Evaluation of the psychometric properties of the health care providers' pain and impairment relationship scale (HC-PAIRS) in health professionals and university students from Chile and Colombia.

Background: Chronic back pain is a frequent and disabling health problem. There is evidence that ignorance and erroneous beliefs about chronic low back pain among health professionals interfere in the treatment of people who suffer from it. The Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) has been one of the most used scale to assess these misbeliefs, but no studies have been reported in Latin America. Method: We studied the factorial structure of the HC-PAIRS in health personnel and health sciences university students in two Latin American countries: Colombia (n = 930) and Chile (n = 190). Spain's data was taken of the original study of the Spanish version of the HC-PAIRS (171 Physiotherapy students). Additionally, the measurement invariance of this scale among Chile, Colombia and Spain was evaluated by calculating three nested models: configural, metric and scalar. We used a Confirmatory Factor Analysis (CFA) in both Latin American samples, with Maximum Likelihood Robust (MLR) estimation to estimate the parameters. For the final model in each sample, reliability was assessed with the Composite Reliability (CR) index, and to obtain the proportion of variance explained by the scale the Average Variance Extracted (AVE) was calculated. Results: The one-factor solution shows an acceptable fit in both countries after deleting items 1, 6, and 14. For the resulting scale, the CR value is adequate, but the AVE is low. There is scalar invariance between Chile and Colombia, but not between these two countries and Spain. Conclusions: HC-PAIRS is useful for detecting misconceptions about the relationship between chronic low back pain that would cause health personnel to give wrong recommendations to patients. However, it has psychometric weaknesses, and it is advisable to obtain other evidence of validity.

Risk factors for predicted refractive error after cataract surgery in clinical practice. Retrospective observational study.

OBJECTIVES: To describe the preoperative characteristics of patients undergoing cataract surgery in our hospital, to determine the final visual and refractive results and to determine the preoperative characteristics that conditioned the presence of a residual refractive error (RRE) greater than one diopter. METHODS: Retrospective analysis of cataract surgeries performed at Araba University Hospital between February 2017 and December 2019. Sociodemographic, eye comorbidity, biometric, surgical and post-surgical characteristics were collected. RESULTS: A total of 1419 patients and 1578 surgeries were included for analysis. Of these, 9.07% had preoperative legal blindness, 31.69% eye comorbidity and 4.18% had previous surgery. Overall, 95.82% of patients achieved a corrected final visual acuity (VA) ≥ 0.5 Snellen decimal and 63.12% ≥ 1, and 96.70% of patients improved VA after surgery. RRE was between ±0.5 diopters in 77.82% of patients and between ±1 diopter in 94.74%. The most prominent risk factors that conditioned the presence of RRE greater than 1 diopter were the use of ultrasonic contact biometer, a history of glaucoma surgery, the presence of white or hard cataract, and prior legal blindness. CONCLUSIONS: The visual results of cataract surgery were excellent, with 63.12% of patients obtaining corrected VA ≥ 1 and an RRE of ±1 diopter in 94.74%. Different risk factors influenced the achievement of poor refractive outcomes: preoperative conditions (previous surgeries, white/hard cataract, previous VA) and biometrics.

Stabilization of a type VI turn in a family of linear peptides in water solution.

The sources of the stability of a type VI turn formed with high population in the cis isomeric form of an unblocked six residue peptide, Ser1-Tyr2-Pro3-Tyr4-Asp5-Val6 (SYPYDV), were investigated by making extensive amino acid substitutions at residues 2, 4 and 5. Several NMR parameters indicate the presence of the turn, including significant upfield shifts of the proton resonances of the cis proline, a small 3JHN alpha coupling constant for residue 2, a cross-turn d alpha N(i,i+2) from residue 2 to residue 4 and in increased mole fraction of the cis form in the conformational ensemble. By these criteria, a number of peptides were found to contain significant populations of type VI turn conformers in the cis form of the peptide. The NMR parameters are highly dependent on the sequence of the peptide, and are strongly correlated with each other and with the population of type VI turn. The greatest populations of turn conformations were observed for peptides of the general form AA-Ar-Pro-Ar-Hp, where AA represents any amino acid, Ar an aromatic residue and Hp a small hydrophilic residue. There is no evidence in the form of lowered amide proton temperature coefficients for direct hydrogen bonding as a primary source of turn stability. Instead, the major stabilizing factor, indicated by the strong dependence of the turn population on the presence of aromatic (not hydrophobic) residues at positions 2 and 4, is the stacking of the aromatic and proline rings. A measurable preference for deprotonated aspartate at position 5, which is not part of the turn itself, and the destabilization of the turn at high and low pH, indicate that electrostatic interactions between the unblocked N terminus and the aspartate carboxyl group also act to stabilize the turn conformation when the Ar-Pro-Ar sequence is present. Implications for stabilization of local elements of secondary structure during the earliest events in protein folding are discussed.

