The Mediterranean diet and micronutrient levels in depressive patients / Dieta mediterránea y niveles de micronutrientes en pacientes depresivos

Introduction: An inverse association between depression and some serum micronutrient levels (selenium, zinc, iron, magnesium, vitamin B and folic acid) has been reported. In addition, other studies reported that this micronutrient supplementation may improve depressed mood. The Mediterranean diet contains a sufficient amount of the micronutrients mentioned, although no study has reported an association between diet prescription and increased levels of them in depressive patients. Objective: To examine the impact of dietary patterns recommendations on micronutrient levels in depressive patients. Methods: 77 outpatients were randomly assigned either to the active (hygienic-dietary recommendations on diet, exercise, sleep, and sun exposure) or control group. Outcome measures were assessed before and after the six month intervention period. Results: Serum selenium and zinc levels were slightly low at basal point and serum selenium was inversely correlated with severity of depression (r=-0.233; p=0.041). A better outcome of depressive symptoms was found in the active group. Nevertheless, no significant differences in micronutrient levels were observed after the Mediterranean diet pattern prescription, probably due to an insufficient adherence. Conclusion: Selenium, zinc, iron, magnesium, vitamin B12 and folic acid serum levels didn`t increase in depressed patients after six months of the Mediterranean diet pattern prescription (AU)

Introducción: Se ha comunicado una correlación inversa entre depresión y el nivel sérico de algunos micronutrientes (selenio, zinc, hierro, magnesio, vitamina B y ácido fólico). Además, otros estudios han señalado que la suplementar de estos micronutrientes puede mejorar la depresión. La dieta mediterránea proporciona una suficiente cantidad de los micronutrientes mencionados, aunque ningún estudio ha probado si la prescripción de dicha dieta puede incrementar los niveles de micronutrientes en pacientes depresivos. Objetivo: Examinar el impacto de recomendar un patrón dietético mediterráneo en los niveles de micronutrientes de pacientes deprimidos. Material y Métodos: 77 pacientes ambulatorios se aleatorizaron entre un grupo de intervención (recomendaciones higiénico-dietéticas sobre dieta, ejercicio, sueño y exposición solar) y un grupo control. La evolución fue evaluada antes y después de los seis meses del periodo de intervención. Resultados: Los niveles de selenio y de zinc fueron ligeramente bajos en la determinación basal y el nivel de selenio correlacionaba inversamente con la severidad de la depresión (r=-0.233; p=0.041). El grupo activo evolucionó mejor de la clínica depresiva. Sin embargo, no se observaron diferencias significativas en los niveles de micronutrientes después de la prescripción del patrón de dieta mediterránea probablemente a causa de una insuficiente adherencia. Conclusión: Los niveles séricos de selenio, zinc, hierro, magnesio vitamina B12 y ácido fólico no aumentaron en pacientes depresivos seis meses después de prescribir un patrón de dieta mediterránea (AU)

The Mediterranean diet and micronutrient levels in depressive patients.

INTRODUCTION: An inverse association between depression and some serum micronutrient levels (selenium, zinc, iron, magnesium, vitamin B and folic acid) has been reported. In addition, other studies reported that this micronutrient supplementation may improve depressed mood. The Mediterranean diet contains a sufficient amount of the micronutrients mentioned, although no study has reported an association between diet prescription and increased levels of them in depressive patients. OBJECTIVE: To examine the impact of dietary patterns recommendations on micronutrient levels in depressive patients. METHODS: 77 outpatients were randomly assigned either to the active (hygienic-dietary recommendations on diet, exercise, sleep, and sun exposure) or control group. Outcome measures were assessed before and after the six month intervention period. RESULTS: Serum selenium and zinc levels were slightly low at basal point and serum selenium was inversely correlated with severity of depression (r=-0.233; p=0.041). A better outcome of depressive symptoms was found in the active group. Nevertheless, no significant differences in micronutrient levels were observed after the Mediterranean diet pattern prescription, probably due to an insufficient adherence. CONCLUSION: Selenium, zinc, iron, magnesium, vitamin B12 and folic acid serum levels didn`t increase in depressed patients after six months of the Mediterranean diet pattern prescription.

Introducción: Se ha comunicado una correlación inversa entre depresión y el nivel sérico de algunos micronutrientes (selenio, zinc, hierro, magnesio, vitamina B y acido fólico). Además, otros estudios han señalado que la suplementar de estos micronutrientes puede mejorar la depresión. La dieta mediterránea proporciona una suficiente cantidad de los micronutrientes mencionados, aunque ningún estudio ha probado si la prescripción de dicha dieta puede incrementar los niveles de micronutrientes en pacientes depresivos. Objetivo: Examinar el impacto de recomendar un patrón dietético mediterráneo en los niveles de micronutrientes de pacientes deprimidos. Material y Métodos: 77 pacientes ambulatorios se aleatorizaron entre un grupo de intervención (recomendaciones higiénico-dietéticas sobre dieta, ejercicio, sueño y exposición solar) y un grupo control. La evolución fue evaluada antes y después de los seis meses del periodo de intervención. Resultados: Los niveles de selenio y de zinc fueron ligeramente bajos en la determinación basal y el nivel de selenio correlacionaba inversamente con la severidad de la depresión (r=-0.233; p=0.041). El grupo activo evolucionó mejor de la clínica depresiva. Sin embargo, no se observaron diferencias significativas en los niveles de micronutrientes después de la prescripción del patrón de dieta mediterránea probablemente a causa de una insuficiente adherencia. Conclusión: Los niveles séricos de selenio, zinc, hierro, magnesio vitamina B12 y acido fólico no aumentaron en pacientes depresivos seis meses después de prescribir un patrón de dieta mediterránea.

