Depression in internal medicine inpatients at the time of hospital discharge and referral to primary care

Background and objectives. This is the first multi-center study intended to document the prevalence, characteristics, and associations of depression in Medicine patients at the time of hospital discharge and their referral to Primary Care (PC). Methods. Adult patients randomly selected among consecutive admissions to Medicine wards in 8 hospitals in Spain, covering health districts, were examined in a two-phase 'case-finding' procedure. Standardized, Spanish versions of instruments were used, including the Standardized Polyvalent Psychiatric Interview (SPPI) and Cumulative Illness Rating Scale (CIRS). Cases of depression were diagnosed according to ICD-10 general hospital research criteria. Results. Three hundred and twelve patients with treatable depression and 777 non-depressed controls were identified. In a conservative estimate, the global prevalence of major depression was 7.1%, dysthymia 4.2% and adjustment depression 7.1%, and 51.9% of cases were of moderate/ severe intensity. Depression was more frequent in women, the differences being significant in all categories of depression. The prevalence of depression was lower in individuals aged 85 or more years, the differences being significant in cases of both dysthymia and adjustment depression. A clear pattern of decreasing prevalence with age was observed in women. The depressed had as an average five medical systems affected, and higher CIRS scores compared with the controls, the differences being significant in cases of both major depression and dysthymia. Conclusions. This is the first report showing a considerable prevalence of treatable cases of depression in Medicine patients at the time of hospital discharge and referral to PC. Depression is associated with the severity of the medical condition, and differences observed by age and sex have clinical implications. Paper read at the 3rd Annual Meeting of the European Association of Psychosomatic Medicine, Nuremberg 2015.

Analgesia epidural continua para trabajo de parto en una paciente con polineuropatía desmielinizante periférica / Continuous epidural analgesia for labour and delivery in a patient with demyelinating peripheral polyneuropathy

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Enhanced nonreciprocal effects in magnetoplasmonic systems supporting simultaneously localized and propagating plasmons.

Perforated magnetoplasmonic Au/Co/Au multilayers support both localized and propagating surface plasmon resonances. The presence of holes produces an enhancement of the magnetic field modulation of the propagating surface plasmon wavevector with respect to the isostructural continuous film in the spectral region corresponding to the hole associated localized plasmon resonance. This is due to the increased electromagnetic field in the surrounding area of the resonant hole, and the subsequent additional contribution to the magnetic modulation of the continuous film. This novel concept that gives rise to enhanced magnetic field induced nonreciprocal effects can be of interest in the development of innovative platforms for sensing applications, optical isolators and modulators.

Mimicking electromagnetically induced transparency in the magneto-optical activity of magnetoplasmonic nanoresonators.

We show that the interaction between a plasmonic and a magnetoplasmonic metallic nanodisk leads to the appearance of magneto-optical activity in the purely plasmonic disk induced by the magnetoplasmonic one. Moreover, at specific wavelengths the interaction cancels the net electromagnetic field at the magnetoplasmonic component, strongly reducing the magneto-optical activity of the whole system. The MO activity has a characteristic Fano spectral shape, and the resulting MO inhibition constitutes the magneto-optical counterpart of the electromagnetic induced transparency.

Magnetic modulation of surface plasmon modes in magnetoplasmonic metal-insulator-metal cavities.

The magnetic modulation of the surface plasmon-polariton (SPP) wavevector is experimentally and theoretically studied for the plasmonic modes excited in metal-insulator-metal (MIM) magnetoplasmonic cavities. For this purpose, Ag/SiO2/Ag multilayers with different SiO2 layer thickness in which a thin Co layer is positioned near the top Ag/SiO2 interface, near the bottom SiO2/Ag one, or near both of them, are studied. The magnetoplasmonic MIM cavities present symmetric (SM) and antisymmetric (AM) plasmonic modes, of different wavevector and electromagnetic field profiles inside the MIM cavity. We show that the magnetic SPP wavevector modulation strongly depends on which mode is considered, the cavity thickness, and the number and specific location of Co layers within the structure. With only one ferromagnetic layer, a net modulation is obtained, of higher magnitude as we reduce the SiO2 layer thickness. The introduction of a second Co layer in the structure reduces the modulation due to the non-reciprocal character of SPP modes under an applied magnetic field. Moreover, we demonstrate that the non-reciprocal nature of the SPP modulation can be experimentally visualized in the magnetic hysteresis loops under plasmon excitation conditions by using two Co layers with different magnetization switching fields.