Obesity favors surgical and infectious complications after renal transplantation.

UNLABELLED: The prevalence of obesity is increasing in the renal transplant population. There are controversial data with respect to posttransplant outcome. We performed a study comparing the incidence of surgical and infectious complications among 40 obese patients (body mass index [BMI] pretransplant > or =30 kg/m2) versus a matched nonobese control group (BMI <30 kg/m2) transplanted at our center between June 1989 and March 2001. RESULTS: There were no differences in patient demographic variables (mean age, gender, cause of renal failure, or percentage of diabetes or hepatitis C virus infection). Donor age, HLA mismatching, sensitization, cold ischemia time, and immunosuppressive regimen were similar in both groups. The mean pretransplant BMI in obese and nonobese patients was 34.1+/-4.0 versus 23.00+/-2.73 kg/m2 (P<.01). The obese group showed a higher incidence of delayed graft function (30% versus 5%, P<.05) and wound infections (12.5%) posttransplant with similar incidences of wound dehiscence, perigraft collections, and graft function at the end of follow up.

[Membranoproliferative glomerulonephritis associated with autoimmune thyroiditis]. / Glomerulonefritis membranoproliferativa hipocomplementémica asociada a tiroiditis autoinmune.

Several cases of glomerular disease have been associated to thyroid diseases. The most frequent lesion described is membranous glomerulopathy, presented as a nephrotic syndrome. Here we report a 67-year-old man who developed a nephrotic syndrome accompanied by rapid derangement of renal function shortly after the onset of a primary hypothyroidism due to autoimmune thyroiditis. High titers of circulating anti-thyroglobulin and anti-microsomal thyroid antigen antibodies were detected. Serum levels of C3 and C4 fractions of complement were markedly decreased. Renal biopsy showed a membranoproliferative glomerulonephritis with severe mesangial proliferation, a type of glomerular involvement non-described previously in the literature, in relation with thyroid diseases. Four boluses of intravenous steroids were administered, followed by oral prednisone for three months. A dramatic recovery of renal function, together with normalization of urinary sediment, proteinuria decrease and normalization of serum complement were observed. Three years later, the patient suffered from a similar event, with a positive response to steroids again. One year later, the patient had a new recurrence and was treated with mycophenolate mofetil , improving his clinical situation.

[Immunoallergic interstitial nephritis vs. cholesterol atheroembolism. Differentiating characteristics]. / Nefritis intersticial inmunoalérgica vs ateroembolismo de colesterol. Características diferenciales.

The commonest clinical presentation of both immunoalergic interstitial nephritis (IIN) and atheroembolic renal disease (ATD) is an acute renal failure accompanied by skin lesions and eosinophilia. As a consequence, differential diagnosis between both entities is often very difficult. We have performed a comparative retrospective study of those patients diagnosed as having IIN or ATD in our Hospital in the period 1980-2000. A total of 42 patients have been diagnosed of IIN and 16 of ATD. Demographic data, as well as clinical and laboratory parameters and outcomes of every studied patient were analysed. We found a significantly higher prevalence of male sex (100% vs 57%, p < 0.01), previous history of hypertension (100% vs 55%, p < 0.01), chronic renal insufficiency (56% vs 17%, p < 0.01), ischemic heart disease (56% vs 14%, p < 0.001), peripheral ischemic disease, endovascular procedures (87% vs 7%, p < 0.001) and anticoagulant treatments (25% vs 5%, p < 0.001) among patients with ATD as compared with IIN, respectively. On the contrary, previous infections (45% vs 12%, p < 0.01) and exposure to new drugs (100% vs 40%, p < 0.001) were significantly more frequent among IIN patients in compare with ATD. ATD patients showed skin lesions consisting of livedo reticularis and digital infarcts (63% vs 31%, p < 0.05) accompanied by blood pressure increase (100% vs 24%, p < 0.001), whereas IIN patients showed fever (41% vs 19%, p < 0.05) and cutaneous rash as significant clinical manifestations, respectively. The number of ATD patients with proteinuria > 1 g/24 h was significantly higher, but no differences between both groups in the prevalence of urinary sediment abnormalities were observed. The prevalence of absolute eosinophilia was high in both groups (88% among ATD patients, 64% among IIN patients; pNS). Prognosis of both entities was clearly different: Almost all patients with ATD died (69%) or evolved to end-stage renal failure, whereas most patients with IIN showed a recovery of renal function after withdrawal of responsible drugs and steroid treatment. In summary, the analysis of clinical and laboratory data allows an initial differential diagnosis in patients suspected as having IIN or ATD.

