RESUMO
OBJECTIVES: Recognized the value of gestational diabetes (GD) as a health problem, our aim in this work has been to analyze the diagnostic performance of the different today's existing criteria (GEDE, O'Sullivan and Carpenter) after the overload of 100 g of glucose and revise how to increase its efficiency. MATERIALS AND METHODS: We carried out a description of all the variables. In the analytical phase of the work, we used Pearson's Chi square to see if there were differences in the percentage of cases collected in each health center and the proportions contrast test to study the differences between the experimental prevalence. We completed binary logistic regression models using as result variable having or not having gestational diabetes (yes/no) and as predictors the four measurements of the curve with 100 g of glucose overload. To decide which model was better, the stepwise backward-forward analysis and the surface of the ROC curve generated by each of them were considered. RESULTS: We obtained a sample of 170 pregnant women from six different Primary Care Area of Seville health centers who had shown a positive O'Sullivan test with a median age of 35 years. There were significant differences in the prevalence proportions according to the criteria used: GEDE/O'Sullivan p < 0.001; GEDE/Carpenter p < 0.001. Logistic models with three and four predictor variables were equal in discriminatory diagnostic capacity when the GEDE criteria were used (area under the ROC curve = 0.96, 95% CI: 0.93-0.98). The back-forward stepwise analysis stayed with the three-variable model as the most parsimonious. The same did not occur when applying the other two criteria. CONCLUSIONS: Regarding an observational design, we state that there are significant differences in the prevalence proportions observed according to the criteria applied (p < 0.001) and we can also support that using the GEDE criteria, the taking of the third hour could be dispensed with, based on Bayesian criteria and the application of the ROC curve analysis.
Assuntos
Diabetes Gestacional , Adulto , Teorema de Bayes , Glicemia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Glucose , Humanos , Gravidez , PrevalênciaRESUMO
BACKGROUND: The aim of this analysis was to ascertain the type of relationship between fish and seafood consumption, omega-3 polyunsaturated fatty acids (ω-3 PUFA) intake, and depression prevalence. METHODS: Cross-sectional analyses of the PREDIMED-Plus trial. Fish and seafood consumption and ω-3 PUFA intake were assessed through a validated food-frequency questionnaire. Self-reported life-time medical diagnosis of depression or use of antidepressants was considered as outcome. Depressive symptoms were collected by the Beck Depression Inventory-II. Logistic regression models were used to estimate the association between seafood products and ω-3 PUFA consumption and depression. Multiple linear regression models were fitted to assess the association between fish and long-chain (LC) ω-3 PUFA intake and depressive symptoms. RESULTS: Out of 6587 participants, there were 1367 cases of depression. Total seafood consumption was not associated with depression. The odds ratios (ORs) (95% confidence intervals (CIs)) for the 2nd, 3rd, and 4th quintiles of consumption of fatty fish were 0.77 (0.63â»0.94), 0.71 (0.58â»0.87), and 0.78 (0.64â»0.96), respectively, and p for trend = 0.759. Moderate intake of total LC ω-3 PUFA (approximately 0.5â»1 g/day) was significantly associated with a lower prevalence of depression. CONCLUSION: In our study, moderate fish and LC ω-3 PUFA intake, but not high intake, was associated with lower odds of depression suggesting a U-shaped relationship.