Magneto-optical properties of core-shell magneto-plasmonic Au-Co(x)Fe(3 - x)O4 nanowires.

The magneto-optical properties of Au-Co(x)Fe(3 - x)O(4) core-shell nanowires embedded in porous alumina membranes are studied. The structures were obtained by depositing Co(x)Fe(3 - x)O(4) on the pore walls of alumina membranes by atomic layer deposition and filling the resulting nanotube with gold by electrodeposition. The effect of plasmon resonance excitation on the magneto-optical activity is clearly observed as a modification of the spectral line shape of the Kerr rotation signal.

[Complications after regional anesthesia]. / Complicaciones tras técnicas de anestesia regional.

In recent years, there has been a considerable increase in the number of procedures carried out under regional anesthesia. The techniques used can be associated with a number of complications, which should be understood so that they can be recognized and managed appropriately. The overall incidence of reported complications associated with these techniques is low and therefore, with currently available data, we can only have an approximate idea of their incidence. The objective of this study is to systematically describe the complications that may arise from the use of neuraxial and peripheral regional anesthesia techniques.

Complicaciones tras técnicas de anestesia regional / Complications after regional anesthesia

En los últimos años se ha producido un incrementoconsiderable del número de procedimientos llevados acabo con técnicas de anestesia regional. Dichas técnicaspueden llevar asociadas una serie de complicacionescuyo conocimiento es importante para la identificación ycorrecto manejo de las mismas. La incidencia global decomplicaciones asociadas a la realización de dichas técnicases baja y por ello, y con los datos de que disponemosen la actualidad, sólo podemos aproximar su incidenciaexacta.En el presente trabajo se pretende ordenar esquemáticamentey describir las posibles complicaciones que sederivan de la realización de técnicas regionales tantoneuroaxiales como periféricas (AU)

In recent years, there has been a considerableincrease in the number of procedures carried out underregional anesthesia. The techniques used can beassociated with a number of complications, which shouldbe understood so that they can be recognized andmanaged appropriately. The overall incidence ofreported complications associated with these techniquesis low and therefore, with currently available data, wecan only have an approximate idea of their incidence.The objective of this study is to systematically describethe complications that may arise from the use ofneuraxial and peripheral regional anesthesia techniques (AU)

Perfil de los pacientes ambulatorios con trastorno bipolar: un estudio transversal en la Comunidad de Madrid / Profile of bipolar disorder outpatients: a cross-sectional study in the Madrid Community

Introducción. El propósito de este estudio transversal es obtener un perfil de las características sociodemográficas, clínicas, de funcionamiento psicosocial y pautas terapéuticas de los pacientes con trastorno bipolar atendidos de forma ambulatoria en la Comunidad de Madrid. Metodología. Un total de 115 pacientes fueron incluidos en el estudio de forma consecutiva por 10 psiquiatras. Resultados. Desde el inicio de los síntomas hasta recibir un diagnóstico correcto de trastorno bipolar habían transcurrido una media de 7,6 años. La depresión fue la forma de inicio de la enfermedad en la mayoría de los pacientes, independientemente del subtipo. El 47% de los pacientes presentaba alguna sintomatología clínica sindrómica o subsindrómica, siendo depresiva la más predominante (33,1%). Una percepción subjetiva reducida de la calidad de vida se asoció a la presencia de síntomas depresivos y a una peor evolución el año previo. Más de la mitad del total de los pacientes (58,2%) se encontraban en una situación de sobrepeso u obesidad. El litio fue el estabilizador del humor más utilizado (71,3%), aunque el 41% de los pacientes recibía al menos tres psicofármacos. Conclusiones. Los resultados obtenidos en este estudio confirman en gran medida buena parte de los datos conocidos en la actualidad sobre el trastorno bipolar. Destaca la disminución en la calidad de vida de los pacientes bipolares relacionada con la presencia de síntomas depresivos. Se hace necesario optimizar los tratamientos en el trastorno bipolar para mejorar así su pronóstico (AU)