Genetic diversity of clinical Pseudomonas aeruginosa isolates in a public hospital in Spain.

BACKGROUND: Pseudomonas aeruginosa is an important nosocomial pathogen that exhibits multiple resistances to antibiotics with increasing frequency, making patient treatment more difficult. The aim of the study is to ascertain the population structure of this clinical pathogen in the Hospital Son Llàtzer, Spain. RESULTS: A significant set (56) of randomly selected clinical P. aeruginosa isolates, including multidrug and non-multidrug resistant isolates, were assigned to sequence types (STs) and compared them with their antibiotic susceptibility profile classified as follows: extensively drug resistant (XDR), multidrug resistant (MDR) and non-multidrug resistant (non-MDR). The genetic diversity was assessed by applying the multilocus sequence typing (MLST) scheme developed by Curran and collaborators, and by the phylogenetic analysis of a concatenated tree. The analysis of seven loci, acsA, aroE, guaA, mutL, nuoD, ppsA and trpE, demonstrated that the prevalent STs were ST-175, ST-235 and ST-253. The majority of the XDR and MDR isolates were included in ST-175 and ST-235. ST-253 is the third in frequency and included non-MDR isolates. The 26 singleton sequence types corresponded mainly to non-MDR isolates. Twenty-two isolates corresponded to new sequence types (not previously defined) of which 12 isolates were non-MDR and 10 isolates were MDR or XDR. CONCLUSIONS: The population structure of clinical P. aeruginosa present in our hospital indicates the coexistence of nonresistant and resistant isolates with the same sequence type. The multiresistant isolates studied are grouped in the prevalent sequence types found in other Spanish hospitals and at the international level, and the susceptible isolates correspond mainly to singleton sequence types.

Cost analysis of HIV treatment and drug-related adverse events when fixed-dose combinations of antiretrovirals (FDCs) were stopped, versus continuation with FDCs.

BACKGROUND: The lower sales price of generic lamivudine has caused healthcare administrators to consider abolishing fixed-dose antiretroviral combinations (FDCs) that contain lamivudine and emtricitabine. The alternative is to administer the individual components of the FDCs separately, thus incorporating the new generic lamivudine medication. METHODS: The Balearic Islands Health Service ordered the discontinuation of the treatment with FDCs in July 2010, but FDCs were reintroduced in August 2010. At that point, an independent, retrospective cost analysis was performed by Son Llàtzer Hospital. A total of 75 patients who were treated from July to August 2010 underwent replacement of their FDC treatment with the individual components. Additionally, 150 patients who continued using FDCs were randomly selected. For both patient groups, the antiretroviral therapy that was administered and the costs associated with management of adverse events were recorded. The study period used for the cost calculations was the average number of days that patients used separate components of FDCs (120 days). An alternative analysis was performed to consider the costs of the extra follow-up visit (consultation and clinical tests) that was required for patients who changed their antiretroviral therapy. RESULTS: Considering antiretroviral therapies and adverse events, the administration of the separate components increased the total daily cost by 0.72 € per patient compared to treatment with FDCs. When the cost of an extra follow-up visit was considered, the daily cost increased by 3.61 € per patient. CONCLUSIONS: Our study suggests that the discontinuation of FDC treatment and the replacement with the administration of separate antiretroviral agents could lead to an increase in healthcare costs due to the higher rate of adverse events that was observed with the discontinuation of FDCs.

Diseminación nosocomial de Staphylococcus hominis resistente al linezolid en dos hospitales de Mallorca / Nosocomial spread of linezolid-resistant Staphylococcus hominis intwohospitals in Majorca