Assuntos
Depressão/epidemiologia , Transtorno Depressivo/epidemiologia , Dieta , Ácidos Graxos Ômega-3/administração & dosagem , Comportamento Alimentar , Peixes , Alimentos Marinhos , Idoso , Animais , Estudos Transversais , Depressão/prevenção & controle , Transtorno Depressivo/prevenção & controle , Inquéritos sobre Dietas , Ingestão de Energia , Ácidos Graxos Ômega-3/uso terapêutico , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Inquéritos e QuestionáriosRESUMO
BACKGROUND AND AIMS: Several studies have demonstrated a relationship between increased serum uric acid (SUA) concentrations and the prevalence of metabolic syndrome (MetS) in the oriental population. However, to the best of our knowledge, the association between SUA and MetS has never been investigated in elderly European individuals at high cardiovascular risk. The aim of this study was to conduct a cross-sectional and prospective evaluation of the associations between SUA concentrations and the MetS in elderly individuals at high cardiovascular risk. METHODS AND RESULTS: Men and women (55-80 years of age) from different PREDIMED (Prevención con DIeta MEDiterránea) recruiting centers were studied. Baseline cross-sectional (n = 4417) and prospective assessments (n = 1511) were performed. MetS was defined in accordance with the updated harmonized criteria. Anthropometric measurements and biochemical determinations were assessed at baseline and yearly during follow-up. Unadjusted and adjusted regression models were fitted to assess the risk of MetS and its components according to the levels of baseline SUA. Participants in the highest baseline sex-adjusted SUA quartile showed an increased prevalence of MetS than those in the lowest quartile, even after adjusting for potential confounders (odd ratio (OR): 2.3 (95% confidence interval (CI), 1.8-2.8); P < 0.001). Participants in the highest baseline sex-adjusted SUA quartile presented a higher incidence of new-onset MetS than those in the lowest quartile (hazard ratios (HR): 1.4 (95% CI, 1.1-1.9); P < 0.001). Participants initially free at baseline of hypertriglyceridemia (HR: 1.9 (1.6-2.4); P < 0.001), low high-density lipoprotein (HDL)-cholesterol (HR: 1.4 (1.1-1.7); P = 0.002), and hypertension components of MetS (HR: 2.0 (1.2-3.3); P = 0.008) and who were in the upper quartile of SUA had a significantly higher risk of developing these MetS components during follow-up. CONCLUSIONS: Elevated SUA concentrations are significantly associated with the development of MetS.
Assuntos
Síndrome Metabólica/sangue , Ácido Úrico/sangue , Idoso , Idoso de 80 Anos ou mais , Povo Asiático , Índice de Massa Corporal , Doenças Cardiovasculares/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Estudos Transversais , Feminino , Seguimentos , Humanos , Hipertensão/sangue , Hipertrigliceridemia/sangue , Hiperuricemia/sangue , Hiperuricemia/complicações , Modelos Logísticos , Masculino , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
BACKGROUND AND AIM: Hypertension is one of the main cardiovascular risk factors in the elderly. The aims of this work were to evaluate if a one-year intervention with two Mediterranean diets (Med-diet) could decrease blood pressure (BP) due to a high polyphenol consumption, and if the decrease in BP was mediated by plasma nitric oxide (NO) production. METHODS AND RESULTS: An intervention substudy of 200 participants at high cardiovascular risk was carried out within the PREDIMED trial. They were randomly assigned to a low-fat control diet or to two Med-diets, one supplemented with extra virgin olive oil (Med-EVOO) and the other with nuts (Med-nuts). Anthropometrics and clinical parameters were measured at baseline and after one year of intervention, as well as BP, plasma NO and total polyphenol excretion (TPE) in urine samples. Systolic and diastolic BP decreased significantly after a one-year dietary intervention with Med-EVOO and Med-nuts. These changes were associated with a significant increase in TPE and plasma NO. Additionally, a significant positive correlation was observed between changes in urinary TPE, a biomarker of TP intake, and in plasma NO (Beta = 4.84; 95% CI: 0.57-9.10). CONCLUSIONS: TPE in spot urine sample was positively correlated with plasma NO in Med-diets supplemented with either EVOO or nuts. The statistically significant increases in plasma NO were associated with a reduction in systolic and diastolic BP levels, adding to the growing evidence that polyphenols might protect the cardiovascular system by improving the endothelial function and enhancing endothelial synthesis of NO.