Introduction. The purpose of this cross-sectional study is to obtain a sociodemographic, clinical, psycho-social functioning and therapeutic profile of bipolar outpatients in the Madrid Community. Methods. A total of 115 outpatients were consecutively recruited by 10 psychiatrists. Results. Mean time between initial symptoms and an accurate bipolar diagnosis was of 7.6 years. A depressive episode was the onset of the illness in most patients independently of clinical subtype. Syndromal or subsyndromal symptoms were present in 47% of the patient population, dominating the depressive polarity (33.1 %). A subjectively reduced perception of quality of life was associated to the presence of depressive symptoms and a worse clinical outcome last year. More than half of the patients (58.2%) were overweight or obese. Lithium was the most frequently used mood stabilizer (71.3%), whereas41 % of the patients were taking at least three psychotropic drugs. Conclusions. Results of this study widely confirm previous data on bipolar disorder. Reduction in quality of life of bipolar patients associated to depressive symptoms must be highlighted. It is necessary to optimize treatments in bipolar disorder in order to improve prognosis (AU)

CYP2A6 activity in a healthy Spanish population: effect of age, sex, smoking, and oral contraceptives.

This study was performed to assess the influence of age, sex, smoking, and contraceptive use on CYP2A6 activity. In the metabolism of caffeine, the conversion of 1,7 dimethylxanthine (17X) to 1,7 dimethiylurate (17U) is catalyzed primarily by CYP2A6. CYP2A6 phenotype was determined by the urinary ratio 17U:17X in the interval of 4-5 h after caffeine intake in 179 healthy white Spaniards (102 women and 76 men). There were 99 non-smokers and 80 smokers. Among women, 26 were taking oral contraceptives. The age was the most important predictive factor of CYP2A6 activity (P < 0.001) with older subjects having higher activity. The influence of the gender was more modest (P = 0.07) with women exhibiting borderline increased values of the CYP2A6 marker than men. Tobacco smoking did not affect CYP2A6 activity. However, the CYP2A6 marker resulted to be strongly related to the use of oral contraceptives. The women users of oral contraceptives had higher values of CYP2A6 marker than both women not taking oral contraceptives and men (P < 0.001 in both comparisons). The results indicate that age, oral contraceptive use, and possibly gender should be controlled in epidemiological studies dealing with CYP2A6 activity and its relationship with xenobiotics exposure and genetic or pathological factor.

[Profile of bipolar disorder outpatients: a cross-sectional study in the Madrid Community]. / Perfil de los pacientes ambulatorios con trastorno bipolar: un estudio transversal en la Comunidad de Madrid.

INTRODUCTION: The purpose of this cross-sectional study is to obtain a sociodemographic, clinical, psychosocial functioning and therapeutic profile of bipolar outpatients in the Madrid Community. METHODS: A total of 115 outpatients were consecutively recruited by 10 psychiatrists. RESULTS: Mean time between initial symptoms and an accurate bipolar diagnosis was of 7.6 years. A depressive episode was the onset of the illness in most patients independently of clinical subtype. Syndromal or subsyndromal symptoms were present in 47% of the patient population, dominating the depressive polarity (33.1%). A subjectively reduced perception of quality of life was associated to the presence of depressive symptoms and a worse clinical outcome last year. More than half of the patients (58.2%) were overweight or obese. Lithium was the most frequently used mood stabilizer (71.3%), whereas 41% of the patients were taking at least three psychotropic drugs. CONCLUSIONS: Results of this study widely confirm previous data on bipolar disorder. Reduction in quality of life of bipolar patients associated to depressive symptoms must be highlighted. It is necessary to optimize treatments in bipolar disorder in order to improve prognosis.

Genotyping of Mycobacterium tuberculosis over two periods: a changing scenario for tuberculosis transmission.

OBJECTIVE: To evaluate changes in the molecular epidemiology of tuberculosis (TB) in Zaragoza, Spain, over a decade that has seen large social and health changes, including the attenuation of the human immunodeficiency virus (HIV) epidemic and increased immigration. DESIGN: A population-based molecular study was conducted using standard restriction fragment length polymorphism IS6110 typing that included all patients with bacteriologically confirmed TB living in the Zaragoza area from 2001 to 2004. The current situation was compared with that described in a previous study from 1993 to 1995. RESULTS: A total of 454 Mycobacterium tuberculosis isolates were genotyped; 239 (52.6%) were grouped in 45 clusters composed of 2 to 85 isolates. Independent risk factors for clustering were identified. The main differences with the previous study were the increase of TB cases among immigrants, a decrease in HIV-TB co-infected patients and the occurrence of a large TB outbreak involving 85 patients (M. tuberculosis Zaragoza [MTZ] strain). CONCLUSION: A change in the epidemiological pattern of TB has been observed in the last years. TB transmission is more common among the Spanish-born population, while foreign birth is significantly less associated with clustering. A single epidemic strain caused 18.7% of all TB cases.