Introducción A partir del 2008 se detectaron varios aislados de Staphylococcus hominis (S. hominis) multirresistentes, incluyendo resistencia al linezolid y a la teicoplanina, en pacientes ingresados en dos hospitales de Mallorca. Por ello, se inició un estudio para determinar la epidemiología molecular y el mecanismo de resistencia al linezolid. Métodos El estudio de epidemiología molecular se realizó mediante electroforesis en campo pulsado (ECP), tras digestión con ApaI. Se efectuó amplificación de un fragmento de los genes ARNr 23S (con secuenciación posterior) y cfr. Resultados Desde marzo de 2008 hasta febrero de 2009 se detectaron 15 aislados de S. hominis resistentes al linezolid y a la teicoplanina, procedentes de 14 pacientes. Todos ellos excepto uno habían ingresado en las Unidades de Cuidados Intensivos de alguno de los dos hospitales. La mayoría de los aislados (9) se obtuvieron en hemocultivos. Gran parte de los pacientes infectados (12 de los 15 episodios infecciosos, el 80,0%) recibieron pautas de linezolid antes de la detección del aislado resistente. La ECP reveló la presencia de un único clon entre los aislados de S. hominis resistentes al linezolid. Se detectó la mutación G2576T en todas las cepas resistentes, mientras que la PCR del gen cfr fue negativa en las mismas. Todos los aislados fueron también resistentes a la penicilina, oxacilina, trimetoprim-sulfametoxazol, ciprofloxacino, levofloxacino y tobramicina; y sensibles a la eritromicina, tetraciclina, gentamicina y daptomicina. La CMI a la vancomicina fue de 4μg/ml en todos ellos. Conclusiones La detección de cepas de estafilococos resistentes al linezolid resalta la necesidad de racionalizar el uso del linezolid y mantener un control activo de dicha resistencia con objeto de preservar la utilidad clínica de este antimicrobiano (AU)

Objective: Since March 2008, several linezolid and teicoplanin-resistant Staphylococcus hominis (S. hominis)isolates have been recovered from patients admitted to the two major hospitals on the island of Majorca, Spain. For this reason, a study was conducted to determine the molecular epidemiology of these isolates and the mechanism of linezolid resistance. Methods: The molecular epidemiology study was performed by pulsed-field gel electrophoresis (PFGE)analysis, after digestion with ApaI. Linezolid resistance mechanisms were evaluated by PCR amplification of a fragment of the domain V of the 23S rRNA gene (followed by sequencing) and cfr gene. Results: From March 2008 to February 2009, 15 linezolid and teicoplan in-resistant S. hominis isolates were recovered from 14 patients. All of them, except one, were hospitalised in the intensive care units of either of the two institutions. Isolates were obtained mainly from blood cultures (9). The majority of infected patients (12 of 15 infectious episodes, 80.0%) had received courses of linezolid prior to detection of the resistant isolate. PFGE analysis revealed the presence of a unique clone among linezolid resistant S. hominisisolates. The G2576T mutation was detected in all the linezolid resistant strains. None of the resistant isolates showed a positive PCR for the cfr gene. All of the isolates were also resistant to penicillin, oxacillin, trimethoprim-sulfamethoxazole, ciprofloxacin, levofloxacin, and tobramicin; whereas all of them were susceptible to erythromycin, tetracycline, gentamicin, and daptomycin. The MIC of vancomycin was4 g/ml for all the strains. Conclusions: The detection of linezolid resistant Staphylococci highlights the need to rationalise the use of linezolid, and maintain an active surveillance of its resistance to preserve the clinical usefulness of this antimicrobial (AU)

Neumonía neumocócica en la era de la vacuna conjugada heptavalente / Pneumococcal pneumonia in the era of heptavalent pneumococcal conjugate

Introducción: Describir las características clínicas, las complicaciones, los serotipos y las resistencias antibióticas en la neumonía neumocócica en nuestro medio tras la generalización de la vacuna conjugada heptavalente (VNC-7) en pediatría. Material y métodos: Estudio prospectivo de los episodios de neumonía neumocócica, con cultivos positivos, en pacientes atendidos en urgencias desde enero de 2006 hasta febrero de 2010.Resultados: Se estudiaron 346 episodios en 320 pacientes; 335 correspondían a 309 pacientes adultos,221 (71,5%) varones, mediana de edad 68 años (rango: 16-94) y 11 episodios a pacientes < 15 años. Fueron de adquisición comunitaria 237 episodios (68,5%). Presentaron bacteriemia 130 (37,6%) casos, evidenciando una tendencia al aumento de riesgo en los pacientes < 65 años (OR = 1,56; IC del 95%, 0,96-2,56;p = 0,07). Desarrollaron empiema 13 (3,8%) y shock séptico 33 (9,5%). La media de edad de los pacientes con empiema fue menor (p = 0,03). En el análisis multivariante se relacionaron con la presencia de bacteriemia: antecedente de patología respiratoria = (..) (AU)

