Predictors of psychological distress in advanced cancer patients under palliative treatments.

This work aims to investigate the factors associated with psychological distress in advanced cancer patients under palliative treatment. We comprehensively assessed the demographic, psychosocial and health factors of 158 advanced cancer patients. Patients with high and low distress, according to the Hospital Anxiety and Depression Scale, were compared. A regression analysis was built to identify the best predictors of distress. Patients with high psychological distress (81%) were more likely to have lung cancer, suicidal ideation, hopelessness, low quality of life and poor body image than those without. In the multivariate model, only poor emotional functioning (OR = .89; 95% CI = .83-.95; p ≤ .001), hopelessness (OR = .86; 95% CI = .78-.94; p ≤ .001) and body image distortions (OR = .77; 95% CI = .68-.85; p = .005) were retained. High levels of hopelessness, impaired emotional functioning and body image distortions are the main factors associated with psychological distress in patients with advanced cancer. Potential interventions to modify these factors in palliative units are discussed.

Suicide ideation among oncologic patients in a Spanish ward.

Oncologic patients are exposed to a higher risk of suicidal behaviors than the general population. In this study, we aim to examine the severity of suicidal ideation in a sample of oncologic patients considering different psychological and clinical features. We interviewed 202 inpatients receiving curative or palliative treatment in a medical oncology ward of a Spanish hospital during the period 2012-2014. A complete assessment of psychosocial factors, cancer diagnoses (lung, colon rectum, and genitourinary system), and suicidal behaviors were made during admission, including validated questionnaires about depression, anxiety, personality, quality of life, body image, life threatening events, hopelessness, and suicidal ideation. The characteristics of inpatients with high and low suicidal ideation were retrospectively compared. A logistic regression model was constructed to examine the relationship between the significant factors retained after the univariate analyses. One of every four patients (n = 51; 25.24%) presented high scores of suicidal ideation. Logistic regression analyses retained depression (OR = 3.55; 95% CI = 1.25-11.68; p = .016), hopelessness (OR = 8.78; 95% CI = 3.44-25.88; p ≤ .001), personality (OR = .44; 95% CI = .2-.96; p = .038), and advanced age (OR = 2.60; 95% CI = 1.18-5.98; p = .016) as the main risk factors for high suicidal ideation. Suicidal ideation was frequent among oncologic patients. These patients should receive closer monitoring, especially, when old, retired, or severely depressed.

Reduced cannabinoid CB1 receptor binding in alcohol dependence measured with positron emission tomography.

Brain cannabinoid CB1 receptors contribute to alcohol-related behaviors in experimental animals, but their potential role in humans with alcohol dependence is poorly understood. We measured CB1 receptors in alcohol dependent patients in early and protracted abstinence, and in comparison with control subjects without alcohol use disorders, using positron emission tomography and [(18)F]FMPEP-d2, a radioligand for CB1 receptors. We scanned 18 male in-patients with alcohol dependence twice, within 3-7 days of admission from ongoing drinking, and after 2-4 weeks of supervised abstinence. Imaging data were compared with those from 19 age-matched healthy male control subjects. Data were also analyzed for potential influence of a common functional variation (rs2023239) in the CB1 receptor gene (CNR1) that may moderate CB1 receptor density. On the first scan, CB1 receptor binding was 20-30% lower in patients with alcohol dependence than in control subjects in all brain regions and was negatively correlated with years of alcohol abuse. After 2-4 weeks of abstinence, CB1 receptor binding remained similarly reduced in these patients. Irrespective of the diagnostic status, C allele carriers at rs2023239 had higher CB1 receptor binding compared with non-carriers. Alcohol dependence is associated with a widespread reduction of cannabinoid CB1 receptor binding in the human brain and this reduction persists at least 2-4 weeks into abstinence. The correlation of reduced binding with years of alcohol abuse suggests an involvement of CB1 receptors in alcohol dependence in humans.

Exploración funcional renal básica en pediatría / Basic kidney function examination in pediatrics

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Actualizaciones en el diagnóstico y tratamiento de la insuficiencia renal crónica durante la infancia y adolescencia / Updating in the diagnosis and treatment of chronic renal failure during infancy and adolescence

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[Infrequent manifestations of Henoch-Schonlein purpura]. / Manifestaciones infrecuentes en la púrpura de Schönlein-Henoch.