[Treatment of dysthymia with sertraline]. / Tratamiento de las distimias con sertralina.

We studied 50 patients (40 females, 10 males) diagnosed of dysthymia according to 1CD-10 criteria (F34.1), retrospectively and prospectively. All were treated with Sertraline, with an initial dose of Sertraline 50-100 mg/day, allowing increases to a maximum of 200 mg/day during the follow up. The clinical and therapeutical evolution was measured by HDRS (Hamilton Depression Rating Scale) 21 items, HARS (Hamilton Anxiety Rating Scale), Clinical Global Impression (CGI), subjective patient impression, compliance, secondary effects, complementary treatments when needed, severity, evolution evaluated on days 15, 30, 60 and 90, from the patient and psychiatrist perspective. Seventy two percent of the sample completed the three months of treatment. We obtained a good clinical efficacy with sertraline observed by a statistical significant decrease (p < 0.01) in the scales in the second week of treatment, which continued in following weeks. The mean doses varted from 78 mg/day to 98.7 mg/day during the three months of follow up The tolerance to Sertraline in our sample was good and similar to other data in the literature. Fourteen patients withdrew, but only six (12%) were due to secondary effects In spite of the study's limitations due to the lack of a control group, we could affirm that sertraline was an effective treatment for dysthymic patients and it should be recommended as a first choice in the treatment of affective disorders, facilitating other psychotherapeutical approach due to its favourable tolerance profile.

Sleep disorders in bipolar depression: hypnotics vs sedative antidepressants.

Ninety-six patients with bipolar disorder who attended a lithium clinic were reviewed in a retrospective study. Sleep disorders were studied in 85 depressive episodes. Eighty-one percent of the subjects presented with insomnia; the mixed type being the most frequent (49%) followed by early awakening (25%). The evolution of depression in the patients was compared according to the treatment received for insomnia: sedative antidepressants vs other anxiolytic or hypnotic drugs. Fifteen percent of patients shifted to mania, this group more frequently receiving sedative antidepressants (p < 0.05). Moreover, the patients who had received sedative antidepressants as therapy for insomnia (N = 61) showed a tendency to have a shorter asymptomatic interval before the following relapse (13 months vs 19 months; p = 0.06). In view of these results, we consider that the use of sedative antidepressants as a treatment for insomnia during depressive episodes in bipolar patients could be a factor contributing to worse prognoses; in these cases it appears that the use of other hypnotic drugs would be more advisable.

[ICD-9 versus DSM-III in the psychoses: anamnestic and catamnestic implications]. / ICD-9 versus DSM-III en las psicosis: implicaciones anamnésicas y catamnésicas.

We pretend with our study to compare the DSM-III diagnostic criteria with ICD-9 diagnostic criteria for psychotic episodes and to look for the diagnostic stability for both classifications. We studied 79 first psychotic episodes following ICD-9 and retrospectively we applied the DSM-III diagnostic criteria to the same patients. The mean follow up time was 46.6 +/- 6.7 months. In the ICD-9 the schizophrenic psychoses represented the main diagnostic group, not only the day they were discharged from the hospital 31.6% but also in the follow up 39.2%. On the other hand in the DSM-III, in the discharge day the schizophreniform disorder was the more frequent diagnostic 24%, while in the follow up the schizophrenic disorder came to the first position 32.9%. In the ICD-9 there was a 15.1% of diagnostic changes and in the DSM-III nearly the double 30.3%. In both classifications the unspecified and the atypical suffered a great diagnostic mobility; in both nosologies the schizophrenia was the most unchangeable diagnosis, no patient discharged with this diagnosis changed to another in the follow up. ICD-9 could be said that has a great sensitivity and an acceptable specificity for this entities, and DSM-III would have a moderate sensitivity but a very diagnostic specificity for these disorders.