Cuestionario de funcionalidad para esclerosis sistémica (SySQ): validación en español del original en alemán y su relación con la enfermedad y la calidad de vida / The Systemic Sclerosis Questionnaire (SySQ): validation of the translation of the original German version into Spanish and its relationship to the disease and to quality of life

OBJETIVO: Traducción, transculturización y validez del cuestionario autoadministrado para funcionalidad (Systemic Sclerosis Questionnaire [SySQ]) en esclerosis sistémica al idioma español y su relación con la enfermedad y la calidad de vida. PACIENTES Y MÉTODOS: Estudio observacional analítico. Validación realizada por panel de expertos, en apariencia y contenido. La metodología incluyó: a) adaptación al español del constructo por traducción, retrotraducción, y transculturización; b) consistencia interna para todas y cada una de las categorías del SySQ (alfa de Cronbach), y c) la reproducibilidad se evaluó tomando en cuenta todas las ocasiones en que se realizó la prueba con kappa de Cohen. Adicionalmente calculamos el coeficiente de correlación de Spearman con: 1) escala de severidad de Medsger; 2) Health Assessment Questionnaire, y 3) prueba SF-36. RESULTADOS: Se incluyeron 70 pacientes con esclerosis sistémica, edad 17-78 (51+/-12) años, 65 (93%) mujeres, subtipo difuso/limitado 64/36%, evolución de la enfermedad 0,5-40 años. Observamos consistencia interna óptima de la versión final del SySQ (alfa de Cronbach 0,961) y buena reproducibilidad intraobservador entre pruebas con intervalo de 2 semanas (kappa de Cohen 0,618) y óptima interobservador el mismo día (kappa de Cohen 0,911). Moderada correlación entre los cuestionarios de funcionalidad SySQ y de discapacidad de Health Assessment Questionnaire (r=0,573; p < 0,0001). Correlación inversa entre SySQ y calidad de vida en dominio mental del SF-36 (r=-0,435; p < 0,001) y en dominio físico del SF-36 (r=-0,680; p < 0,001). La escala de severidad de la enfermedad de Medsger (tendón, corazón, pulmón, vascular) también mostró correlación significativa con SySQ. CONCLUSIONES: Esta versión en español del cuestionario autoadministrado SySQ es un instrumento válido para evaluar el estado funcional de pacientes con esclerosis sistémica. La menor funcionalidad está relacionada con una mayor afección a tendón y vascular periférico y con una menor calidad de vida

OBJECTIVE: Translation, transculturation and validity of the self-administered questionnaire for functionality (Systemic Sclerosis Questionnaires [SySQ]) for use in Spanish patients with systemic sclerosis and its relationship to the severity of the disease and to quality of life. PATIENTS AND METHODS: We conducted an observational analytical study to perform a cross-cultural validation of the self-administered questionnaire on functionality in scleroderma. The validity of the form and content was evaluated by an expert panel. The method included: a) adaptation into Spanish of the construct for translation and back translation, and transculturation; b) internal consistency with the SySQ (Cronbach's alpha), and c) reproducibility was assessed taking into account all occasions in which the test was performed with Cohen's kappa. Additionally, we calculated the Spearman correlation coefficient with the Medsger severity scale, Health Assessment Questionnaire score and SF-36 score. RESULTS: We included 70 patients with systemic sclerosis: age 17-78 (51+/-12) years, 65 (93%) were women, diffuse/limited subtype 64/36%, disease duration of 0.5-40 years. Optimal internal consistency for all categories of the final version of SySQ (Cronbach's alfa of 0.961) and intraobserver reliability in 2 tests over a 2-week interval (Cohen's kappa coefficient 0.618) and optimal interobserver reliability in 2 tests on the same day (Cohen's kappa coefficient 0.911). Moderate correlation between functionality by SySQ and by Health Assessment Questionnaire (r=0.573, P<.0001). Inverse correlation between SySQ and quality of life mental health domain SF-36 (r=-0.435, P<.001) and physical domain SF-36 (r=-0.638, P<.001). Medsger severity scale (tendon, heart, lung, vascular) also showed significant correlation with SySQ. CONCLUSIONS: SySQ in this validated Spanish version is a suitable instrument to measure functional status in patients with systemic sclerosis. Reduced functionality is related to greater tendon and peripheral vascular involvement and to a poorer quality of life

