Diagnostic accuracy of visual analysis versus dual time-point imaging with 18F-FDG PET/CT for the characterization of indeterminate pulmonary nodules with low uptake. / Precisión diagnóstica del análisis visual frente al protocolo de imagen tardía con 18F-FDG PET/TC para la caracterización de nódulos pulmonares indeterminados con baja captación.

OBJECTIVE: To determine the accuracy of visual analysis and the retention index (RI) with dual-time point 18F-FDG PET/CT for the characterization of indeterminate pulmonary nodules (IPN) with low FDG uptake. MATERIALS AND METHODS: A retrospective analysis was performed on 43 patients (28 men, 64 ± 11 years old, range 36-83 years) referred for IPN characterization with 18F-FDG-PET/CT and maximum standard uptake value ≤ 2.5 at 60 minutes post-injection (SUVmax1). Nodules were analyzed by size, visual score for FDG uptake on standard (OSEM 2,8) and high definition (HD) reconstructions, SUVmax1, SUVmax at 180 minutes post-injection (SUVmax2), and RI was calculated. The definitive diagnosis was based on histopathological confirmation (n = 28) or ≥ 2 years of follow-up. RESULTS: Twenty-four (56%) nodules were malignant. RI ≥ 10% on standard reconstruction detected 18 nodules that would have been considered negative using the standard SUVmax ≥ 2.5 criterion for malignancy. RI ≥ 10% had a sensitivity, specificity, PPV, NPV and accuracy of 75, 73.7, 78.3, 70, and 74.4%, respectively, while for FDG uptake > liver on HD these were 79.1, 63.2, 73.1, 70.6, and 72.1%, respectively. SUVmax1 ≥ 2, SUVmax2 > 2.5 and FDG uptake > liver on standard reconstruction had a PPV of 100%. FDG uptake > mediastinum on HD had a NPV of 100%. CONCLUSIONS: RI ≥ 10% was the most accurate criterion for malignancy, followed by FDG uptake > liver on HD reconstruction. On standard reconstruction, SUVmax1 ≥2 was highly predictive of malignancy, as well as SUVmax2 > 2.5 and FDG uptake > liver. FDG uptake < mediastinum on HD was highly predictive of benign nodules.

Non-motor symptom burden in patients with Parkinson's disease with impulse control disorders and compulsive behaviours: results from the COPPADIS cohort.

The study was aimed at analysing the frequency of impulse control disorders (ICDs) and compulsive behaviours (CBs) in patients with Parkinson's disease (PD) and in control subjects (CS) as well as the relationship between ICDs/CBs and motor, nonmotor features and dopaminergic treatment in PD patients. Data came from COPPADIS-2015, an observational, descriptive, nationwide (Spain) study. We used the validated Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) for ICD/CB screening. The association between demographic data and ICDs/CBs was analyzed in both groups. In PD, this relationship was evaluated using clinical features and treatment-related data. As result, 613 PD patients (mean age 62.47 ± 9.09 years, 59.87% men) and 179 CS (mean age 60.84 ± 8.33 years, 47.48% men) were included. ICDs and CBs were more frequent in PD (ICDs 12.7% vs. 1.6%, p < 0.001; CBs 7.18% vs. 1.67%, p = 0.01). PD patients had more frequent previous ICDs history, premorbid impulsive personality and antidepressant treatment (p < 0.05) compared with CS. In PD, patients with ICDs/CBs presented younger age at disease onset, more frequent history of previous ICDs and premorbid personality (p < 0.05), as well as higher comorbidity with nonmotor symptoms, including depression and poor quality of life. Treatment with dopamine agonists increased the risk of ICDs/CBs, being dose dependent (p < 0.05). As conclusions, ICDs and CBs were more frequent in patients with PD than in CS. More nonmotor symptoms were present in patients with PD who had ICDs/CBs compared with those without. Dopamine agonists have a prominent effect on ICDs/CBs, which could be influenced by dose.

Lercanidipine-induced chylous ascites: Case report and literature review.