Assuntos
Doenças Cardiovasculares/prevenção & controle , Dieta Mediterrânea , Hipertensão/dietoterapia , Óxido Nítrico/sangue , Nozes , Sobrepeso/dietoterapia , Óleos de Plantas/uso terapêutico , Idoso , Biomarcadores/urina , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Corylus/química , Dieta com Restrição de Gorduras , Feminino , Seguimentos , Humanos , Hipertensão/sangue , Hipertensão/complicações , Hipertensão/metabolismo , Hipertensão/fisiopatologia , Juglans/química , Masculino , Pessoa de Meia-Idade , Nozes/química , Azeite de Oliva , Sobrepeso/complicações , Sobrepeso/metabolismo , Sobrepeso/fisiopatologia , Óleos de Plantas/química , Polifenóis/análise , Polifenóis/uso terapêutico , Polifenóis/urina , Prunus/química , Fatores de Risco , Espanha/epidemiologiaRESUMO
OBJECTIVE: We obtained before an explanatory model with six dependant variables: age of the patient, total cholesterol (TC), HDL cholesterol (HDL-C), VLDL cholesterol (VLDL-C), alkaline phosphatase (AP) and the CA 19.9 tumour marker. Our objective in this study was to validate the model by means of the acquisition of new records for an additional analysis. DESIGN: Non-paired case control study. SETTING: Urban and rural hospitals and primary health facilities in Western Andalusia and Extremadura (Spain). PATIENTS: At both the primary care facilities and hospital level, controls were gathered in a prospective manner (n= 275). Cases were prospective and retrospective manner collected on (n=126). MAIN OUTCOME MEASURES: Descriptive statistics, logistic regression and bootstrap analysis. RESULTS: The AGE (odds ratio 1.02; 95% CI 1.003-1.037) (p= 0.01), the TC (odds ratio 0.986; 95% C.I. 0.980-0.992) (p< 0.001) and the CA 19.9 (odds ratio 1.023; 95% C.I. 1.012- 1.034) (p<0.001) were the variables that showed significant values at logistic regression analysis and bootstrap. Berkson's bias was statistically assessed. CONCLUSIONS: The model, validated by means of logistic regression and bootstrap analysis, contains the variables AGE, TC, and CA 19.9 (three of the original six) and has a level 4 over 5 according to the criteria of Justice et al. (multiple independent validations) [Ann. Intern. Med.1999; 130: 515].
Assuntos
Antígeno CA-19-9/sangue , Colesterol/sangue , Neoplasias Colorretais/sangue , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Fosfatase Alcalina/sangue , Estudos de Casos e Controles , Neoplasias Colorretais/patologia , Feminino , Humanos , Lipoproteínas HDL/sangue , Lipoproteínas LDL/sangue , Lipoproteínas VLDL/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Razão de Chances , Curva ROC , Espanha , Triglicerídeos/sangue , Adulto JovemRESUMO
We report a 71 years old man suffering from transient ischemic attack associated with a calcinosis cerebri (Fahr's disease). Arterial hypertension was the unique vascular risk factor disclosed.
Assuntos
Encefalopatias/complicações , Calcinose/complicações , Disartria/etiologia , Ataque Isquêmico Transitório/etiologia , Idoso , Encefalopatias/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Clopidogrel , Disartria/tratamento farmacológico , Humanos , Ataque Isquêmico Transitório/tratamento farmacológico , Imageamento por Ressonância Magnética , Masculino , Inibidores da Agregação Plaquetária/uso terapêutico , Ticlopidina/análogos & derivados , Ticlopidina/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
A pragmatic classification. Rare diseases (RD) might be a research target on primary care because their gift of scientific knowledge building. A rational scheme would be necessary for clinical and scientific findings. Retrospective long-term report of the most important RD achieved for a ten years period by a general practitioner at a non-urban primary care facility (Andalusia-Spain). Our results are classified as: a) rare adverse drug reactions (RADR); b) accurate RD diagnosis (RDD); and c) RD prevalence study (RDP).
Assuntos
Doenças Raras/classificação , Adulto , Idoso , Feminino , Instalações de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Estudos RetrospectivosRESUMO
Will be medical specialties like sciences in the future? Yes, progressively they will. Accuracy in clinical specialties will be dissimilar in the future because formal-logic mathematics, quantum physics advances and relativity theory utilities. Evidence based medicine is now helping to clinical specialties on scientific accuracy by the way of decision theory.
Assuntos
Medicina Baseada em Evidências/normas , Medicina/normas , Especialização , Medicina Clínica/normas , HumanosRESUMO
We report here a case of primary haematogenous osteomyelitis diagnosed in a young mild asthmatic male with immunocompetence. A hard job worked as trigger of the septic picture from a forunculosis lesion located on the abdominal wall. Meticilin-susceptible Staphylococcus aureus was isolated from blood cultures and from sternal aspiration liquid. Two months after clinical onset Ig G 4 elevation was achieved at the immunodeficiency screening. Stafilococycal lung CT images accompanied to the septic course. Intravenous cloxacilin and gentamycin treatment followed by oral rifampicin and levofloxacin achieved a total recovery.
