Association between Cannabis Use Disorder and Mental Health Disorders in the Adolescent Population: A Cohort Study.

INTRODUCTION: According to the literature, early initiation to cannabis use and a dependent pattern of use are important risk factors for the development of mental health disorders. However, there are few cohort studies which look at the development of mental health disorders associated with cannabis use among young people with cannabis use disorder (CUD). The aim of the study was to determine the cumulative incidence of mental health disorders and the risk of developing mental health disorders among minors who commenced treatment for CUD in Catalonia during 2015-2019. METHODS: This was a retrospective fixed cohort study, matched for confounding variables, based on data from the Catalan Health Surveillance System. The exposed cohort comprised young people who entered treatment for CUD during 2015-2019 (n = 948) and who were minors on the date of commencing treatment. Matching was done with a paired cohort (n = 4,737), according to confounding variables. Individuals with a diagnosis of a mental health disorder prior to the study period were excluded. The cumulative incidence was calculated for mental health disorders for the exposed and the paired cohorts and stratified by type of mental disorder. Incidence rate ratios were estimated using the conditional Poisson model with robust variance, stratified by sex. RESULTS: The cumulative incidence for development of a mental health disorder was 19.6% in the exposed cohort and 3.1% in the paired cohort; with higher incidence among females (females 32.7%; males 15.8%). The exposed cohort had an 8.7 times increased risk of developing a mental health disorder than the paired cohort. The most frequent diagnoses were reaction to severe stress, adjustment disorder, and personality disorders. CONCLUSION: This study confirmed that the exposed cohort was at increased risk of developing mental health disorders compared to the paired cohort. To date, few studies have analyzed the association between cannabis use and the development of mental health disorders, considering cannabis dependence. Further studies should be undertaken considering CUD. In addition, more studies are needed to understand the factors that determine the development of CUD. Further research in these areas would contribute to the design of prevention strategies aimed at those young individuals with a higher risk of developing cannabis dependence and suffering its consequences.

Evaluation of the new Abbott®Alinity assay for the measurement of thyroglobulin antibodies in patients with differentiated thyroid carcinoma.

BACKGROUND: Measurement of antithyroglobulin antibodies (TgAb) is important in patients with differentiated thyroid carcinoma (DTC) with total thyroidectomy. These patients are monitored based on serum thyroglobulin (Tg) levels. TgAb is known to interfere with the measurement of Tg by immunoassay. This study evaluates a new methodology for the measurement of TgAb Alinity Abbott® and the concordance with other methods (first and second generation Advia Centaur Systems Siemens® and Phadia 250 Thermofisher®). METHODS: The technical characteristics of Alinity TgAb measurement methodology were analysed, with imprecision and repeatable studies. In order to assess concordance, a minimum of 69 and a maximum of 76 samples from patients with DTC and total thyroidectomy were processed in parallel by several TgAb measurement methodologies. Agreement rates were determined using kappa statistics. The correlation between the four methods was examined pairwise using McNemar test analysis. RESULTS: The coefficients of variation (standard deviation as a percentage of the mean % CV) for the Alinity Abbott kit reagent TgAb were within 10% included the functional sensitivity. On the other hand, the concordance analysis with the kappa index concluded substantial agreement. The McNemar test showed a significant difference between Alinity versus Centaur second generation (difference 8.33%, CI 95% 0.68-8.33, p = .0313). CONCLUSION: The new methodology for the measurement of TgAb meets the imprecision standards while presenting an adequate concordance agreement with other methodologies available in laboratories. It is important to define the functional sensitivity when reporting results so that they are as reliable as possible.

Causes of hyperprolactinaemia in the primary care setting: How to optimise hyperprolactinaemia management.

