of this study was to examine the attitudes of physicians towards the care of their health.A structured questionnaire was addressed to a sample of 795 doctors registered in Barcelona, Spain, who were randomly selected according to sex, age and residence.The response rate was 34%. Nearly half of doctors (49%) admitted not to have a family doctor, and in 33% of cases the family doctor was one of the Public Health. 48% of doctors were found not to have a registered medical chart. On the other hand, 52% of surveyed doctors had asked for health advice to several colleagues, yet only 48% followed their recommendations and 82% admitted to prescribe for themselves. Concerning preventive measures, 47% of doctors did not attend medical visits offered by the occupational health department of their workplaces and 19.5% of those who attended these visits did no follow the medical recommendations.A high proportion of doctors show inadequate attitudes with regard to their health care. Therefore, a reflection should be done within the medical profession in order to change these behaviours.

To asses if the hot flushes during the menopause are associated to alterations in the metabolism of nitric oxide, total antioxidant activity and other biochemical parameters. To evaluate the effect of hormone replacement therapy (HRT) in the metabolism of nitric oxide, total antioxidant activity and biochemistry in menopausal women with and without hot flushes.Experimental study. This study included 29 healthy menopausal women with hot flushes (12 with HRT) and 20 without them (6 with HRT), 45-55 years old, with duration of menopause ranging from 1 to 5 years. Control group included 14 fertile women. Determinations of estradiol, nitrite-nitrate, total antioxidant activity and basic analytic, were performed before previous and after 4-6 month of HRT therapy.Previously to HRT, hot flushes were associated to smaller level of total antioxidant activity (p0.05) in plasma, without differences in nitrite-nitrate concentrations. HRT was associated to increase in total antioxidant activity level and nitrite-nitrate concentrations (p0.05) in menopausal women, with and without hot flushes.Hot flushes during the menopause indicate a high level of oxidative stress and a higher cardiovascular risk. HRT decreased the oxidative stress level and increased the nitric oxide derivate metabolites in menopausal women with and without hot flushes.

Multiple endocrine neoplasia type 2 (MEN 2) syndromes are inherited following an autosomal dominant pattern. RET protooncogen mutations have been associated with MEN 2. The identification of these mutations enables us to diagnose MEN 2. The objectives were to recognize RET mutations and gene carriers in the area of Murcia and to sep up the relationship between genotype and phenotype.284 subjects from 14 MEN 2A kindreds and one MEN 2B family from the Community of Murcia, Spain, were studied. 48 out of them had MEN 2 tumours and 236 subjects were at risk. The initial screening test was single-strand conformation polymorphism (SSCP) in 8 MEN 2A families and denaturing gradient gel electrophoresis (DGGE) in 6 MEN 2A families; the results in all the subjects were confirmed with restriction analysis. The MEN 2A family in which the Cfo-I enzyme detected but did not specify the type of mutation received DNA sequence assay. The MEN 2B kindred was studied with restriction analysis.TGC--TAC and TGC--CGC mutations of codon 634 were found in 13 and one MEN 2A kindreds, respectively. ATG--ACG mutation of codon 918 was present in the MEN 2B family. Clinical diagnosis was confirmed in the 48 patients, 44 new gene carriers were detected and 192 carriers of normal alleles were ruled out. The incidence of hyperparathyroidism was highest if RET mutation was TGC--CGC.Community of Murcia is one of the areas with the highest prevalence of MEN 2. The risk of hyperparathyroidism is increased if TGC--CGC is present.