The Systemic Sclerosis Questionnaire (SySQ): Validation of the translation of the original German version into Spanish and its relationship to the disease and to quality of life. / Cuestionario de funcionalidad para esclerosis sistémica (SySQ): validación en español del original en alemán y su relación con la enfermedad y la calidad de vida.

OBJECTIVE: Translation, transculturation and validity of the self-administered questionnaire for functionality (Systemic Sclerosis Questionnaires [SySQ]) for use in Spanish patients with systemic sclerosis and its relationship to the severity of the disease and to quality of life. PATIENTS AND METHODS: We conducted an observational analytical study to perform a cross-cultural validation of the self-administered questionnaire on functionality in scleroderma. The validity of the form and content was evaluated by an expert panel. The method included: a) adaptation into Spanish of the construct for translation and back translation, and transculturation; b) internal consistency with the SySQ (Cronbach's alpha), and c) reproducibility was assessed taking into account all occasions in which the test was performed with Cohen's kappa. Additionally, we calculated the Spearman correlation coefficient with the Medsger severity scale, Health Assessment Questionnaire score and SF-36 score. RESULTS: We included 70 patients with systemic sclerosis: age 17-78 (51±12) years, 65 (93%) were women, diffuse/limited subtype 64/36%, disease duration of 0.5-40 years. Optimal internal consistency for all categories of the final version of SySQ (Cronbach's α of 0.961) and intraobserver reliability in 2 tests over a 2-week interval (Cohen's kappa coefficient 0.618) and optimal interobserver reliability in 2 tests on the same day (Cohen's kappa coefficient 0.911). Moderate correlation between functionality by SySQ and by Health Assessment Questionnaire (r=0.573, P<.0001). Inverse correlation between SySQ and quality of life mental health domain SF-36 (r=-0.435, P<.001) and physical domain SF-36 (r=-0.638, P<.001). Medsger severity scale (tendon, heart, lung, vascular) also showed significant correlation with SySQ. CONCLUSIONS: SySQ in this validated Spanish version is a suitable instrument to measure functional status in patients with systemic sclerosis. Reduced functionality is related to greater tendon and peripheral vascular involvement and to a poorer quality of life.

Validation of a predictive index of neoplasia in unexplained weight loss / Validación de un índice predictivo de neoplasia en pérdida de peso inexplicada

Background: Involuntary weight loss (IWL) is associated with a bad prognosis. A causal diagnosis is difficult and the priority is to identify those patients at risk of a serious underlying disease, such as malignant neoplasia. Objective: External validation of a prognostic index of neoplasia in patients with IWL. Methods: Patients referred for IWL from 2005 to 2014 to the Department of Internal Medicine, of a specialty care hospital in Mexico City were studied. Al of them underwent an evaluation consisting of medical history, physical examination and basic laboratory studies, those patients without an apparent cause of IWL, were included. A probability of neoplasia according to Hernández prognostic index was calculated. Complementary diagnostic studies were performed until a causal diagnosis was reached, or the cases were classified as "unknown cause", if the etiology was not possible to find after one year of follow-up. A binarian logistic model was constructed with five variables age, leucocyte count, albumin, lactic dehydrogenase and alkaline phosphatase levels, and a prediction rule was developed. Results: 130 Patients were included and 45 of them (30%) had a neoplastic cause of IWL. The prediction rule according to Hernández criteria, correctly classified 65% of the patients (sensitivity 29%, Specificity 85%, positive predictive value 50% and negative predictive value 69%). When the original index was modified in two categories (high and low probability), it showed a sensitivity of 84.4% and a negative predictive value of 85.7%. Conclusion: The Hernández index has a limited value as a screening tool.