[Relapsing nephrotic syndrome in a diabetic patient with minimal change]. / Síndrome nefrótico recidivante por lesiones mínimas en un paciente diabético.

Although nondiabetic nephropathies are common among type 2 diabetic patients, very few cases of minimal change nephrotic syndrome have been reported in diabetic patients. We describe a type 2 diabetic patient that rapidly developed a nephrotic syndrome accompanied by a mild worsening of renal function. Proteinuria was negative one year before and no signs of diabetic retinopathy were found. Renal biopsy established the diagnosis of minimal change disease. Steroid treatment induced a complete remission of nephrotic syndrome and recovery of normal renal function. However, massive proteinuria relapsed two years later. A second cycle of steroids was followed by a disappearance of proteinuria, but a third bout of nephrotic syndrome was observed 6 months later. An 8-weeks cycle of steroids plus chlorambucil induced a complete and persistent remission. Throughout a five-year follow up, no relapse of the nephrotic syndrome was observed and microalbuminuria is negative.

[The "quality of life" concept in medical students and postgraduate residents in a university hospital]. / El concepto de "calidad de vida" en los estudiantes de Medicina y residentes de Postgrado de un hospital universitario.

We investigated the quality of life's concept and its uses by both residents and interns as well as last year medical students in the University Hospital in Caracas (HUC). A random sample by strata, without replacement of 123 persons, completed a self administered questionnaire which included a set of closed questions and one of open questions related to the quality of life's concept. The mean age was 29 years for both sexes (3.55 standard deviation or SD). There was not a statistically significant difference between males and females. More than 50% read about quality of life in either newspapers, journals and fiction literature. There was no difference among the groups (p = 0.25). Only 68% had heard in a different sort of academical institution the term "quality of life" such as in the school of medicine, highschool or in some discussion groups with no differences among the groups (p = 0.15). However, there was no agreement as from whom and where they learned about quality of life (p < 0.001). Although everybody considered that the quality of life was an important element in medical actions such as diagnostic or therapeutics, its importance was reduced for diagnosis compared to treatment (p < 0.0001). All the elements that were considered as part of the concept were also considered as important, regardless of the group and was statistically significant (p < 0.05). The open question analysis showed that the non-medical definitions represent 85.15% of the group, 50% out of them included terms of potentiality or condition. Among the elements included in the definition was the social in 27.65%, psychological in 23.53% and, the economical in 12.35% of the questionnaires. The great majority of the "quality of life" definitions did not include a clearly defined subject and in many cases it was exclusively related to ill persons. Finally, there is an informal and not well oriented form of learning about "quality of life" in residents, interns and last year medical students with a lack of a good applicability in the medical practice. Therefore, there is a need for a formal training on quality of life along the medical studies and its uses in the medical practice in general and with special emphasis on diagnosis and therapeutics.

Factores de riesgo asociados al error refractivo residual tras cirugía de catarata en práctica clínica. Estudio observacional retrospectivo / Risk factors for predicted refractive error after cataract surgery in clinical practice. Retrospective observational study

Objectives: To describe the preoperative characteristics of patients undergoing cataract surgery in our hospital, to determine the final visual and refractive results and to determine the preoperative characteristics that conditioned the presence of a residual refractive error (RRE) greater than one diopter.MethodsRetrospective analysis of cataract surgeries performed at Araba University Hospital between February 2017 and December 2019. Sociodemographic, eye comorbidity, biometric, surgical and post-surgical characteristics were collected.ResultsA total of 1,419 patients and 1,578 surgeries were included for analysis. Of these, 9.07% had preoperative legal blindness, 31.69% eye comorbidity and 4.18% had previous surgery. Overall, 95.82% of patients achieved a corrected final visual acuity (VA) ≥ 0.5 Snellen decimal and 63.12% ≥ 1, and 96.70% of patients improved VA after surgery. RRE was between ± 0.5 diopters in 77.82% of patients and between ± 1 diopter in 94.74%. The most prominent risk factors that conditioned the presence of RRE greater than 1 diopter were the use of ultrasonic contact biometer, a history of glaucoma surgery, the presence of white or hard cataract, and prior legal blindness.ConclusionsThe visual results of cataract surgery were excellent, with 63.12% of patients obtaining corrected VA ≥ 1 and an RRE of ± 1 diopter in 94.74%. Different risk factors influenced the achievement of poor refractive outcomes: preoperative conditions (previous surgeries, white/hard cataract, previous VA) and biometrics (AU)