WHAT IS KNOWN AND OBJECTIVE: Chylous ascites is a rare condition. The most frequent causes are lymphomas, solid malignancies, abdominal trauma and cirrhosis. Isolated case reports describe the relationship between calcium channel blockers (CCB) and chyloperitoneum. Lercanidipine is a third-generation dihydropyridine with low rate of adverse events. We describe a case of lercanidipine-induced chylous ascites. CASE SUMMARY: An 80-year-old white female with hypertension treated with lercanidipine, developed chylous ascites and abdominal pain after the dosage of the CCB was doubled. The initial suspicion was a hidden neoplasm, but after a thorough research, no apparent cause was detected and the symptoms resolved after the drug was suspended. WHAT IS NEW AND CONCLUSION: Calcium channel blockers should be considered as possible causes in cases of chyloperitoneum of unknown aetiology.

Consumo de alcohol y tabaco entre los alumnos de un centro de formación de Fuerzas y Cuerpos de Seguridad del Estado / Consumption of alcohol and tobacco among students from a center of training of forces and state security bodies

El tabaco y el alcohol son drogas de uso legal con una amplia aceptación social y suponen el inicio en otras drogodependencias. Está probada la relación de ambas con la aparición de varias enfermedades y su consumo es cada vez mayor a edades más tempranas. OBJETIVOS: ofrecer una visión descriptiva del consumo de drogas legales en futuros Agentes del Orden Público. MATERIAL Y MÉTODO: se administró a 153 alumnos una encuesta de 47 preguntas de tipo cerrado. Los análisis de las variables se realizaron mediante tabla de cálculo de Excel. RESULTADOS: de una muestra final de 141 encuestados (91'5% hombres y 8'5% mujeres) de entre 18 y 24 años, hay un 37'6% de fumadores que han comenzado a fumar a los 13-16 años y consumen de 1 a 7 cigarrillos (74'55%). El 98% sabe que el consumo es cancerígeno, el 96% que es adictivo y al 18'44% le ha fallecido algún familiar por el tabaco pero el 60% siguen fumando para relajarse. En cuanto al alcohol, beben el 82%, sobre todo cerveza (46%). Se han iniciado en el consumo a los 13-16 años por influencia de amigos (80'5%) o familiares (6'5%). Beben sobre todo los fines de semana (49'5%) y el 81'3% bebe más cuando se reúne con amigos. El 98% sabe que produce daño hepático, el 95'5% conocen sus efectos adictivos y el 23% tienen familiares con problemas por el alcohol, pero el 81% se ha emborrachado alguna vez. CONCLUSIONES: los hábitos de consumo de alcohol y tabaco en este colectivo son similares a los de la población general

Tobacco and alcohol are legal drugs with broad social acceptance and they are the beginning of other drug addictions. The relationship of both with the emergence of various diseases is proven and its consumption is increasing at younger ages. OBJECTIVES: provide a descriptive overview of legal drugs consumption in future Law Enforcement Officers. MATERIAL AND METHOD: a survey of 47 closed questions was administered to 153 students. The analysis of the variables was performed using Excel spreadsheet table. RESULTS: from a final sample of surveyed 141 (91'5% men and 8'5% women) aged 18-24 years, 37'6% are smokers who have started smoking at age 13-16 and consume 1 to 7 cigarettes (74'55%). 98% know that consumption is carcinogenic, 96% which is addictive and 18'44% have relatives who died due to tobacco, but 60% keep smoking to relax. As for alcohol, 82% drink, mostly beer (46%). They have begun in consumption at age 13-16 influence of friends (80'5%) or family (6'5%). They drink mostly weekends (49'5%) and 81'3% drink more when they meet friends. 98% know it causes liver damage, the 95'5% know their addictive effects and 23% have family troubled by alcohol, but 81% has drunk ever. CONCLUSIONS: alcohol and smoking habits of this group are similar to those of general population

Detección de exageración de síntomas en esguince cervical: pacientes clínicos versus sujetos análogos / Detection of symptom exaggeration in whiplash: patients versus analogue participants