Introduction: To describe clinical features, complications, serotypes and antibiotic resistance in pneumococcal pneumonia in our environment after the generalization of the heptavalent conjugate vaccine(PCV-7) in paediatrics. Material and methods: Prospective study of episodes of pneumococcal pneumonia, with positive cultures in patients treated in the emergency department from January 2006 to February 2010.Results: We studied 346 episodes in 320 patients, 335 belonged to 309 adult patients, 221 (71.5%) males, median age 68 years (range 16-94), and 11 episodes to patients < 15 years. Two-hundred and thirty-seven (68.5%) episodes were community acquired. Bacteraemia was present in 130 (37.6%) cases, with a tendency towards an increased risk in patients < 65 years (OR = 1.56, 95% CI 0.96- 2.56, P = .07). Thirteen (3.8%) patients developed empyema and 33 (9.5%) septic shock. The mean age of patients with empyema was lower (P = .03). In the multivariate analysis were related to the presence of bacteraemia: a history of chronic respiratory disease (OR = 0.45, 95% CI 0.25-0.81, P = .008), positive urinary antigen (OR 2.02,95% CI 1 13-3.62, P = .01) and pleural effusion (OR = 3.86, 95% CI 1.79-8.35, P = .001). Shock was associated with Fine IV-V stage (OR = 23.6, 95% CI 4.96-112.82, P < .001), age < 65 years (OR = 4.47, 95% CI 1.75-11.39,P = .002) and pleural effusion (OR = 4.15, 95% CI 1.65 to 10.41, P = .002).Increased mortality risk was associated with presence of any complication (OR = 6.6, 95% CI 1.5-27.2,P = .009) and specifically septic shock (OR = 3.3, 95% CI 1.06-10.3, P = .04). Most serotypes obtained were not included in the VNC-7.Conclusions: Pneumococcal pneumonia after generalisation of PCV-7 is mainly related to non-vaccine serotypes. Younger patients without respiratory disease are at increased risk of bacteraemia, empyema, and septic shock, the latter being associated with a higher mortality (AU)

[Nosocomial spread of linezolid-resistant Staphylococcus hominis in two hospitals in Majorca]. / Diseminación nosocomial de Staphylococcus hominis resistente al linezolid en dos hospitales de Mallorca.

OBJECTIVE: Since March 2008, several linezolid and teicoplanin-resistant Staphylococcus hominis (S. hominis) isolates have been recovered from patients admitted to the two major hospitals on the island of Majorca, Spain. For this reason, a study was conducted to determine the molecular epidemiology of these isolates and the mechanism of linezolid resistance. METHODS: The molecular epidemiology study was performed by pulsed-field gel electrophoresis (PFGE) analysis, after digestion with ApaI. Linezolid resistance mechanisms were evaluated by PCR amplification of a fragment of the domain V of the 23S rRNA gene (followed by sequencing) and cfr gene. RESULTS: From March 2008 to February 2009, 15 linezolid and teicoplanin-resistant S. hominis isolates were recovered from 14 patients. All of them, except one, were hospitalised in the intensive care units of either of the two institutions. Isolates were obtained mainly from blood cultures (9). The majority of infected patients (12 of 15 infectious episodes, 80.0%) had received courses of linezolid prior to detection of the resistant isolate. PFGE analysis revealed the presence of a unique clone among linezolid resistant S. hominis isolates. The G2576T mutation was detected in all the linezolid resistant strains. None of the resistant isolates showed a positive PCR for the cfr gene. All of the isolates were also resistant to penicillin, oxacillin, trimethoprim-sulfamethoxazole, ciprofloxacin, levofloxacin, and tobramicin; whereas all of them were susceptible to erythromycin, tetracycline, gentamicin, and daptomycin. The MIC of vancomycin was 4µg/ml for all the strains. CONCLUSIONS: The detection of linezolid resistant Staphylococci highlights the need to rationalise the use of linezolid, and maintain an active surveillance of its resistance to preserve the clinical usefulness of this antimicrobial.

[Pneumococcal pneumonia in the era of heptavalent pneumococcal conjugate vaccine]. / Neumonía neumocócica en la era de la vacuna conjugada heptavalente.

INTRODUCTION: To describe clinical features, complications, serotypes and antibiotic resistance in pneumococcal pneumonia in our environment after the generalization of the heptavalent conjugate vaccine (PCV-7) in paediatrics. MATERIAL AND METHODS: Prospective study of episodes of pneumococcal pneumonia, with positive cultures in patients treated in the emergency department from January 2006 to February 2010. RESULTS: We studied 346 episodes in 320 patients, 335 belonged to 309 adult patients, 221 (71.5%) males, median age 68 years (range 16-94), and 11 episodes to patients<15 years. Two-hundred and thirty seven (68.5%) episodes were community acquired. Bacteraemia was present in 130 (37.6%) cases, with a tendency towards an increased risk in patients < 65 years (OR=1.56, 95% CI 0.96- 2.56, P=.07). Thirteen (3.8%) patients developed empyema and 33 (9.5%) septic shock. The mean age of patients with empyema was lower (P=.03). In the multivariate analysis were related to the presence of bacteraemia: a history of chronic respiratory disease (OR=0.45, 95% CI 0.25-0.81, P=.008), positive urinary antigen (OR 2.02, 95% CI 1 13-3.62, P=.01) and pleural effusion (OR=3.86, 95% CI 1.79-8.35, P=.001). Shock was associated with Fine IV-V stage (OR=23.6, 95% CI 4.96-112.82, P<.001), age < 65 years (OR=4.47, 95% CI 1.75-11.39, P=.002) and pleural effusion (OR=4.15, 95% CI 1.65 to 10.41, P=.002). Increased mortality risk was associated with presence of any complication (OR=6.6, 95% CI 1.5-27.2, P=.009) and specifically septic shock (OR=3.3, 95% CI 1.06-10.3, P=.04). Most serotypes obtained were not included in the VNC-7. CONCLUSIONS: Pneumococcal pneumonia after generalisation of PCV-7 is mainly related to non-vaccine serotypes. Younger patients without respiratory disease are at increased risk of bacteraemia, empyema, and septic shock, the latter being associated with a higher mortality.