Introducción: la pérdida involuntaria de peso es un factor de mal pronóstico. Su diagnóstico causal es difícil y es prioritario identificar los casos que tienen una enfermedad grave subyacente. Objetivo: validar un índice pronóstico de neoplasia en pacientes con pérdida involuntaria de peso. Métodos: pacientes referidos por pérdida involuntaria de peso de 2005 a 2014, fueron evaluados mediante historia clínica y exámenes básicos de laboratorio; en el estudio fueron incluidos los pacientes sin causa aparente después de la evaluación. Se calculó la probabilidad de neoplasia, según el índice de Hernández. Se realizaron estudios complementarios hasta identificar una causa o fueron clasificados como "causa desconocida", si no se encontró la etiología después de un año de seguimiento. Se construyó un modelo de regresión logística binaria con las variables edad, cifras de leucocitos, albúmina, deshidrogenasa láctica y fosfatasa alcalina; con la ecuación resultante se predijo neoplasia como causa de pérdida involuntaria de peso. Resultados: se incluyeron 130 pacientes, 45 tuvieron causa neoplásica (30%). La ecuación de predicción clasificó correctamente a 65% de los sujetos analizados (especificidad 85%, sensibilidad 29%, valor predictivo positivo 50%, valor predictivo negativo 69%). Al modificarse el índice original en dos categorías (probabilidad alta y baja), mostró una sensibilidad del 84.4% y un valor predictivo negativo del 85.7%. Conclusión: el índice tuvo baja sensibilidad, lo que limita su uso como prueba de tamizaje.

[Atrophy in the mucosa neighboring an intestinal-type gastric adenocarcinoma by comparing the Sydney vs. OLGA systems]. / Atrofia circundante al adenocarcinoma gástrico tipo intestinal. Rendimiento diagnóstico de Sídney y Olga.

BACKGROUND: Gastric carcinoma causes about 700 000 deaths worldwide per year. Is feasible detect it in earlier stages. The aim of this article is to assess the atrophy in the mucosa neighboring an intestinal-type gastric adenocarcinoma by comparing the Sydney vs. OLGA systems. METHODS: Twenty-eight individuals with intestinal-type gastric adenocarcinoma (Lauren) were compared with 32 non-neoplastic cases. Both groups had undergone total gastrectomy. Two pathologists made a consensus-based assessment of the atrophy in non-neoplastic corpus and antral epithelium using the Sydney and OLGA Systems. The mean, median, and distribution of the frequencies were obtained using the measuring and distribution scales of the study variables. The sensitivity, specificity, and predictive values, both positive and negative, for gastric cancer were calculated through the dichotomy of advanced atrophy-positive and advanced atrophy-negative scales. RESULTS: Twenty-four of the 28 cases with intestinal-type gastric carcinoma showed an advanced atrophy with the OLGA system, with a sensitivity and specificity of 77 and 85 %, respectively. Conversely, 4 of the 28 individuals showed an advanced atrophy with the Sydney system, with a sensitivity and specificity of 14 and 100 %, respectively. CONCLUSIONS: The OLGA system has a high sensitivity and specificity (77 y 85 % respectively) for the recognition of preneoplastic changes in the mucosa neighboring a gastric carcinoma.