BACKGROUND AND PURPOSE: To analyse the causes of hyperprolactinaemia in patients with symptoms compatible with hyperprolactinaemia evaluated in a primary care setting. PATIENTS AND METHODS: A retrospective study of all patients tested for serum prolactin levels between 2019 and 2020 in 20 primary care centres at the Hospital Ramón y Cajal in Madrid. Hyperprolactinaemia is defined as a serum prolactin>19.4ng/ml in men and >26.5ng/ml in women. Aetiology is grouped into physiological (pregnancy, lactation, inadequate venipuncture, macroprolactinaemia), pharmacological, pathological (hypothalamic and/or pituitary diseases, chronic renal failure, primary hypothyroidism), and idiopathic. RESULTS: In 1630 patients tested for serum prolactin, 30.7% (n=501) had hyperprolactinaemia. Of these 501 patients, 89.6% were females. 149 patients were referred to the Endocrinology Department and 164 to the Gynaecology Department. Aetiological diagnosis of hyperprolactinaemia was achieved in 411 out of 501 cases. The most frequent cause of hyperprolactinaemia was pharmacological, in 39.1%. The second more frequent cause was idiopathic (29%) and less common were inadequate venipuncture extraction (13.4%), tumour (8.5%) and macroprolactinaemia (3.9%). Patients with tumoural hyperprolactinaemia presented higher serum prolactin levels (87.0±80.19 vs 49.7±39.62ng/ml, P=0.010). In addition, symptoms, such as galactorrhoea (33.3% vs 16.5%, P=0.018), and headache (25.7% vs 13.3%, P=0.045), were more frequent than in patients of the other aetiological groups. CONCLUSION: Hyperprolactinaemia is common among patients evaluated in a primary care setting with symptoms of hyperprolactinaemia, but more than 50% of cases are due to pharmacological treatments or improper sample extraction. It is necessary to establish referral protocols to specialised medicine to optimise healthcare resources and avoid unnecessary studies.

A Multicenter Study on the Impact of Gender, Age, and Dual Diagnosis on Substance Consumption and Mental Health Status in Outpatients Treated for Substance Use Disorders During COVID-19 Lockdown.

Objective COVID-19 and lockdown measures impacted mental health globally and had a particular impact on patients with substance use disorders (SUD). However, the impact of gender, age, and dual diagnosis on consumption patterns and mental health during COVID-19 lockdown among patients with SUD has not been analyzed in depth. Therefore, this study aimed to examine substance use and mental health status during COVID-19 lockdown considering gender, age, and previous dual diagnosis in patients with SUD treated in different outpatient addiction clinics in Catalonia. Methods: Thirteen clinics participated and 588 patients were enrolled in the study, of whom 70.7% were men and 29.3% were women. The mean age was 48 ± 11.3 years, and 63.2% had dual diagnoses. Results: Men reported significantly more frequent alcohol and cocaine consumption during lockdown, while women experienced more anxiety and depressive symptoms. Younger patients more frequently reported consuming cocaine and cannabis, breaking the lockdown rule, worsened family relationships, and reduced incomes. Older patients more frequently reported maintaining abstinence. Previous dual diagnosis was more often associated with benzodiazepine use disorder, less active working during lockdown, and more anxiety and depressive symptoms than not having previous dual diagnosis. Conclusions: Both new psychiatric symptoms and general worsening of existing symptoms were frequent during the lockdown. Differences based on the gender, age, and dual diagnosis of outpatients treated for substance use disorders should be considered in the planning of protection measures such as home confinement.

COVID-19 Lockdown and Consumption Patterns among Substance Use Disorder Outpatients: A Multicentre Study.

INTRODUCTION: COVID-19 has had a great impact on mental health in the general population. However, few studies have focused on patients with substance use disorders (SUDs). This research aimed to compare the clinical status and substance use patterns of SUD outpatients, before and during confinement due to the COVID-19 pandemic. METHODS: This multicentre study recruited 588 patients (29.2% women; M age = 47.4 ± 11.7 years) in thirteen centres for addiction treatment in Catalonia, Spain. All subjects were evaluated with validated instruments and ad hoc questionnaires. The sample was divided into 3 groups according to how the substance consumption pattern changed during lockdown (maintained pattern, worsened pattern, and improved pattern). RESULTS: More than 62% of the patients maintained or worsened their consumption pattern during confinement, and about 38% improved throughout this time. Diverse factors were associated with the changes in pattern like age, addiction severity, psychological distress during lockdown, social and familial issues, and therapeutic variables. CONCLUSION: The home lockdown during the COVID-19 pandemic was associated with major implications for substance consumption and psychiatric distress among SUD outpatients. Considering this, the need to plan appropriate interventions in cases of similar health crises is highlighted.

