[Predictive models of gestational diabetes, a new prediction mode]. / Modelos predictivos de diabetes gestacional, un nuevo modelo de predicción.

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.

Comparación de biomarcadores de primer trimestre en gestantes normotensas según su grado de obesidad en el tercer trimestre / Comparison of first trimester biomarkers in normotensive pregnancies according to their level of obesity in the third trimester

INTRODUCCIÓN: Nuestro trabajo tiene como objetivo aumentar la eficiencia del cribado de aneuploidías del primer trimestre de la gestación mediante la creación de modelos predictivos que sirvan para identificar gestantes en riesgo de desarrollar sobrepeso u obesidad en el tercer trimestre e instaurar medidas preventivas de obesidad a partir de ellos. MÉTODOS: Estudio observacional de tipo ambispectivo realizado en atención primaria, en el que se han recogido un total de 380 registros correspondientes a otros tantos embarazos. Se han muestreado 6 centros de salud con las variables siguientes: edad en la gestación, proteína A placentaria asociada al embarazo (PAPP-A) (mU/ml), gonadotropina coriónica humana (b-HCG) (ng/ml), semana de recogida de la muestra para el cribado de primer trimestre, índice de masa corporal (IMC) a las 12 y a las 28 semanas de gestación, TSH a las 12 semanas de gestación, presión arterial sistólica (PAS), presión arterial diastólica (PAD) y presión arterial media (PAM) a las 12 y a las 28 semanas de gestación. Se recodificó la variable IMC a las 28 semanas, clasificando a las embarazadas en peso normal (IMC<25), sobrepeso (IMC 25-29,99) y obesas (IMC≥30). El IMC a las 28 semanas recodificada fue la variable resultado del modelo de regresión logística ordinal. Utilizamos el estudio ANOVA de varios factores para discernir diferencias entre las presiones arteriales. Se aceptó un error alfa del 5%. RESULTADOS: Las medianas de la PAPP-A y de b-HCG medidas en el primer trimestre son menores de manera progresiva en los grupos de gestantes con normopeso, sobrepeso y obesidad observadas en el tercer trimestre. Estos valores son predictores del peso en el tercer trimestre (regresión logística ordinal) (PAPP-A: p = 0,022; b-HCG: p = 0,002). Ninguna gestante desarrolló preeclampsia. Las PAS, PAD y PAM en el tercer trimestre fueron significativamente diferentes (ANOVA de varios factores; p < 0,05). DISCUSIÓN: La regresión logística ordinal demuestra que la disminución de los valores observada de PAPP-A y de b-HCG en el primer trimestre es predictora del grado de obesidad de forma significativa y gradual en una muestra de gestantes normotensas. No hemos querido confeccionar un modelo de regresión ordinal incluyendo el IMC de las 12 semanas por la colinealidad interna que aportaría al estar basada la variable resultado en él. El efecto predictor de la b-HCG es más homogéneo que el de la PAPP-A para el estado de sobrepeso y obesidad

INTRODUCTION: This study aims to improve the efficiency of aneuploidy screening in the first trimester of pregnancy by creating predictive models that serve to identify pregnant women at risk of becoming overweight or obese in the third trimester and to using them to implement preventive measures of obesity. METHODS: An ambispective, observational, primary care study was conducted in which a total of 380 records corresponding to as many pregnancies were collected. Samples were collected from patients of 6 health centres, in order to determine the following variables: age at gestation, pregnancy-associated plasma protein A (PAPP-A) (mU/ml), human chorionic gonadotropin (b-HCG) (ng/ml), sample collection week for first trimester screening, body mass index at 12 and 28 weeks gestation (BMI), TSH at 12 weeks gestation, and systolic, diastolic, and mean arterial blood pressure (SBP, DBP, and MBP, respectively) at 12 and 28 weeks gestation. The BMI variable was recoded at 28 weeks, classifying pregnant women as normal weight (BMI<25), overweight (BMI 25-29.99), or obese (BMI≥30). The recoded BMI at 28 weeks was the variable resulting from the ordinal logistic regression model. An ANOVA study of several factors was used to discern differences between arterial pressures. A 5% alpha error was accepted. RESULTS: The PAPP-A and b-HCG medians measured in the first trimester are progressively lower in the groups of pregnant women with normal weight, overweight, and obesity observed in the third trimester. These values are predictors of the weight in the third trimester (ordinal logistic regression) (PAPP-A: P=.022; b-HCG: P=.002). No pregnant woman developed pre-eclampsia. The SBP, DBP, and MBP in the third trimester were significantly different (ANOVA in several factors; P<.05). DISCUSSION: The ordinal logistic regression demonstrates that the decrease in the observed values of PAPP-A and b-HCG in the first trimester is a predictor of the level of significant and gradual obesity in a sample of normotensive pregnant women. An ordinal regression model including the 12-week BMI was not made due to the internal collinearity that it would provide if the result variable was based on it. The predictive effect of b-HCG is more homogeneous than that of PAPP-A for the level of overweight and obesity