Objetivos: Describir las características preoperatorias de la población intervenida de cataratas en nuestro hospital, determinar los resultados visuales y refractivos finales y determinar las características previas a la intervención que condicionan la presencia de un error refractivo residual (ERR) mayor de una dioptría.MétodosEstudio retrospectivo de cirugías de catarata realizadas en el Hospital Universitario Araba, entre febrero de 2017 y diciembre de 2019. Se recogieron características sociodemográficas, de comorbilidad ocular, biométricas, quirúrgicas y postquirúrgicas.ResultadosSe incluyeron 1.419 pacientes y 1.578 cirugías para su análisis. El 9,07% presentaron ceguera legal preoperatoria, el 31,69% comorbilidad ocular y el 4,18% había sido previamente intervenido. El 95,82% de los pacientes alcanzaron una agudeza visual (AV) final corregida ≥ 0,5 Snellen decimal y el 63,12% ≥ 1. El 96,70% de los pacientes mejoraron la agudeza visual (AV) tras la intervención. El ERR estuvo entre ± 0,5 dioptrías en el 77,82% de los pacientes y entre ± 1 dioptría en el 94,74%. Los factores de riesgo más destacados que condicionan la presencia de ERR mayor de una dioptría fueron la utilización de biómetro ultrasónico de contacto, el antecedente de cirugía de glaucoma, la presencia de catarata blanca o dura y una AV previa de ceguera legal.ConclusionesLos resultados visuales de la cirugía de cataratas fueron excelentes, alcanzando el 63,12% de los pacientes una AV corregida ≥ 1 y quedando un ERR entre ± 1 dioptría en el 94,74%. Diferentes factores de riesgo influyen en la consecución de peores resultados refractivos: condiciones preoperatorias (intervención previa, catarata blanca/dura, AV previa) y biométricas (AU)

Hipertensión arterial después del trasplante renal / Arterial hypertension after renal transplantation

La hipertensión arterial (HTA) es extremadamente frecuente después del trasplante renal y presenta una clara relación con la nefropatía crónica del injerto y la morbimortalidad cardiovascular, ambas circunstancias principales responsables de la pérdida de los injertos renales a partir del primer año postrasplante.En su etiopatogenia participan numerosos factores, dentro de los cuales la propia medicación inmunosupresora, en concreto, los inhibidores de la calcineurina, desempeñan un papel fundamental. La HTA postrasplante ha de ser tratada enérgicamente con medidas higiénico-dietéticas y farmacológicas. La elección del fármaco antihipertensivo ha de realizarse de manera individualizada. Probablemente los calcioantagonistas sean los fármacos de primera línea, salvo en aquellos pacientes con proteinuria, en los que sería preferible utilizar un inhibidor de la enzima convertidora de angiotensina o un antagonista de los receptores de angiotensina II. El advenimiento de nuevos fármacos inmunosupresores sin capacidad nefrotóxica ni prohipertensiva facilitará en un futuro el desarrollo de nuevos protocolos de inmunosupresión que permitirán minimizar la nefrotoxicidad, con el consiguiente impacto en la HTA postrasplante (AU)

Glomerulonefritis membranoproliferativa hipocomplementémica asociada a tiroiditis autoinmune / Membrand proliferative glomerulonephritis associated to autoinmune thyroiditis

Se han descrito algunos casos de enfermedades glomerulares asociadas a trastornos tiroideos. La lesión descrita como más frecuente corresponde a una glomerulonefritis membranosa con síndrome nefrótico. Presentamos el caso de un varón de 67 años que desarrolló un síndrome nefrótico acompañado de un deterioro de la función renal, poco tiempo después del diagnóstico de hipotiroidismo secundario a una tiroiditis auto inmume. Durante su estudio, se detectaron tí- tulos elevados de anticuerpo antitiroglobulina y antimitocondriales junto con valores de complemento descendidos. Con estos datos, se practicó una biopsia renal que mostró una glomerulonefritis membranoproliferativa con severa proliferación mesangial, patrón histológico no descrito previamente en la literatura, en relación a patología tiroidea. Se trató inicialmente con un choque de esteroides intravenosos, seguidos de prednisona oral durante tres meses, obteniéndose una excelente respuesta (mejoría de la función renal, descenso de la proteinuria y normalización del complemento). Tres años después, el paciente sufrió una recaída similar, con datos de reactivación de la tiroiditis (descenso de hormonas tiroideas, elevación de anticuerpos antitiroideos) y reaparición del síndrome nefrótico con deterioro agudo de función renal. Una segunda biopsia renal mostró nuevamente un patrón de glomerulonefritis membranoproliferativa grave. Con esteroides en dosis altas se logró controlar de nuevo el proceso. Se produjo una nueva recurrencia al año siguiente, introduciéndose micofenolato mofetil como terapia coadyuvante con disminución de la proteinuria y estabilización de la creatinina (AU)