Introducción: el carcinoma gástrico ocasiona al año unas 700 000 muertes en el mundo. El objetivo de este artículo es evaluar la atrofia en la mucosa vecina al adenocarcinoma gástrico tipo intestinal comparando los sistemas Sídney y OLGA. Diferencias en el rendimiento diagnóstico impulsarían el empleo de alguno. Métodos: estudiamos 28 sujetos con adenocarcinoma gástrico tipo intestinal (Lauren), que comparamos con 32 casos sin neoplasia, ambos grupos con gastrectomía total. Dos patólogos evaluaron la atrofia en el epitelio de cuerpo y antro no neoplásico con los sistemas Sídney y OLGA. Se obtuvieron la media, mediana y distribución de frecuencias por escala de medición, así como la distribución de las variables del estudio. Se calculó la sensibilidad, especificidad y los valores predictivos para cáncer gástrico gracias a dicotomizar las escalas con resultado positivo y negativo para atrofia avanzada. Resultados: veinticuatro de 28 casos con adenocarcinoma gástrico tipo intestinal mostraron atrofia avanzada con OLGA con una sensibilidad y especificidad de 77 y 85 % respectivamente. Con el sistema Sídney, 4 de 28 mostraron atrofia avanzada con una sensibilidad y especificidad de 14 y 100 % respectivamente. Conclusiones: el sistema OLGA tiene elevada sensibilidad y especificidad (77 y 85 % respectivamente) para reconocer cambios preneoplásicos en la mucosa vecina al cáncer gástrico. Empero, OLGA no mostró atrofia avanzada en adenomas foveolares con displasia de alto grado, ni en adenocarcinomas en las porciones proximales del estómago.

[Fever of unknown origin, comparing two series with 26 years of difference]. / Fiebre de origen oscuro, comparación de dos series con 26 años de diferencia.

INTRODUCTION: Fever of unknown origin (FUO) remains a syndrome with difficult approach and changing spectrum. Our aim was to compare two series of FUO patients seen at the Department of Internal Medicine, Hospital de Especialidades Centro Medico La Raza, Mexico City. METHODS: Data from FUO series from 1979-87 were compared with those from 2004-14 series. We analyzed demographic data, final diagnoses, and diagnostic tests used. We report median and range for numerical variables and frequencies for nominal data, bivariate analysis was done with chi-square or Fisher´s test as needed using SPSS version 17.0 for MAC and open-epi version 3.7. RESULTS: One hundred twenty seven patients were included in the 1979-87 series and 118 in the 2004-14 series. There were more non-infectious inflammatory diseases (p=0.0004) and less infectious diseases (p=0.024) in the 2004-14 series. We observed no significant differences in neoplastic diseases and undiagnosed cases between the two series. Laboratory tests and their diagnostic utility were similar in both series, but image studies were less useful in the 2004-14 series. Biopsy and laparotomy remained as frequent and useful tools in both series. CONCLUSIONS: The recent series had more non-infectious inflammatory diseases and less infectious causes of FUO. Invasive studies remain as useful diagnostic aids in a significant number of cases.

Introducción: la fiebre de origen oscuro (FOO) es un síndrome de abordaje difícil y espectro cambiante. El objetivo fue comparar dos series de FOO estudiadas en el departamento de Medicina Interna del Hospital de Especialidades del Centro Médico La Raza.Métodos: fue un estudio comparativo de datos secundarios: los datos de la serie 1979-87, que fueron publicados por Frati et al. y los de la serie 2004-14, registrados en la base de datos de FOO del departamento de Medicina Interna. Se compararon datos demográficos, diagnósticos finales y pruebas diagnósticas utilizadas. Se describen mediana y amplitud para las variables numéricas y distribución de frecuencias para las variables nominales. El análisis bivariado se hizo con chi cuadrada o prueba de Fisher con los programas SPSS versión 17.0 para MAC y open epi versión 3.7.Resultados: se incluyeron 127 pacientes en la serie 1979-87, y 118 en la 2004-14. La serie más reciente tuvo menos casos ocasionados por infecciones, (p = 0.024), y más enfermedades inflamatorias no infecciosas (p = 0.0004). Se mantuvieron constantes las enfermedades neoplásicas y los casos con diagnóstico desconocido. Variaron poco las pruebas de laboratorio realizadas y su utilidad diagnóstica; en cambio los estudios de imagen fueron menos útiles en la serie 2004-14 (p = 0.00003). Las biopsias y la laparotomía fueron frecuentemente realizadas y útiles en ambas series.Conclusiones: En la última serie hubo más enfermedades inflamatorias no infecciosas a expensas de un menor número de infecciones. Los estudios invasivos siguen siendo necesarios.

