Association between type 2 diabetes and depressive symptoms after a 1-year follow-up in an older adult Mediterranean population.

OBJECTIVES: To examine the cross-sectional association between baseline depressive symptoms and the presence of type 2 diabetes (T2D), and its association with glycated hemoglobin (HbA1c) and other metabolic variables, and the prospective association of depressive symptoms and HbA1c after 1 year of follow-up. METHODS: n = 6224 Mediterranean older adults with overweight/obesity and metabolic syndrome (48% females, mean age 64.9 ± 4.9 years) were evaluated in the framework of the PREDIMED-Plus study cohort. Depressive symptoms were assessed using the Beck Depression Inventory-II and HbA1c was used to measure metabolic control. RESULTS: The presence of T2D increased the likelihood of higher levels of depressive symptoms (χ2 = 15.84, p = 0.001). Polynomial contrast revealed a positive linear relationship (χ2 = 13.49, p = 0.001), the higher the depressive symptoms levels, the higher the prevalence of T2D. Longitudinal analyses showed that the higher baseline depressive symptoms levels, the higher the likelihood of being within the HbA1c ≥ 7% at 1-year level (Wald-χ2 = 24.06, df = 3, p < .001, for the full adjusted model). Additionally, depressive levels at baseline and duration of T2D predicted higher HbA1c and body mass index, and lower physical activity and adherence to Mediterranean Diet at 1 year of follow-up. CONCLUSIONS: This study supports an association between T2D and the severity of depressive symptoms, suggesting a worse metabolic control from mild severity levels in the short-medium term, influenced by lifestyle habits related to diabetes care. Screening for depressive symptoms and a multidisciplinary integrative therapeutic approach should be ensured in patients with T2D.

Effect of air pollutants on ambulatory blood pressure.

BACKGROUND AND METHODOLOGY: Air pollutants have a significant impact on public health. The aim of the study was to find out the relationship between ambulatory blood pressure measured by 24-h ambulatory blood pressure monitoring (ABPM) and the atmospheric pollutants that are measured regularly (PM10, PM2.5, NO2 and SO2). An observational study of temporal and geographic measurements of individual patients (case-time series design) was carried out in Primary Care Centres and Hypertension Units in the Barcelona metropolitan area. We included 2888 hypertensive patients≥18 years old, untreated, with a first valid ABPM performed between 2005 and 2014 and with at least one air pollution station within a radius of <3km. RESULTS AND CONCLUSIONS: The mean age was 54.3 (SD 14.6) years. 50.1% were women and 16.9% of the sample were smokers. Mean 24-h blood pressure (BP) was 128.0 (12.7)/77.4 (9.7) mmHg. After adjusting for mean ambient temperature and different risk factors, a significant association was found between ambulatory diastolic BP (DBP) and PM10 concentrations the day before ABPM. For each increase of 10µg/m3 of PM10, an increase of 1.37mmHg 24-h DBP and 1.48mmHg daytime DBP was observed. No relationship was found between PM2.5, NO2 and SO2 and ambulatory BP, nor between any pollutant and clinical BP. The concentration of PM10 the day before the ABPM is significantly associated with an increase in 24-h DBP and daytime DBP.

Efficacy of capacitive resistive monopolar radiofrequency in the physiotherapeutic treatment of chronic pelvic pain syndrome: study protocol for a randomized controlled trial.

BACKGROUND: Chronic pelvic pain syndrome (CPPS) is a multifactorial disorder that affects 5.7% to 26.6% of women and 2.2% to 9.7% of men, characterized by hypersensitivity of the central and peripheral nervous system affecting bladder and genital function. People with CPPS have much higher rates of psychological disorders (anxiety, depression, and catastrophizing) that increase the severity of chronic pain and worsen quality of life. Myofascial therapy, manual therapy, and treatment of trigger points are proven therapeutic options for this syndrome. This study aims to evaluate the efficacy of capacitive resistive monopolar radiofrequency (CRMRF) at 448 kHz as an adjunct treatment to other physiotherapeutic techniques for reducing pain and improving the quality of life of patients with CPPS. METHODS: This triple-blind (1:1) randomized controlled trial will include 80 women and men with CPPS. Participants will be randomized into a CRMRF activated group or a CRMRF deactivated group and receive physiotherapeutic techniques and pain education. The groups will undergo treatment for 10 consecutive weeks. At the beginning of the trial there will be an evaluation of pain intensity (using VAS), quality of life (using the SF-12), kinesiophobia (using the TSK-11), and catastrophism (using the PCS), as well as at the sixth and tenth sessions. DISCUSSION: The results of this study will show that CRMRF benefits the treatment of patients with CPPS, together with physiotherapeutic techniques and pain education. These results could offer an alternative conservative treatment option for these patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT03797911 . Registered on 8 January 2019.