Prevalence of vitamin D deficiency and association with parathyroid hormone.

Objectives: We evaluated the prevalence of 25-hydroxyvitamin D (25-(OH)D) deficiency in our setting according to season, sex, and age. We also studied the association with parathyroid hormone (PTH) levels. Methods: The study population comprised all patients with requests for assessment of 25-(OH)D between January 1 and December 31, 2018, as registered in the database of the laboratory information system. Major exclusion criteria were pediatric samples (<18 years) and factors affecting 25-(OH)D and/or PTH levels (i.e., kidney injury, liver disease, PTH disorders). Results: Among 33,601 patients (24,028 women, 9,573 men), the prevalence of 25-(OH)D deficiency was 48%. Prevalence was greater in males than in females (53% vs. 46%). By age group, deficiency was more prevalent in quartile 1 (Q1, 74-87 years) and less prevalent in quartile 2 (Q2, 60-73 years). By season, deficiency was greater in spring (nonsignificant differences with respect to winter) and lower in summer. The association between 25-(OH)D and PTH was assessed in 9,368 persons. Linear regression analysis showed a weak association (coefficient - 0.303). Multiple logistic regression analysis revealed a significant association between 25-(OH)D deficiency and increased PTH (Odds ratio (OR), 1.63). Other risk factors for increased PTH include female sex (OR, 1.27), season (winter, OR 1.63, spring OR 1.16), and age (quartile 1, OR, 3). Conclusions: The prevalence of 25-(OH)D deficiency differed according to sex, age, and season of the year. Furthermore, elevation of PTH is mainly influenced by low 25-(OH)D, female sex, season, and age.

Litiasis urinaria: epidemiología y clasificación del cálculo urinario / Urinary lithiasis: epidemiology and classification of urinary calculus / Urolitíase: epidemiologia e classificação dos cálculos renais

Se estima que la incidencia de cálculos renales en España se ha incrementado en los últimos años. En este trabajo se realizó una aproximación epidemiológica de la litiasis urinaria, y se estableció una clasificación de los cálculos urinarios analizados durante un año. Se ha creado una base de datos con los cálculos analizados mediante espectroscopía de infrarrojos con Transformada de Fourier, considerando edad, sexo, recidivas y parámetros bioquímicos, en orina de 24 horas. La influencia del sexo en la litiasis urinaria es muy marcada y el número de cálculos en el varón es muy superior. Además, el factor edad incrementa la litiasis desde 5% a los 30 años hasta 25% a los 60. Estos datos se refieren a los cálculos totales y no diferencian su composición química. Si se diferencian según la composición, se ha encontrado una tendencia similar en hombres y mujeres en los cálculos de oxalato cálcico monohidratado, pero muy distinta en los de oxalato cálcico dihidratado y fosfocarbonato cálcico. La incidencia en menores de 20 años es muy baja, y prevalece en los niños en la primera década y en las niñas en la segunda década de vida. Además, se ha observado una mayor prevalencia de cálculos en los meses de verano asociada a mayores valores séricos de vitamina D. Por lo tanto, es imprescindible partir de unos criterios taxativos de clasificación de los cálculos urinarios para la realización de estudios epidemiológicos. En los últimos años la proporción entre las diferentes composiciones ha cambiado y se ha producido un aumento en los cálculos de oxalato.