Bacteriemia por anaerobios estrictos: estudio de 68 pacientes / Anaerobic bloodstream infections: Study of 68 episodes

Introducción Existe controversia en la literatura médica sobre la bacteriemia por anaerobios: algunos autores detectaron en las últimas décadas un aumento de su incidencia, y otros, una franca disminución, e incluso se ha propuesto el no hacer de forma habitual hemocultivos para anaerobios. Presentamos un análisis prospectivo de los casos de bacteriemia por anaerobios diagnosticados en nuestro centro entre enero de 2003 y mayo de 2008.ResultadosSe identificaron 68 pacientes con bacteriemia verdadera por anaerobios estrictos. La edad media fue de 64±19 años. La mayoría (63,2%) tenía al menos una comorbilidad, en el 20,6% de los casos fue una neoplasia sólida frecuentemente relacionada con el tracto digestivo. El foco principal de la bacteriemia fue abdominal (42,6%). Los gérmenes más frecuentemente aislados fueron diversas especies del grupo Bacteroides fragilis (36,7%), Clostridium spp. (17,6%), Peptostreptococcus spp. (16,1%) y Prevotella spp. (16,1%). El tratamiento antibiótico empírico más utilizado fue un carbapenémico en el 35,3% de los casos y se utilizó biterapia en el 30,9%. En la mayoría de los casos el tratamiento antibiótico empírico fue adecuado. La mortalidad bruta fue del 23,5% y directamente relacionada con la bacteriemia (9,2%). La presencia de sepsis, shock séptico o un score de Pitt mayor de 4 fueron predictores de mortalidad. Conclusiones La incidencia de bacteriemia por anaerobios en nuestro centro se cifra en 0,89 casos/1.000 ingresos hospitalarios. Los pacientes de mayor riesgo son los ancianos con diferentes comorbilidades o con procesos oncológicos; la mortalidad fue elevada (AU)

Introduction There is some controversy regarding the current rates of anaerobic bacteremia. Some authors have described an increasing incidence in recent years, whereas others report declining rates. There is even debate over whether to routinely perform anaerobic blood cultures. We present a prospective analysis of anaerobic bloodstream infections diagnosed at our medical center from January 2003 to May 2008.ResultsSixty-eight patients had bloodstream infection caused exclusively by anaerobic bacteria. Median age was 64±19 years and 63.2% had at least one comorbid condition, including 20.6% with a solid neoplasm, often related to the gastrointestinal tract. The main focus of anaerobic bacteremia was the abdomen (42.6%). The most common isolates were several species from the Bacteroides fragilis group (36.7%), Clostridium spp. (17.6%), Peptostreptococcus spp. (16.1%), and Prevotella spp. (16.1%). Empirical antimicrobial treatment was adequate in 69.1%. Overall mortality was 23.5%, and bacteremia-related mortality was 9.2%. Sepsis, septic shock, and a Pitt score >4 were independent predictors of mortality. Conclusions The incidence of anaerobic bacteremia in our hospital was 0.89 cases per 1000 hospital admissions. Patients at high risk were elderly persons with associated underlying diseases including malignant disease. Mortality was high (AU)

[Anaerobic bloodstream infections: study of 68 episodes]. / Bacteriemia por anaerobios estrictos: estudio de 68 pacientes.

INTRODUCTION: There is some controversy regarding the current rates of anaerobic bacteremia. Some authors have described an increasing incidence in recent years, whereas others report declining rates. There is even debate over whether to routinely perform anaerobic blood cultures. We present a prospective analysis of anaerobic bloodstream infections diagnosed at our medical center from January 2003 to May 2008. RESULTS: Sixty-eight patients had bloodstream infection caused exclusively by anaerobic bacteria. Median age was 64+/-19 years and 63.2% had at least one comorbid condition, including 20.6% with a solid neoplasm, often related to the gastrointestinal tract. The main focus of anaerobic bacteremia was the abdomen (42.6%). The most common isolates were several species from the Bacteroides fragilis group (36.7%), Clostridium spp. (17.6%), Peptostreptococcus spp. (16.1%), and Prevotella spp. (16.1%). Empirical antimicrobial treatment was adequate in 69.1%. Overall mortality was 23.5%, and bacteremia-related mortality was 9.2%. Sepsis, septic shock, and a Pitt score >4 were independent predictors of mortality. CONCLUSIONS: The incidence of anaerobic bacteremia in our hospital was 0.89 cases per 1000 hospital admissions. Patients at high risk were elderly persons with associated underlying diseases including malignant disease. Mortality was high.

Low-frequency transcranial magnetic stimulation in patients with fibromyalgia and major depression.