[Frequency of chest X-ray suggestive of SARS-CoV-2 involvement from March to May 2020 in the population of an urban health area]. / Frecuencia de Rx de tórax indicativas de afectación por SARS-CoV-2 de marzo a mayo de 2020 en la población de un área de salud urbana.

OBJECTIVE: Know the number and percentage of chest X-rays (CXR) referred to a Primary Care Imaging Center and Primary Care Emergency Center to rule out lung involvement due to SARS-CoV-2 from March 16 to May 15, 2020, in an urban health area of about 400,000 reference population inhabitants. To determine the percentage of cases suggestive of pulmonary involvement due to SARS-CoV-2 CXR and the percentage of cases without pulmonary involvement of the total CXR derived in the reference population from March 16 to May 15, 2020. MATERIAL AND METHODS: Design observational descriptive study. The radiological criteria to classify probable pulmonary infection by SARS-CoV-2 (RxT[+]) are: 1) focal opacity; 2) faint focal opacity; 3) faint diffuse increase in density; 4) focal or diffuse interstitial pattern, and 5) focal or diffuse interstitial alveolus pattern. RESULTS AND CONCLUSIONS: Maintain CXR as a useful screening method in the middle stages of the disease, when CXR is more sensitive to detect lung involvement due to SARS-CoV-2. Our graph of affectation by SARS-CoV-2 does not present assessable differences with the expected curve in an epidemic.

Which DSM validated tools for diagnosing depression are usable in primary care research? A systematic literature review.

INTRODUCTION: Depression occurs frequently in primary care. Its broad clinical variability makes it difficult to diagnose. This makes it essential that family practitioner (FP) researchers have validated tools to minimize bias in studies of everyday practice. Which tools validated against psychiatric examination, according to the major depression criteria of DSM-IV or 5, can be used for research purposes? METHOD: An international FP team conducted a systematic review using the following databases: Pubmed, Cochrane and Embase, from 2000/01/01 to 2015/10/01. RESULTS: The three databases search identified 770 abstracts: 546 abstracts were analyzed after duplicates had been removed (224 duplicates); 50 of the validity studies were eligible and 4 studies were included. In 4 studies, the following tools were found: GDS-5, GDS-15, GDS-30, CESD-R, HADS, PSC-51 and HSCL-25. Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value were collected. The Youden index was calculated. DISCUSSION: Using efficiency data alone to compare these studies could be misleading. Additional reliability, reproducibility and ergonomic data will be essential for making comparisons. CONCLUSION: This study selected seven tools, usable in primary care research, for the diagnosis of depression. In order to define the best tools in terms of efficiency, reproducibility, reliability and ergonomics for research in primary care, and for care itself, further research will be essential.

[Impact of caring for grandchildren on the perceived health and social support of the grandmothers]. / Impacto del cuidado de los nietos en la salud percibida y el apoyo social de las abuelas.

OBJECTIVE: To find out the impact on health related quality of life and social support perceived by grandmothers caring for their grandchildren part time. DESIGN: Observational cross-sectional study. SETTING: Semi-urban primary care health area, in the metropolitan area of Barcelona, Spain. PARTICIPANTS: Women aged more than 55, randomised from the assigned population. Caregivers were grandmothers who took care of their grandchildren aged less than 8 years old, at least 4 hours a day, for 5 or more days a week without remuneration. VARIABLES: Perceived health was obtained by means of an SF-12 questionnaire and social support by a Duke-UNC questionnaire. Educational level, chronic illness, and characteristics associated with the care of grandchildren were recorded. RESULTS: Of the 129 participants, 44 were caregivers. Mean age was 62.4 (6.3) years. Social support was significantly higher in the group of caregivers than in the remainder (48.5 [40.2-53.7] vs 42.0 [36.0-47.0]; P=.006). No differences in health related quality of life between both groups were found. Perceived mental health was better when parents' work originated the need for care. Social support was greater when the parents were those who demanded the care. CONCLUSION: Grandchildren care improves perceived social support in grandmothers and it has no effect on perceived health status.