We review the cases of 148 children with Henoch-Schönlein purpura diagnosed in a period of seventeen years (from 1975 to 1992). Thirteen cases (8.7%) of unusual clinical manifestations were found: testicular affection in six cases (7.6% of the males); IgA nephropathy in four (2.7%); exudative enteropathy in two (1.3%); duodenal syndrome in two; previous abdominal manifestation which led to surgical procedures in one (0.7%) and another case with detachment of the retina. These clinical findings are analyzed and the possibility of unnecessary therapeutic acts is discussed.

[Guide for the prevention of renal diseases during and after childhood]. / Guía para la prevención de las enfermedades renales en y desde la infancia.

Kidney disease Prevention in childhood can be made from three levels. In the first level or Primary Prevention one must prevent kidney disease taking steps for "Kidney Health" promotion: environmental factors, nourishing, sanitary education and preventive pediatrics. Secondary Prevention lies in the correct diagnostic during first years in life and in a suitable treatment of the kidney diseases, especially in children to have a kidney failure risk: obstructive uropathy and vesicoureteral reflux. Tertiary Prevention deals with aggravating factors in an established Kidney chronic failure, and its prevention includes: normoproteic diet, phosphorus restriction, arterial hypertension control and nutritional and pharmacological steps to reduce the hyperlipidemia.

Familial hypouricaemia due to an isolated tubular defect of urate reabsorption.

Hypouricaemia due to an isolated renal tubular defect is a rare condition. Several members from an affected family are described. The propositus is a 12-year-old girl with hypouricaemia (0.7-1.1 mg/dl) and increased fractional excretion of uric acid (50%). Pyrazinamide and sulphinpyrazone tests revealed an attenuated response in this subject to both drugs. The mother and one of the propositus' two brothers have the same defect. The other brother has uric acid levels at the lower limit of normal and increased fractional excretion of uric acid. These results suggest familial hypouricaemia due to a pre-secretory reabsorptive tubular defect, transmitted by autosomal dominant inheritance.

[Yield of laboratory tests in the detection of excessive drinkers in the work place]. / Rendimiento de las pruebas de laboratorio en la detección de bebedores excesivos en el medio laboral.

BACKGROUND: The identification of personnel consuming excess quantities of alcoholic beverages in the work place is necessary due to the economic, health, and laboral problems caused by alcohol. The objectivity of laboratory tests provides great credibility and these tests have replaced other methods as the anamnesis. METHODS: A transversal study was carried out of the employees of a Barcelona enterprise. During the periodic medical check ups the consumption of alcoholic beverages and laboratory blood tests were obtained from the employees seven days previously. RESULTS: All the laboratory tests presented a weak positive correlation with the consumption of alcohol. The calculation of diagnostic efficacy for weekly consumption equal to or grater than 280 g of pure alcohol in a male shows that the greatest sensitivity corresponds to mean corpuscle volume (33%) followed by gammaglutamyltranspeptidase (GGT) (16%) with high specificity being observed in both (85% and 93%, respectively). The results are better in employee consuming more than or equal to 420 g of alcohol weekly. CONCLUSIONS: The diagnostic efficacy of laboratory tests in identifying subjects with elevated consumption of alcohol in the work place has low clinical performance and the use of anamnesis on the consumption of alcoholic beverages should first be evaluated.

[Parathyroid insufficiency syndrome. Two new cases: type Ia pseudohypoparathyroidism and pseudo-idiopathic hypoparathyroidism]. / Síndrome de insuficiencia paratiroidea. Dos nuevos casos: pseudohipoparatiroidismo tipo Ia e hipoparatiroidismo pseudoidiopático.

Two new cases with parathyroid insufficiency syndrome are described. The first one is a seven year and 6 months old male with Pseudohypoparathyroidism Type Ia, who has presented: hypocalcemia, hyperphoforemia, increased PTH and TSH, prolactin decreased and Albright hereditary osteodystrophy phenotype. The second one in a six year and four months old female with Pseudo-idiopathic hypoparathyroidism who has presented: hypocalcemia, hyperphosforemia, increased PTH, without any hormonal disturbances nor dysmorphias. Ellsworth-Howard test with 50 micrograms of 1-34 hPTH is made in both, remarking the different renal response about phosphaturia and plasmatic, urinary and nephrogenic cyclic AMP. The treatment is performed in both with calcitriol and oral calcium (L-Thyroxine is associated for the first patient). Biochemical disturbances are normalized. Other parathyroid insufficiency syndrome are revised.

[Bladder calculus formed on chromic suture]. / Cálculo vesical formado sobre sutura crómica.

This is a description of a clinical case of a two-and-a-half year old male child who developed a urinary bladder stone seeded on chromic catgut used to suture of the bladder wall which was damaged in the course of the surgical repair of an inguinal hernia.