Several cases of glomerular disease have been associated to thyroid diseases. The most frequent lession described is membranose glomerulopathy, presented as a nephroic syndrom. Here we report a 67-year-old man who developed a nephrotic syndrome accompanied by rapid derangement of renal function shortly after the onset of a primary hypothyroidism due to autoimmune thyroiditis. High titers of circulating anti-thyroglobulin and anti-microsomal thyroid antigen antibodies were detected. Serum levels of C3 and C4 fractions of complement were markedly decreased. Renal biopsy showed a membranoproliferative glomerulonephritis with severe mesangial proliferation, a type of glomerular involvement non described previously in the literature, in relation with thyroid diseases. Four boluses of intravenous steroids were administered, followed by oral prednisone for three months. A dramatic recovery of renal function, together with normalization of urinary sediment, proteinuria decrease and normalization of serum complement were observed. Three years later, the patient suffered from a similar event, with a positive response to steroids again. One year later, the patient had a new recurrence and was treated with mofetil michophenolate, improving his clinical situation (AU)

Nefritis intersticial inmunoalérgica vs ateroembolismo de colesterol. Características diferenciales / Differential diagnosis features between acute interstitial nephritis and atheroembolic renal disease

El diagnóstico diferencial entre la nefritis intersticial inmunoalérgica (NIIA) y la enfermedad por ateroembolismo de colesterol (AE) puede ser muy difícil por presentarse a menudo ambas entidades como fracasos renales agudos con eosinofilia llamativa y lesiones cutáneas. Realizamos un estudio comparativo retrospectivo de las series de NIIA y de AE registradas en nuestro Hospital, en el período comprendido entre 1980 y diciembre del 2000. En total, se estudiaron 42 pacientes diagnosticados de NIIA y 16 pacientes diagnosticados de AE. Se analizaron los parámetros epidemiológicos, clínicos, analíticos y de evolución renal, así como la morbi-mortalidad. Se encontraron diferencias significativas en las prevalencias de sexo masculino (100% frente a 57%, p 1 g/día en un porcentaje mayor de casos de AE (44% vs 26%, p < 0,05), sin observarse diferencias en la presencia de eosinofilia (88% en la AE vs 64% en la NIIA pNS), microhematuria o leucocituria. Desde el punto de vista del pronóstico renal y la morbi-mortalidad asociada, se observa una evolución casi constante hacia la IRC terminal en el AE, así como una mortalidad elevada (69% vs 5%, p < 0,001), que contrasta con la mejor evolución de los casos con NIIA. En conclusión, la presencia de determinados datos clínicos y analíticos, en conjunto, nos permiten una orientación inicial para el diagnóstico diferencial entre ambas entidades

The commonest clinical presentation of both immunoalergic interstitial nephritis (IIN) and atheroembolic renal disease (ATD) is an acute renal failure accompanied by skin lesions and eosinophilia. As a consequence, differential diagnosis between both entities is often very difficult. We have performed a comparative retrospective study of those patients diagnosed as having IIN or ATD in our Hospital in the period 1980-2000. A total of 42 patients have been diagnosed of IIN and 16 of ATD. Demographic data, as well as clinical and laboratory parameters and outcomes of every studied patient were analysed. We found a significantly higher prevalence of male sex (100% vs 57%, p 1 g/24 h was significantly higher, but no differences between both groups in the prevalence of urinary sediment abnormalities were observed. The prevalence of absolute eosinophilia was high in both groups (88% among ATD patients, 64% among IIN patients; pNS). Prognosis of both entities was clearly different: Almost all patients with ATD died (69%) or evolved to end-stage renal failure, whereas most patients with IIN showed a recovery of renal function after withdrawal of responsible drugs and steroid treatment. In summary, the analysis of clinical and laboratory data allows an initial differential diagnosis in patients suspected as having IIN or ATD