Assuntos
Osteomielite/microbiologia , Pneumonia Estafilocócica/diagnóstico , Sepse/diagnóstico , Infecções Estafilocócicas/diagnóstico , Adulto , Asma , Humanos , Imunocompetência , Masculino , Osteomielite/tratamento farmacológico , Pneumonia Estafilocócica/tratamento farmacológico , Sepse/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , EsternoRESUMO
BACKGROUND AND OBJECTIVE: We have carried out a comparative prediction analysis in sporadic colorectal carcinoma of plasmatic lipids and currently tumor markers used in this neoplasia (carcinoembrionary antigen - CEA, CA 19.9 and sialic acid -SA). PATIENTS AND METHODS: Transversal hospital-based case-control study. Sample was composed by 53 sporadic colorectal neoplasia patients just before surgery and 40 non matched controls. A 90 per cent of cases were at Dukes A and B stages. A multivariable model was fitted with non-conditional logistic regression. Confidence intervals were calculated at 95 per cent of confidence. Model sensibility and specificity were performed at 50 per cent cutting point. We also explored possible interactions. RESULTS: All three tumor markers (CEA, CA 19.9 and SA) were elevated in cases (p<0.01). Multivariable model included: Total cholesterol (TC) (OR= 0.69; CI: 0.50-0.96) high density lipoprotein fraction (HDL) (OR = 0.30; CI: 0.11-0.83) very low density lipoprotein fraction (VLDL) (OR = 2.21; CI = 1.07-4.55) years of age (OR = 1.11; CI = 0.98-1.26) CA 19.9 (OR = 1.20; CI = 1.02-1.42) and alkaline phosphatase (OR = 1.09; CI = 1.01 - 1.19). No interactions were found out. Model sensibility reached 96.23% and a specificity of 92.50%. CONCLUSIONS: HDL showed a similar diagnostic strength than CA 19.9 in this sporadic colorectal carcinoma sample but with an inverse OR. This multivariable model is going to be validated.
Assuntos
Biomarcadores Tumorais/sangue , Antígeno CA-19-9/sangue , HDL-Colesterol/sangue , Neoplasias Colorretais/sangue , Humanos , Sensibilidade e EspecificidadeRESUMO
Superficial thoracic wall and dorsal vein of the penis phlebitis are uncommon diseases. Both are known as Mondor's disease. Two cases have been diagnosed in a short period of time in a Southern. Spain primary care clinics.
Assuntos
Epônimos , Pênis/irrigação sanguínea , Flebite , Parede Torácica/irrigação sanguínea , Adulto , Feminino , Infecções por HIV/complicações , Dependência de Heroína/complicações , Humanos , Injeções Intravenosas/efeitos adversos , Masculino , Mastectomia Segmentar , Flebite/classificação , Flebite/epidemiologia , Flebite/etiologia , Complicações Pós-Operatórias , Abuso de Substâncias por Via IntravenosaRESUMO
We report on a case of adult chronic granulomatous disease which first manifested as a pulmonary mass, and was histologically diagnosed as bronchocentric granulomatosis associated with aspergillosis in a patient with a deficiency of p67phox and a low oxidative response. Antifungal treatment was required for clinical resolution.
Assuntos
Aspergilose Broncopulmonar Alérgica/diagnóstico , Broncopatias/diagnóstico , Granuloma do Sistema Respiratório/diagnóstico , Fosfoproteínas/deficiência , Adulto , Aspergilose Broncopulmonar Alérgica/tratamento farmacológico , Biópsia por Agulha , Broncopatias/terapia , Feminino , Seguimentos , Granuloma do Sistema Respiratório/terapia , Humanos , Itraconazol/administração & dosagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Kluyvera genus usually shows two kinds of species: K. ascorbata and K. cryocrescens, DNA hybridization let us to differentiate a third group: Kluyvera species 3. Its diagnosis is quite uncommon and its taxonomy have been recently clarified. We report here a ten years female record with a chronic proteinuria and a positive urine-culture for K. cryocrescens. Axetil cefuroxime treatment was absolutely succesful. Kluyvera infections are difficult on the whole to joint with some specific clinical features.