Seafood Consumption, Omega-3 Fatty Acids Intake, and Life-Time Prevalence of Depression in the PREDIMED-Plus Trial.

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 (0.63⁻0.94), 0.71 (0.58⁻0.87), and 0.78 (0.64⁻0.96), respectively, and p for trend = 0.759. Moderate intake of total LC ω-3 PUFA (approximately 0.5⁻1 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.

Effects of total dietary polyphenols on plasma nitric oxide and blood pressure in a high cardiovascular risk cohort. The PREDIMED randomized trial.

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.

Associations between serum uric acid concentrations and metabolic syndrome and its components in the PREDIMED study.

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.

Evaluación de la intervención grupal avanzada en una muestra de fumadores / Evaluation of advanced group intervention in a sample of smokers

Introducción y objetivo. Nos planteamos un análisis de los resultados de la intervención grupal en los primeros meses de rodaje del programa en nuestro centro de salud. Método. Se seleccionaron todas las historias que ingresaron en el programa desde octubre del 2011 hasta junio del 2012. El seguimiento se realizó hasta junio del 2013. Las variables fueron: edad, sexo, Fageström, Richmond, tasa de cigarrillos diarios, intentos previos, coximetría inicial, entorno fumador y, finalmente, el método seguido para la deprivación tabáquica. Esta última variable contemplaba tres categorías: nicotina más terapia grupal, fármacos más terapia grupal y terapia grupal solamente. Resultados. Se obtuvieron un total de 84 historias pertenecientes a 35 varones y 49 mujeres. La distribución de los tratamientos fue la siguiente: 24 personas (28,57%) con fármacos y terapia grupal, 15 personas (17,86%) con substitutivos de la nicotina y terapia grupal y 45 personas (53,57%) solo con terapia grupal. Al final del seguimiento se observó que 23 pacientes estaban en abstinencia tabáquica (27,38% del total de la muestra). La única variable con significación predictiva en los modelos de regresión logística multivariante fue el test de Richmond (OR= 1,5; p<0,05, IC= 1,063-2,123). Conclusión. La terapia grupal en solitario o acompañada de fármacos y/o de terapia substitutiva con nicotina ha mostrado una efectividad de más del 27% en los pacientes de nuestra muestra a los doce meses de seguimiento (AU)

Introduction and objective. We propose an analysis of the results of the group intervention in the first months of running the program in our primary health care center. Method. All the records that were admitted from October 2011 to June 2012 were selected. Patients were followed until June 2013. The variables were: age, sex, Fageström, Richmond, daily cigarette rate, previous attempts, initial cooximetry, smoking environment and finally the method used for smoking deprivation. The latter variable contained three categories: group therapy more nocotine, group therapy more drugs and group theraphy only. Results. A total of 84 stories were collected belonging to 35 men and 49 women. The distribution of treatments was as follows: 24 persons (28.57%) and drug therapy group, 15 persons (17.86%) with nicotine substitutes and group therapy and 45 people (53, 57%) group therapy only. At end of follow it was observed that 23 patients were in smoking abstinence (27, 38% of the total sample). The only variable with predictive significance in multivariate logistic regression models was the Richmond test (OR = 1.5, p <0.05, CI = 1.063 to 2.123). Conclusion. Group therapy alone or accompanied by drugs and / or nicotine replacement therapy has shown effectiveness of over 27% in the patients in our sample at twelve month follow-up (AU)

Multivariate explanatory model for sporadic carcinoma of the colon in Dukes' stages I and IIa.