El objetivo de este trabajo es el estudio multidimensional del patrón de exageración de síntomas en esguince cervical (EC), con el fin de obtener indicadores discriminantes de simulación de dolor y discapacidad. La muestra es incidental, compuesta por 77 participantes: 47 pacientes que presentan EC y 30 eran sujetos participantes sanos que actuaban como «análogos»; es decir, que fueron deliberadamente instruidos para simular esguince cervical. Se les administra una batería de pruebas médicas y psicológicas, que incluye diversas pruebas médicas complementarias: Neck Pain Questionnaire, Cuestionario de Salud SF-36, Inventario Estructurado de Simulación de Síntomas (SIMS) e Inventario Multifásico de Personalidad de Minnesota 2 Forma Reestructurada (MMPI-2-RF) Se presentan datos referidos a diferencias entre grupos y validez predictiva de los instrumentos (AU)

A multidimensional study on the symptom exaggeration in whiplash is presented. The main aim is to detect discriminant patterns of malingered pain-related disability. Overall sample (n=77) was divided in two groups: whiplash patients (n=47), and analogue whiplash-instructed participants (n=30). Several medical and psychological tests: were administered to participants, including: medical complementary tests, the Neck Pain Questionnaire, the SF-36 Health Survey, the Structured Inventory of Malingered Symptomatology (SIMS), and the Minnesota Multiphasic Personality Inventory - 2 -Restructured Form (MMPI-2-RF). Data on mean group differences and predictive accuracy of the instruments used are presented (AU)

Abordaje multidisciplinar para la detección de la simulación en lumbalgia crónica / A multidisciplinary approach to the detection of malingering in chronic low back pain

El objetivo de este trabajo es el estudio multidimensional del patrón de exageración de síntomas en lumbalgia crónica, con el fin de obtener indicadores discriminantes de simulación de dolor y discapacidad, y elaborar un protocolo detallado de actuación para aquellos casos en los que el profesional de la salud implicado detecte la posibilidad de existencia de síntomas de simulación, en especial en aquellos pacientes en los que el contexto social, laboral, familiar o personal haga pensar en la obtención de beneficios económicos o eximentes laborales. La muestra del estudio estaba compuesta por 88 participantes, divididos en cuatro grupos: lumbalgia no litigante (n=15), lumbalgia litigante (n=23), lumbalgia análogo (n=20) y grupo control (n=30). Se les administra una batería de pruebas médicas y psicológicas, que incluyen diversas pruebas médicas complementarias: Escala de Valoración Personal Vital, Escala de Autoeficacia Percibida, Índice de Discapacidad de Oswestry (IDO), Índice de Discapacidad Crónica de Waddell (IDC), Cuestionario de Salud SF-36, Inventario Estructurado de Simulación de Síntomas (SIMS) e Inventario Multifásico de Personalidad de Minnesota 2 Forma Reestructurada (MMPI-2-RF). Se presentan datos referidos a diferencias entre grupos y validez predictiva de los instrumentos utilizados y se propone un protocolo de actuación para la detección de la simulación en función del perfil diferencial obtenido entre los pacientes no litigantes y litigantes con sospecha clínica de simulación (AU)

A multidimensional study on the symptom exaggeration in chronic low back pain patients is presented. The main aim is to detect discriminant patterns of malingered pain-related disability in order to develop a detailed protocol to the assessment of suspected malingering in cases with false or grossly exaggerated physical or psychological symptoms motivated by external incentives. Overall sample (n=88) was divided in four groups: low back pain patients not involved in litigation (n=15), low back pain patients involved in litigation (n=23), analogue low back pain-instructed participants (n=20), and control group (n=30). Several medical and psychological tests were administered to participants, including: medical complementary tests, self-efficacy and life personal self-report scales, the Oswestry Disability Index, the Chronic Disability Index of Waddell, the SF-36 Health Survey, the Structured Inventory of Malingered Symptomatology (SIMS), and the Minnesota Multiphasic Personality Inventory - 2 - Restructured Form (MMPI-2-RF). Data on mean group differences and predictive accuracy of the instruments used are presented. A protocol for the detection of malingering based on the differential profile scores between low back pain non-litigants and litigants is also addressed (AU)

Emotional-type psychopathologic symptoms among patients with terminal chronic alcohol-induced liver cirrhosis.