Impacto del cuidado de los nietos en la salud percibida y el apoyo social de las abuelas

Objetivo. Cono cer la repercusión del cuidado a tiempo parcial de los nietos sobre la calidad de vida relacionada con la salud y el apoyo social percibido por las abuelas cuidadoras. Diseño. Estudio observacional, transversal. Emplazamiento. Área básica de salud semiurbana, en el área metropolitana de Barcelona. Participantes. Muestra aleatoria de mujeres > 55 años. Eran cuidadoras las que se hacían cargo de sus nietos < 8 años, al menos 4h diarias durante 5 días por semana y sin recibir remuneración económica. Mediciones principales. La salud percibida se obtuvo mediante el cuestionario SF-12 y el apoyo social mediante el cuestionario de Duke-UNC. Se registraron el nivel de estudios, la presencia de enfermedades crónicas y las características relacionadas con el cuidado de los nietos. Resultados. De las 129 participantes, 44 eran cuidadoras. La edad media de la muestra fue 62,4 ± 6,3 años. El apoyo social percibido fue significantemente mayor en el grupo de cuidadoras que en el resto (48,5 [40,2-53,7] frente a 42,0 [36,0-47,0]; p=0,006). No se encontraron diferencias en la calidad de vida relacionada con la salud entre los 2 grupos. La salud mental percibida fue mejor cuando el motivo que originó el cuidado era el trabajo de los padres y el apoyo social fue mayor cuando la iniciativa del cuidado partió de los padres y peor cuando los nietos dormían en casa de la abuela. Conclusión. El cuidado de los nietos costituye un elemento favorecedor del apoyo social percibido por las abuelas y no tiene una repercusión significativa sobre su salud.(AU)

Ofuji papuloerythroderma evolving to cutaneous T-cell lymphoma.

Ofuji papuloerythroderma is an uncommon entity of unknown aetiology, characterized by a pruritic eruption of widespread, red-brown, flat papules that leads to spare skin folds. A number of cases have been described associated with tumour pathology, mainly cutaneous T-cell lymphomas. We report a new case of Ofuji papuloerythroderma evolving to cutaneous T-cell lymphoma in an 85-year-old woman who had been previously diagnosed with papuloerythroderma 7 years previously.

[Ofujis papuloerythroderma. Presentation of 3 cases and review of its concept and etiology]. / Papuloeritrodermia de Ofuji. Presentación de tres casos y revisión de su concepto y etiología.

Ofuji's papuloerythroderma is not a specific clinical entity, but a concequence of numerous inflammatory dermatoses and neoplasms. Some authors advocate that it is possible to find this erupcion in elderly patients with different types of erythroderma of known or unknown origin. It is necessary to recognize this condition since these patients can develop a lymphoma in the future. In this article three atopic patients are described with clinical lesions of papuloerythroderma respecting the cutaneous folds, with eosinophilia, increase of the IgE levels and histological characteristics of atopic eczema. We think that atopic dermatitis should be considered in the etiologic study of patients with papuloerythroderma.

Sebaceus naevi: a clinicopathologic study.

OBJECTIVE: To analyse sebaceus naevus (SN) incidence, associated malignancies, and developmental defects in a retrospective study. METHODS: We retrospectively analysed all cases of SN excised in our Department over a 20-year period. All cases of epidermal naevus syndrome (Schimmelpenning syndrome) associated with SN were recorded, as well as all patients with histological changes suggesting degeneration of the initial SN. RESULT: A total 226 patients with SN were included in the study. Stage II was the most common (65%), and the parietal area was the most common location of SN (42%), with only 7% located in non-scalp areas. Syringocystadenoma papilliferum and trichoblastoma were the most common tumours arising on SN. We only found five patients with basal cell carcinoma arising on previous SN. Epidermal naevus syndrome associated with SN was diagnosed in 16 patients, and this was the most common neurocutaneous association. CONCLUSION: The incidence of malignancy arising on SN was very low, indicating that prophylactic surgery of NS in children is not recommendable. Developmental defects should be investigated in order to evidence possible epidermal naevus syndrome associated with SN.

Acanthosis nigricans: a new cutaneous sign in severe atopic dermatitis and Down syndrome.

Acanthosis nigricans (AN) occurs associated with many different systemic diseases, such as endocrine disorders and internal malignant neoplasms. To our knowledge, the association of AN with severe atopic dermatitis (AD) or Down syndrome has not been described before. This 82-month retrospective study included 1038 patients: AN was present in 4.9% of atopic patients and 50.9% of subjects with Down syndrome. AN was more frequent in patients with severe AD and in 100% of cases of hand dermatitis and juvenile plantar dermatosis, located on the interphalangeal and metacarpophalangeal joints, whereas in Down syndrome other flexures were also affected. The pathogenesis of AN in AD is unknown, but in Down syndrome it seems to be related to obesity. Possible insulin resistance underlyng the pathogenesis of AN in these patients is still unknown.