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].

[Transient ischemic attack associated with a calcinosis cerebri syndrome]. / Accidente isquémico transitorio asociado a síndrome de calcinosis cerebral.

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.

Accidente isquémico transitorio asociado a síndrome de calcinosis cerebral / Transient ischemic attack associated with a calcinosis cerebri syndrome

Presentamos un caso de calcinosis cerebral (posiblemente por una enfermedad de Fahr primaria) asociado a un cuadro de accidente isquémico transitorio (disartria) en un varón anciano con hipertensión arterialy sin ningún otro factor de riesgo vascular

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

Investigando enfermedades raras del adulto en atención primaria: una hipótesis clasificatoria / Rare diseases at a primary care facility

Las enfermedades raras (ER) han de ser un objetivo de investigación en atención primaria por su potencial de productividad científico-biológica. Nos parece necesaria una sistematización de los resultados. Hemos realizado este trabajo retrospectivo longitudinal que recoge los hallazgos más importantes de nuestro interés en las ER de base genética. Los resultados se han clasificado en: a) observación y comunicación de reacciones adversas a medicamentos raras (RAMR); b) diagnóstico de entidades nosológicas raras (ENR); y c) estudio de prevalencia de ER (PER)

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)

[Rare disease at a primary care facility]. / Investigando enfermedades raras del adulto en atención primaria: una hipótesis clasificatoria.

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).

El concepto de exactitud científica en las especialidades clínicas / Upon scientific accuracy scheme at clinical specialties

¿Tendrán las especialidades clínicas un estatuto epistemológico de ciencia en el futuro? Sí, lo tendrán mediante una transformación de tipo continuo. El concepto clínico de exactitud es muy posible que sea diferente gracias a las aportaciones lógico-formales de las matemáticas, al desarrollo de la física cuántica y a las aplicaciones de la teoría de la relatividad. La medicina basada en la evidencia está ayudando al tránsito hacia la “exactitud científica” de las especialidades clínicas sobre todo en el campo de la teoría de la decisión

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

Reflexiones sobre la actualización de una monografía / Reflections on updating a monograph

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[Upon scientific accuracy scheme at clinical specialties]. / El concepto de exactitud científica en las especialidades clínicas.

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.

Disfunción diastólica con fracción de eyección conservada en una paciente con enfermedad de Paget poliostótica / Diastolic dysfunction with preserved ejection fraction in a patient with Paget´s disease of bone

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[Hematogenous sternal osteomyelitis and community acquired pneumonia in a methicillin-susceptible Staphilococcus aureus sepsis]. / Osteomielitis esternal hematógena y neumonía de la comunidad secundarias a una sepsis por Staphylococcus aureus sensible a meticilina.

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.

Osteomielitis esternal hematógena y neumonía de la comunidad secundarias a una sepsis por Staphylococcus aureus sensible a meticilina / Haematogeous sternal osteomyelitis and community pneumonia ina meticilin-susceptible staphilococcus aureus sepsis

Presentamos un caso de osteomielitis esternal hematógena en un varón joven con antecedentes de asma moderado y normalidad de las funciones inmunológicas. El cuadro se desencadenó después de un esfuerzo físico importante y probablemente por la reactivación de una lesión foruncular en la pared del abdomen. Se aisló Staphylococcus aureus sensible a meticilina tanto en los hemocultivos como en el líquido extraído de la lesión esternal. Se pudo objetivar una elevación de la fracción Ig G 4 en la fase de reimisión clínica. El cuadro séptico se acompañaba de lesiones pulmonares sugerentes de neumonía neumocócica. El tratamiento a base de cloxacilina y gentamicina por vía endovenosa seguido por Rifampicina y Levofloxacino por vía oral dio como resultado una “restitutio ad integrum"

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

[CA 19.9 and HDL-cholesterol behaviour in a sporadic colorectal carcinoma sample]. / Compartimiento del CA 19.9 y de fracción HDL-colesterol en una muestra de pacientes con carcinoma colorrectal esporádico.

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.