Primary and secondary central nervous system vasculitis: clinical manifestations, laboratory findings, neuroimaging, and treatment analysis.

The objectives of this study are to compare the initial clinical, laboratory, and imaging features in primary central nervous system vasculitis (PCNSV) vs secondary central nervous system vasculitis (SCNSV) and follow up after treatment with intravenous cyclophosphamide (IV-CYC) plus glucocorticosteroids (GCS): methylprednisolone (MP). Neurological, laboratory, and neuroimaging findings were analyzed in PCNSV and SCNSV patients. Cerebral biopsy (CB) was performed in nine patients. Both groups received at onset MP plus IV-CYC for 6 months, followed by bimonthly IV-CYC plus prednisone (PND) for 12 months. All patients were followed during 36 months. Thirty patients were included (12 PCNSV and 18 SCNSV). Focal and non-focal neurological manifestations were similar in both groups, headache being the most frequent manifestation in both groups. Fatigue, myalgias, arthralgias, neuropathy, low leukocytes and platelets, elevated erythrocyte sedimentation rate, positive antinuclear antibodies (ANA), anti-double-stranded DNA (dsDNA), antineutrophil cytoplasmic antibodies (ANCA), low complement, and rheumatoid factor were more frequent in SCNSV (p < 0.05). In cerebrospinal fluid, pleocytosis and proteins were higher in PCNSV (p < 0.05). Periventricular and subcortical hyperintense lesions were observed in cranial magnetic resonance imaging in both vasculitides. Cerebral angiography and angioresonance showed narrowing of vasculature in all patients in both groups. CB showed gliosis and lymphocytic infiltration within and around the walls in four patients and granulomatous infiltration in the other patients. After treatment, the Kaplan-Meier survival curve showed a higher relapse-free survival in PCNSV (p < 0.05). Neurological manifestations and neuroimaging findings were similar in both groups of vasculitides, but general symptoms, joint, musculoskeletal, and peripheral neuropathy were preponderant in SCNSV. After treatment with IV-CYC and GCS, patients with PCNSV had a higher relapse-free survival than those with SCNSV.

Risk factors and correlates for anemia in HIV treatment-naïve infected patients: a cross-sectional analytical study.

BACKGROUND: Hematologic manifestations of the human immunodeficiency virus (HIV) infection are a well-recognized complication of the disease and may be clinically important. Our objective was to determine the risk factors for anemia and its correlation with HIV treatment-naïve infected patients without co-infection or opportunistic diseases. FINDINGS: We performed a cross-sectional comparative study in which HIV treatment-naïve infected patients with anemia were compared with a control group of HIV patients without anemia. The interrelationship between risk factors and anemia was determined. Odds ratio and 95% confidence intervals were calculated, to adjust for the effects of potential confounders and we used a logistic regression model. Pearson's correlation coefficient was obtained to calculate the correlation between risk factors and hemoglobin.We enrolled 54 men and 9 women. Anemia was found in 13 patients; prevalence .20 (CI 95% 0.12-0.32). Severe anemia was found in only one patient (1.5%). Only CD4+ Cells Count <200 cells/mm3 was associated with increased risk of anemia in the multivariate analysis. There was a moderately strong, positive correlation between WBC and hemoglobin (r = 0.49, P < 0.001) and between CD4+ cell count and hemoglobin (r = 0.595, P < 0.001) and a moderately strong, negative correlation between HIV RNA viral load and hemoglobin (r = - 0.433, P < 0.001). CONCLUSIONS: Anemia is a common manifestation in the Mexican population without antiretroviral therapy. In HIV naïve patients a CD4+ Cell Count < 200 cells/mm3 was associated with an increased risk of anemia. There is a positive correlation between hemoglobin and CD4+ cell count.