[Social inequities in the use of primary care services: a long way to go]. / Desigualdades sociales en la utilización de servicios de atención primaria: un largo camino por recorrer.

OBJECTIVE: To describe the relation between the main variables related with social inequality and the utilization of primary care services. METHODS: Socio-demographic variables and the number of consultations were collected in a cross-sectional study. RESULTS: 264 subjects were interviewed. 66% of the population belonged to social classes IV and V. There was statistical signification between age and number of visits (p = 0.0014) and between number of visits and monoparental families (p = 0.01). CONCLUSIONS: Most of the attended population belonged to the low and middle socio-economic levels. The relationship between non-structured families and hyper-utilization and the relationship between age and hyper-utilization is confirmed.

Extensive and deep dermatophytosis caused by Trichophyton mentagrophytes var. interdigitalis in an HIV-1 positive patient.

BACKGROUND: Cutaneous infections are common in HIV-1 positive patients and are usually severe, recurrent, and caused by microorganisms that are unusual in immunocompetent patients. OBJECTIVE: We report a case of an HIV-1-positive 23-year-old male, with a history of intravenous drug use, in stage C-II (CDC '86), with a CD4 lymphocyte count of 335 cells/mm3. He had multiple, large erythematous, circinate and pustular plaques on his abdomen, back, arms and legs. RESULTS: We isolated Trichophyton mentagrophytes var. interdigitalis from the lesions. The biopsy showed suppurative deep dermatophytosis and folliculitis. The patient satisfactorily responded to itraconazole (100 mg/d for 14 days). CONCLUSION: This is the first reported case of deep dermatophytosis caused by T. mentagrophytes in an HIV-positive patient.

Management of facial hyperpigmentation.

Facial and neck pigmentations are the most cosmetically important. They are common in middle-aged women, and are related to endogenous (hormones) and exogenous factors (such as use of cosmetics and perfumes, and exposure to sun radiation). Melasma (chloasma) is the most common cause of facial pigmentation, but there are many other forms such as Riehl's melanosis, poikiloderma of Civatte, erythrose peribuccale pigmentaire of Brocq, erythromelanosis follicularis of the face and neck, linea fusca, and cosmetic hyperpigmentations. Treatment of melasma and other facial pigmentations has always been challenging and discouraging. It is important to avoid exposure to the sun or to ultraviolet lamps, and to use broad-spectrum sunscreens. Several hypopigmenting agents have been used with differing results. Topical hydroquinone 2 to 4% alone or in combination with tretinoin 0.05 to 0.1% is an established treatment. Topical azelaic acid 15 to 20% can be as efficacious as hydroquinone, but is less of an irritant. Tretinoin is especially useful in treating hyperpigmentation of photoaged skin. Kojic acid, alone or in combination with glycolic acid or hydroquinone, has shown good results, due to its inhibitory action on tyrosinase. Chemical peels are useful to treat melasma: trichloroacetic acid, Jessner's solution, Unna's paste, alpha-hydroxy acid preparations, kojic acid, and salicyclic acid, alone or in various combinations have shown good results. In contrast, laser therapies have not produced completely satisfactory results, because they can induce hyperpigmentation and recurrences can occur. New laser approaches could be successful at clearing facial hyperpigmentation in the future.

[Family dysfunction as predisposing factor of mental disease. Does that relationship exist?]. / La disfunción familiar como predisponente de la enfermedad mental. Existe tal asociación?

OBJECTIVES: The purpose is to describe the relationship between family disfunction and mental disorder. The secondary objective is to know the prevalence and distribution of mental disorders in primary care attended population. DESIGN: A cross-sectional study was conducted in a primary care setting. PATIENTS AND METHODS: Random sample was selected over 280 subjects from consultant population. The variables (family function, family structure, social and economic conditions and mental disorders) were collected through interview. APGAR test and Mini International Neuropsychiatric Interview test were performed. RESULTS: 264 patients were finally included (64% women). Mean age was 45.6 years (SD 16.7). Mental disorders were detected in 87 patients (33%). The most prevalent disorders were generalized anxiety disorder, dysthymia and major depression, family disfunction was found in 32 patients (12.3%). Prevalence of mental disorders wasn't statistically different in the group with family disfunction. CONCLUSION: Mental disorders are a common problem between primary care attended population. There wasn't any association between family disfunction and mental disorders, because of the limitations in the APGAR test in detecting family disfunction.