OBJECTIVE: To study the efficacy of low-frequency transcranial magnetic stimulation in patients with fibromyalgia and major depression. DESIGN: Twenty-eight patients were randomly assigned to receive 20 sessions of real or sham transcranial magnetic stimulation of the right dorsolateral prefrontal cortex. The main stimulation parameters were 15 trains at 110% of the motor threshold for 60 seconds at a frequency of 1 Hz. Blinded external evaluators administered the fibromyalgia scales (FibroFatigue, Likert pain) and the depression scales (Hamilton Depression Rating Scale, Clinical Global Impression) during the study. RESULTS: Both treatment groups (real and sham) improved their scores in some of the scales (FibroFatigue and Clinical Global Impression), although there were no differences between them. No improvements were observed in the Likert Pain Scale in either of the groups. CONCLUSION: With the methodology used in this study, patients with fibromyalgia and major depression who received real magnetic stimulation did not present significant differences in symptoms with respect to those who received sham magnetic stimulation.

[Bacteremia in very elderly patients: risk factors, clinical characteristics and mortality]. / Bacteriemia en pacientes muy ancianos: factores de riesgo, características clínicas y mortalidad.

INTRODUCTION: There is little information on bacteremia in very elderly patients. This study describes the characteristics of bacteremia in this population. METHODS: This is a prospective study investigating bacteremia episodes in patients over 80 years old in comparison with episodes in patients aged 18-64 and 65-79 years. RESULTS: A total of 146 bacteremia episodes were analyzed in patients over 80 years old. Comorbidity was documented in 66.4% and immunodeficiency in 6.8% of patients. Among the total, 82.2% had no underlying disease or a disease considered non-fatal. Eighty episodes were community-acquired. The main infectious foci included primary (25.3%) and urinary tract (20.5%) infection, and the most frequent isolates were Escherichia coli (28.2%), coagulase-negative Staphylococcus (14.7%) and S. aureus (13.6%). Sepsis or septic shock occurred in 55.5% of the cases, and 31 patients died due to a bacteremia-related cause. Immunodeficiency was less frequent in patients over 80 years old, but they had a higher proportion of community-acquired infections and gram-negative infections. Bacteremia-related mortality was highest in the oldest group of patients and was associated with a fatal or ultimately fatal underlying disease, S. aureus infection, and inappropriate empirical antibiotic treatment. A lower Pitt severity score was related to lower mortality risk. CONCLUSIONS: Very elderly bacteremic patients showed a lower frequency of immunodeficiency, a higher percentage of community-acquired and gram-negative infections. Bacteremia-related mortality was greater in the most elderly group and was associated with fatal or ultimately fatal underlying disease, S. aureus infection and initiation of inappropriate empirical antibiotic treatment.

Bacteriemia en pacientes muy ancianos: factores de riesgo, características clínicas y mortalidad / Bacteremia in very elderly patients: risk factors, clinical characteristics and mortality

Introducción. Existe poca información sobre bacteriemias en pacientes muy ancianos. El objetivo del trabajo fue describir las características de éstas en esta población. Métodos. Estudio prospectivo de las bacteriemias en pacientes mayores de 80 años y comparación con pacientes de 18-64 y de 65-79 años. Resultados. Se analizaron 146 bacteriemias en pacientes mayores de 80 años. En el 66,4% hubo alguna comorbilidad y en el 6,8%, alguna causa de inmunodeficiencia. El 82,2% no tenía enfermedad de base o ésta no fue fatal. El origen fue comunitario en 80 casos. Los principales focos fueron: primario (25,3%) y urinario (20,5%); y los aislamientos más frecuentes: Escherichia coli (28,2%), Staphylococcus coagulasa negativos (14,7%) y Staphylococcus aureus (13,6%). Presentaron sepsis o shock séptico el 55,5%, y fallecieron 31 en relación con la bacteriemia. Los pacientes mayores de 80 años tuvieron menos frecuencia de inmunodeficiencia y mayor proporción de infecciones comunitarias y por gramnegativos. La mortalidad relacionada con la bacteriemia fue mayor en el grupo de más edad y se asoció con la presencia de una enfermedad de base fatal o finalmente fatal, la bacteriemia por S. aureus y con el inicio de un tratamiento empírico inapropiado. Un índice de gravedad de Pitt más bajo se mostró como una variable protectora. Conclusiones. Los pacientes muy ancianos con bacteriemia tienden a presentar menos causas de inmunodeficiencia, mayor frecuencia de infecciones comunitarias y por gérmenes gramnegativos. Existe mayor riesgo de mortalidad relacionada, sobre todo en presencia de enfermedad de base, bacteriemia por S. aureus o tras un tratamiento empírico inapropiado (AU)