The incidence of renal calculus in Spain has been increased in recent years. In this work, an epidemiological approach of urinary lithiasis has been made, establishing a classification of the urinary calculi analyzed during a year. A database has been created with the analyzed calculi by Fourier Transform Infrared Spectroscopy, collecting age, sex, recurrences and biochemical parameters obtained from 24-hour urine. The influence of sex on urinary lithiasis is very marked and the number of stones in the male in much higher. In addition, the age factor increases lithiasis from 5% at 30 years of age to 25% at 60 years of age. These data refer to the total calculi, without differentiating their chemical composition. If differentiation is made according to the composition, a similar tendency is found in men and women in the monohydrate calcium oxalate calculi, but very different in those of dihydrate calcium oxalate and calcium phosphocarbonate. The incidence in children under 20 years of age is very low; males have more calculi in the first decade of life and girls in the second decade of life. In addition, a higher prevalence of stones has been observed in the summer months associated with higher serum levels of vitamin D. Thus, it is essential to stablish classification criteria of urinary calculi for epidemiological studies. In recent years, the ratio of the different compositions has changed, resulting in an increase of oxalate calculi.

Estima-se que a incidência de cálculos renais na Espanha tem aumentado nos últimos anos. Este trabalho foi realizado com uma abordagem epidemiológica da litíase urinária, estabelecendo uma classificação de cálculos urinários analisados durante um ano. Foi criado um banco de dados com os cálculos analisados por espectroscopia de infravermelho com Transformada de Fourier, considerando idade, gênero, recidivas e parâmetros bioquímicos na urina de 24 horas. A influência do gênero na litíase urinária é muito acentuada e o número de cálculos em homens é muito maior. Além disso, o fator idade aumenta a litíase de 5% aos 30 anos para 25% aos 60 anos. Estes dados referem-se os cálculos totais e não diferenciam sua composição química. Diferenciam-se de acordo com a composição, foi encontrada uma tendência semelhante em homens e mulheres nos cálculos de oxalato de cálcio mono-hidratado, mas muito diferente em oxalato de cálcio di-hidratado e fosfo-carbonato de cálcio. A incidência em pessoas menores de 20 anos é muito baixa, prevalecendo em meninos na primeira década e em meninas na segunda década de vida. Além disso, foi observada maior prevalência de cálculos nos meses de verão associada a maiores níveis séricos de vitamina D. Portanto, é essencial a partir de critérios taxativos de classificação dos cálculos urinários para realizar exames epidemiológicos. Nos últimos anos, a proporção entre as diferentes composições tem mudado, resultando num aumento dos cálculos de oxalato.

Diagnóstico diferencial del hiperaldosteronismo primario / Differential diagnosis of primary aldosteronism

El aldosteronismo primario se considera una de las causas más comunes de hipertensión secundaria. Los datos indican que puede ocurrir en hasta el 5-15% de los pacientes con hipertensión. Aunque esta enfermedad sigue siendo un reto diagnóstico considerable, el reconocimiento de la condición es crítica, debido a que la hipertensión asociada al aldosteronismo primario a menudo se puede curar con la intervención quirúrgica o médica adecuada. El diagnóstico se realiza en 3 etapas, que implican un cribado inicial, una confirmación del diagnóstico, y una clasificación del subtipo específico de aldosteronismo primario. Se describe el caso de un paciente con hipertensión resistente e hipopotasemia. La prueba inicial incluye la cuantificación de las concentraciones de aldosterona y actividad de renina en plasma. En nuestro laboratorio la medida de estos 2 parámetros se realizó por radioinmunoanálisis. En este caso, el paciente tenía elevado el cociente aldosterona/renina y la producción de aldosterona de forma autónoma se confirmó con una prueba de supresión con sobrecarga intravenosa de sodio. Una vez confirmado el aldosteronismo primario, se determinó el subtipo para guiar el tratamiento. La prueba inicial en la evaluación del subtipo es la tomografía axial computarizada (TAC) de las glándulas suprarrenales. Además, si se considera el tratamiento quirúrgico, el muestreo de la vena adrenal es el método más preciso para distinguir entre la producción de aldosterona adrenal unilateral o bilateral. En este caso se muestra como el laboratorio juega un papel fundamental en el diagnóstico del aldosteronismo primario, con el fin de lograr el tratamiento óptimo (AU)