To compare standard chemotherapy CHOP (cyclophosphamide, adriamycin, vincristine and prednisone) with the regimen CHOP/VIA (VP-16, iphosphamide and cytarabine) in terms of response to therapy, response duration, survival and toxicity in patients with aggressive lymphoma.132 patients (84 males and 48 females; median age, 55 years) were included from 12 Spanish Institutions, diagnosed of non-Hodgkin's lymphoma of intermediate or high grade, in stages II-IV and previously untreated. Patients were randomized to receive CHOP or CHOP/VIA.After excluding 14 not assessable cases, 62 patients (52.5%) received CHOP, and 56 (47.5%) CHOP/VIA. No significant differences were found on main prognostic factors between such groups. Response was assessable in 114 cases (CHOP: 61; CHOP/VIA: 53) 39 patients (64%) receiving CHOP achieved complete response (CR), and 2 (3%) partial response (PR), whereas in the CHOP/VIA group CR and PR rates were 63% (34/53), and 7% (4/53), respectively. 14 patients (36%) treated with CHOP and 12 (35%) treated with CHOP/VIA eventually relapsed, with an actuarial risk of relapse at 36 months of 43% and 40%, respectively. Median survival was 37 months. No differences were found between both therapeutic groups, with an overall survival at 36 months from diagnosis of 53.5% (CI 95%: 40-67) for CHOP and 48% (CI 95%: 34-62) for CHOP/VIA. Finally, toxicity was not different for both arms.In the present study in patients with aggressive NHL chemotherapy regimens CHOP and CHOP/VIA showed similar results in terms of response, response duration, survival and toxicity.

The study was carried out in order to assess the inter-observer reliability and validity in respect of clinical appraisal given by the Appropriateness Evaluation Protocol (AEP), in the context of the Spanish Public Hospital System.In order to assess the reliability a total of 614 hospital stays chosen at random from 56 hospital admissions were independently analysed by three reviewers (two doctors and one nurse). In order to assess the validity, the findings obtained by the nurse were compared with the majority opinion given by the 7 hospital specialists in respect of each of hospital stays under evaluation. As part of the analytical procedure, indices for observed agreement, and specific agreement were calculated, as well as the Kappa statistic, all forming of various random samples of 614 hospital stays. In order to assess the predictive validity of the AEP, its sensitivity, specificity and predictive values were all measured against the majority clinical judgement.The study exhibited a high degree of inter-observer reliability (specific agreement64%, kappa0.75) and a reasonable validity in comparison with the consensus of opinions formed by a least 4 or 5 of its 7 clinical reviewers (specific agreement61%, kappa0.64), these values decreasing notably when the consensus of 6 or 7 of the reviewers was required. The AEP revealed a high degree of sensitivity and a low degree of specificity in comparison with the majority clinical assessment, thus minimising the occurrence of false results when the stay was regarded as appropriate, and producing false negatives (appropriate hospital stays regarded as inappropriate) varying in degree from moderate to very high.The results showing high reliability and moderate validity regarding clinical assessment shows the AEP to be a useful instrument in the sifting-out of inappropriate use of hospitalisation, although they do not allow a definitive judgement to be made concerning the efficiency of hospital services nor judgements regarding individual cases.

The investigation of drug dependency has been strengthened in the last few years in Spain. One indicator of the scientific production in one area is constituted by the analysis of the studies included in data bases.The Spanish publications in the field of drug dependency from 1985-1990 were reviewed. The references of studies published by Spanish authors collected in MEDLINE with Medical Subject Headings (MeSH) corresponding to Substance abuse or Substance dependence were selected. The following studies were collected a) those in which Spain was reported as the country of the author; b) published in Spanish journals; c) those in which Spain was indicated as the MeSH; b) and c) were not included if the publications did not correspond to Spanish authors.Three hundred thirty-one references were collected; 273 corresponded to Substance dependence and 58 to Substance abuse. The two themes most frequently studied were dependent on heroin (n = 99) and alcoholism (n = 94). Most studies were done in universities, mainly in schools of Medicine. Forty-three percent of the papers were signed by three or four authors. There were 1,044 authors; 844 (81%) authors published one article and 9 published seven or more. Twenty-three percent of the articles were published in 1988 and 20% in 1989. Three hundred thirty-one studies were published in 78 journals. Sixty percent of the journals published one article and 17% two. The journal which published the most articles were Medicina Clínica (n = 112), and Revista Clínica Española (n = 40). The foreign journal which published the most articles was Drug and Alcohol Dependence (n = 11). Twenty-nine articles were published in 7 of the journals with greatest impact factor in this area.These results confirm the tendency observed in other studies and indicate the increase in the quantity and quality of the Spanish publications on drug dependence.