Introduction. There is little information on bacteremia in very elderly patients. This study describes the characteristics of bacteremia in this population. Methods. This is a prospective study investigating bacteremia episodes in patients over 80 years old in comparison with episodes in patients aged 18-64 and 65-79 years. Results. A total of 146 bacteremia episodes were analyzed in patients over 80 years old. Comorbidity was documented in 66.4% and immunodeficiency in 6.8% of patients. Among the total, 82.2% had no underlying disease or a disease considered non-fatal. Eighty episodes were community-acquired. The main infectious foci included primary (25.3%) and urinary tract (20.5%) infection, and the most frequent isolates were Escherichia coli (28.2%), coagulase-negative Staphylococcus (14.7%) and S. aureus (13.6%). Sepsis or septic shock occurred in 55.5% of the cases, and 31 patients died due to a bacteremia-related cause. Immunodeficiency was less frequent in patients over 80 years old, but they had a higher proportion of community-acquired infections and gram-negative infections. Bacteremia-related mortality was highest in the oldest group of patients and was associated with a fatal or ultimately fatal underlying disease, S. aureus infection, and inappropriate empirical antibiotic treatment. A lower Pitt severity score was related to lower mortality risk. Conclusions. Very elderly bacteremic patients showed a lower frequency of immunodeficiency, a higher percentage of community-acquired and gram-negative infections. Bacteremia-related mortality was greater in the most elderly group and was associated with fatal or ultimately fatal underlying disease, S. aureus infection and initiation of inappropriate empirical antibiotic treatment (AU)

Prevention of osteoporosis: four-year follow-up of a cohort of postmenopausal women treated with an ossein-hydroxyapatite compound.

BACKGROUND: The long-term effects of ossein-hydroxyapatite compound (OHC), a drug used for osteoporosis prevention, have not been previously reported. The aim of this study was to assess the long-term efficacy of OHC in postmenopausal women with bone mineral density (BMD) in the osteopenia range. METHODS: We performed a retrospective 4-year follow-up study in a primary-care setting to assess changes in BMD in a cohort of 112 postmenopausal women included in an osteoporosis programme that included health and dietary advice and who were treated with OHC 1660mg every 12 hours. BMD was measured annually in the distal part of the forearm, with T- and Z-score values being calculated for trabecular and total bone. RESULTS: A progressive and statistically significant increase in BMD was observed in trabecular and total T- and Z-score mean values. At baseline, mean +/- SD trabecular T- and Z-scores were -1.27 +/- 0.7 and -1.03 +/- 0.7, respectively, and -0.86 +/- 0.7 and -0.62 +/- 0.7, respectively, at the end of the 4-year follow-up period (both p < 0.0001). Mild constipation was observed in 3.2% of patients during the follow-up period. CONCLUSION: Ossein-hydroxyapatite compound could be an effective and safe agent for the prevention of bone loss in postmenopausal osteopenic women, with significant increases in BMD being observed in this group of patients.

Uso de antidepresivos en pacientes diagnosticados de trastorno depresivo mayor y trastorno adaptativo / Use of antidepressants in major depression versus adjustment disorder

Introducción: En los últimos años ha aumentado mucho el uso de antidepresivos, incluso en enfermedades con una indicación poco clara, como los trastornos adaptativos. En España se ha incrementado en un 247% entre 1985 y 1994. En la mayoría de los estudios consultados se observa un incremento del uso de inhibidores selectivos de la recaptación de serotonina a expensas fundamentalmente de los inhibidores de la monoaminooxidasa y los heterocíclicos. Aunque el uso de los antidepresivos está muy extendido, hay pocos estudios centrados en el tratamiento psicofarmacológico en la depresión menor o en el trastorno adaptativo. Es importante el balance riesgo/beneficio de éste, sobre todo por los posibles efectos nocivos a largo plazo. En los trastornos depresivos menores, incluidos los adaptativos, se ha preconizado el tratamiento psicoterapéutico. El pronóstico en estos casos no es tan favorable como parecería: alrededor del 25% desarrolla una forma de depresión más grave. Hay pocas evidencias con antidepresivos, pero parecen mostrar resultados prometedores en el tratamiento a corto-medio plazo. Material y métodos: Estudiamos el uso de antidepresivos en nuestra población en 2 grupos, uno de 91 pacientes con diagnóstico de trastorno depresivo mayor (TDM) y otro de 81 con diagnóstico de trastorno adaptativo (TA). Resultados: Detectamos datos de mejor cumplimiento en los pacientes deprimidos: el 54,5% dice no olvidar nunca el tratamiento, frente al 39,7% de los pacientes con trastorno adaptativo. La adaptación laboral es menor en el grupo de TDM, pero los pacientes con TA tienden a vivir menos con compañía. En el TDM hay antecedentes de más episodios previos. Conclusiones: Los pacientes con trastorno depresivo mayor y con trastorno adaptativo reciben un tratamiento antidepresivo similar, aunque en el primer grupo hay tendencia a ser más "agresivo"