Primary aldosteronism is considered one of the most common causes of secondary hypertension. Data indicate that it may occur in as many as 5-15% of patients with hypertension. Although it is still a considerable diagnostic challenge, recognising the condition is critical as primary aldosteronism associated hypertension can often be cured with the proper surgical or medical intervention. The diagnosis is generally 3-tiered, involving an initial screening, a confirmation of the diagnosis, and a determination of the specific subtype of primary aldosteronism. The case is described of a patient with resistant hypertension and hypokalaemia. The initial tests included the measurement of plasma aldosterone levels and plasma rennin activity, which is by Radioimmunoassay in our laboratory. In this case, the patient had an increased aldosterone/renin ratio, and the free aldosterone production was confirmed with an aldosterone suppression test (intravenous salt loading test). Once primary aldosteronism was confirmed, the subtype was determined to guide treatment. The initial test in subtype evaluation is computed axial tomography imaging (CAT) of the adrenal glands. Furthermore, if surgical treatment is considered, adrenal vein sampling is the most accurate method for distinguishing between unilateral and bilateral adrenal aldosterone production. In this case is shown as the laboratory plays a fundamental role in the diagnosis of primary aldosteronism, in order to achieve the optimal treatment (AU)

Valor de la punción-aspiración con aguja fina en el diagnóstico del cáncer mamario IOLR / The value of aspiration citology with fine needle in the diagnostic of breast neoplasms

La punción aspiración con aguja fina se ha convertido en un método fundamental en el diagnóstico del cáncer mamario, debido a las numerosas ventajas que ofrece ya que es un procedimiento simple, rápido, confiable, de bajo costo y con alta sensibilidad. Para evaluar de manera prospectiva, la eficacia de la misma frente a otros métodos de diagnóstico como son la citología por impronta y la biopsia extemporánea se estudiaron entre los meses de octubre de 1994 y julio de 1995, 46 pacientes que consultaron al servicio de patología mamaria del Instituto de Oncología "Luis Razetti", con diagnóstico clínico de carcinoma mamario. Se le practicó mamografía, citología por punción aspiración con aguja fina con reporte inmediato de los resultados y citología por impronta de la muestra para biopsia extemporánea. Los resultados citológicos obtenidos, fueron comparados con los de la biopsia extemporánea y el diagnóstico definitivo de anatomía patológica. La sensibilidad fué del 100 por ciento para todos los métodos. La especificidad para la biopsia extemporánea fué de 83,35 por ciento y 66,6 por ciento para la citología por impronta y 42,8 por ciento para la punción aspiración con aguja fina. El valor predictivo positivo para biopsia extemporánea fué de 96,5 por ciento, 93,7 por ciento para la citología por impronta y 90 por ciento para la punción aspiración. Junto al valor predictivo negativo fué de 100 por ciento para todos los métodos. En conclusión la punción aspiración con aguja fina es un método excelente con muy alta sensibilidad comparable a todos los métodos incluyendo la histología definitiva; pero que nuestra experiencia tiene una baja especificidad; en la actualidad no podemos tomar desiciones radicales o definitivas, solamente con el diagnóstico de la punción aspiración y seguimos ameritando de la biopsia extemporánea para definir la conducta terapéutica en carcinoma de mama

Evaluación de la citología en pesquisa de carcinoma del cervix / Evaluation of the cytology in searching of uterine cervix

La citología exfoliativa del cuello uterino, reforzada por estudios complementarios de tipo del test de Schiller, la Colposcopia y la Biopsia dirigida, continua formando parte importante en la pesquisa de lesiones malignas en grandes grupos de población, asintomática o no. La sencillez de su ejecución, lo inócuo y poco del procedimiento lo convierten en auxiliar invalorable. Haciendo hincapié en la importancia de los cuidados en la toma de la muestra y en la evaluación por personal con experiencia en su interpretación