Introduction: In the last few years, the use of antidepressants has risen substantially and has been extended to disorders in which their suitability is unclear, such as adjustment disorders. In Spain, the consumption of antidepressants increased by 247% between 1985 and 1994. Most of the studies consulted show a greater use of selective serotonin reuptake inhibitors, mainly at the expense of monoamine oxidase inhibitors and heterocyclics. Despite the widespread use of antidepressants, few studies have investigated the pharmacological treatment of minor depression or adjustment disorder (AD). The risk-benefit balance of this therapy is important, especially because of the potential harmful effects in the long term. In minor depressive disorders, including AD, psychotherapeutic treatment has been recommended. The prognosis in these patients is not as favorable as it would appear: around 25% of patients develop a more severe form of depression. There is little evidence on antidepressant agents, but these drugs appear to show promising results in short- to medium-term treatment. Material and methods: We compared the use of antidepressants in 2 groups of patients: one group (n = 91) with a diagnosis of major depression (MDD) and another (n = 81) with a diagnosis of AD. Results: Compliance was better in patients with MDD: 54.5% reported full compliance compared with 39.7% of patients with AD. Adaptation to the work environment was poorer in the group with MDD, but patients with AD had a greater tendency to live alone. A personal history of prior episodes was more common in patients with MDD. Conclusions: Patients with MDD and AD received similar antidepressant treatment, although the former tended to be more "aggressive"

[Adherence to antiretroviral therapy measured by pill count and drug serum concentrations. Variables associated with a bad adherence]. / Adherencia a los fármacos antirretrovirales medida por la concentración de fármacos y el recuento de comprimidos. Variables relacionadas con una mala adherencia.

BACKGROUND: We aimed at measuring the adherence to HAART by means of pill count and drug plasma levels. In addition, we aimed at determining variables associated with suboptimal adherence. PATIENTS AND METHOD: Prospective observational study of 202 consecutive patients with HIV infection who were receiving antiretroviral treatment, followed up during 9 months. At baseline and at the end of the study a structured questionnaire was administered and a review of medical charts was performed. The adherence was assessed by monthly pill count while drug plasma levels were measured every three months. We considered that a patient adherence was not fulfilled when the mean pill count was < 90% or when any plasma drug level was lower than that expected. RESULTS: Of 143 available patients, 41.2% were non-adherent. According to the univariate analysis, non-adherent patients were more likely to be younger, female, under a methadone maintenance scheme, under psychiatric treatment, to have depression (according to the Beck Depression Inventory), to have adverse antiretroviral effects and to have a previous history of voluntary withdrawal of the treatment. Men who had sex with other men were significantly more adherent. In the multivariate analysis, female sex [OR 2.6 (1.04-6.65)], to be under a methadone program [OR 9.43 (1.01-88)], to have adverse drug effects [OR 2.63 (1.09-6.33)] and to have a previous history of voluntary withdrawal [OR 2.63 (1.09-6.36)] were independent risk factors for non-adherence. CONCLUSIONS: Adherence to antiretroviral therapy was 58.8%, similar to that seen in other chronic diseases. To be under a methadone maintenance program and having an active drug addiction was related with non-adherence. Women with worst adherence levels had frequently psychiatric comorbidity and more adverse drug effects.

Adherencia a los fármacos antirretrovirales medida por la concentración de fármacos y el recuento de comprimidos. Variables relacionadas con una mala adherencia / Adherence to antiretroviral therapy measured by pill count and drug serum concentrations. Variables associated with a bad adherence

FUNDAMENTO: Determinar el porcentaje de pacientes adherentes a los fármacos antirretrovirales, mediante recuento de comprimidos y concentraciones de fármacos. Establecer las variables que se relacionan con una mala adherencia. PACIENTES Y MÉTODO: Estudio observacional y prospectivo de una muestra de 202 pacientes, en tratamiento antirretroviral, seguidos durante 9 meses. Durante el período de seguimiento se practicó recuento de los comprimidos dispensados y se realizaron determinaciones trimestrales de los valores séricos de los fármacos. Al inicio y al final del seguimiento se realizaron un cuestionario estructurado y una revisión de las historias clínicas. Se consideró a un paciente como no adherente si la media del recuento de comprimidos fue inferior al 90 por ciento o alguna de las determinaciones de fármacos era inferior al nivel umbral establecido. RESULTADOS: El porcentaje de pacientes no adherentes fue del 41,2 por ciento. En el análisis univariante, los pacientes no adherentes eran más jóvenes, de sexo femenino, en programa de mantenimiento con metadona (PMM), con puntuaciones más elevadas en el test de Beck Depression Inventory, requiriendo más frecuentemente tratamiento psiquiátrico, presentaron con más frecuencia efectos secundarios y habían realizado previamente interrupciones voluntarias del tratamiento. Los pacientes con relaciones homosexuales presentaron una mejor adherencia. En el análisis multivariante las variables que mejor explicaron la no adherencia fueron: pertenecer al sexo femenino (odds ratio [OR] = 2,6 [1,04-6,65], estar en PMM (OR = 9,43 [1,01-88]), presentar efectos secundarios (OR = 2,63 [1,09-6,33]) y tener antecedentes de interrupciones voluntarias del tratamiento (1,09-6,36). CONCLUSIONES: El porcentaje de pacientes adherentes a los tratamientos antirretrovirales (58,8 por ciento) no difiere del observado en otras enfermedades crónicas. Los factores sociodemográficos (sexo femenino, bajo nivel de estudios), estar en PMM o con consumo activo de tóxicos y tener problemas psiquiátricos, principalmente depresión, parecen determinantes en la adherencia a estos fármacos (AU)