INTRODUCTION: Patients with toxic substance abuse syndrome, such as alcohol abuse, have elevated psychopathologic morbidity and mortality such as mood disorders. OBJECTIVE: To evaluate the emotional-type psychopathologic symptoms in patients with alcohol-induced hepatic cirrhosis on the liver transplant waiting list. MATERIALS AND METHODS: Patients with alcoholic liver cirrhosis who were candidates for liver transplant (n = 41) completed the SA-45 questionnaire (González y Cuevas; 88), which assesses nine dimensions: somatizations, obsessive-compulsivity, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. A control group consisted of patients with chronic nonalcoholic terminal hepatopathies (n = 22). RESULTS: Seventy-six percent of patients had some kind of psychopathologic symptom compared to 68% of the patients in the control group with other nonalcoholic etiologies (P > .05). The emotional-type clinical symptoms were: (1) somatizations: 37% of patients with alcoholic cirrhosis had this type of clinical symptoms compared to 32% of the control group (P > .05); (2) obsessive-compulsivity: 56% versus 46%, respectively (P > .05); (3) interpersonal sensitivity: 19% versus 9%, respectively (P > .05); (4) depression: 54% versus 27%, respectively (P = .045); (5) anxiety: 59% versus 46%, respectively (P > .05); (6) hostility: 29% versus 5%, respectively (P = .021); (7) phobic anxiety: 10% versus 14%, respectively (P > .05); (8) paranoid Ideation: 7% versus 5%, respectively (P > .05); (9) psychoticism: 5% versus 4%, respectively (P > .05). CONCLUSIONS: The patients with alcoholic liver cirrhosis on the liver transplant waiting list had elevated psychopathologic symptoms. Depressive- and hostile-type emotional alterations were most frequent in this type of patients.

Estudio de la eficacia de la combinación de repaglinida y metformina en el fracaso secundario a monoterapia en diabetes mellitus tipo 2 / Efficacy of combined metformin and repaglinide therapy after secondary failure of metformin monotherapy in type 2 diabetes mellitus

Muchos pacientes con Diabetes Mellitus tipo 2 necesitan tratamiento combinado para alcanzar un control glucémico adecuado. El objetivo de este estudio fue valorar la eficacia de la asociación de repaglinida y metformina, en diabéticos tipo 2 con fracaso secundario a monoterapia. Un total de 46 pacientes consecutivos con diabetes tipo 2, que tenían un. control glucémico insuficiente (HbA1c > 7,5) cuando estaban con glibenclamida o metformina, fueron tratados con la asociación de repaglinida y metformina durante 12 meses, tras ajustar dosis en las primeras 2 semanas. En los pacientes con tratamiento combinado, descendió de manera significativa la Hbalc 1,47 +/- 1,06%, la glucosa plasmática basal 54,4 +/- 47,7 mg/dl y la glucemia postprandial 64,6 +/- 52,8 mg/dl. El IMC, los triglicéridos, colesterol total y LDL colesterol también disminuyeron. Al final del estudio, el 50% de los pacientes lograron un control metabólico bueno (HbAlc <= 7,5%), La única variable independiente que influyó en alcanzar una respuesta ade cuada fue la edad más avanzada. El tratamiento combinado con repaglinida y metformina, fue bien tolerado y mejoró el control metabólico y los niveles de lípidos en pacientes con diabetes tipo 2, mal controlados con monoterapia

Most patients with type 2 diabetes require combination therapy to reach an acceptable level of glycemic control. The present study aimed to assess the efficacy of repaglinide plus metformin in subjects with type 2 diabetes, not under optimal glycemic control with monotherapy. A total of 46 patients with type 2 diabetes, who had inadequate glycemic control (HbA1c > 7,5%) when receiving glibenclamide or metformin, were enrolled to receive repaglinide plus metformin, the optimal dose was determinated during 2 week and continued for a 12-month periodo In subjects receiving combined therapy, HbA1c decresed sygnificantly by 1,47 +/- 1,06%, fasting plasma glucose by 54,4 +/- 47,7 mg/dl and postprandial glucose by 64,6 +/- 52,8 mg/dl. BMI, tryglicerides, total colesterol and LDL colesterol were also reduced. At end point, 50% of pattients had achieved good or borderline control (HbAlc s 7,5%). Patients more likely to achieve target levels were older than other patients. Combined metformin and repaglinide therapy was well tolerated and improved glycemic control and lipid concentrations in patients with type 2 diabetes poorly controlled with monotherapy

Factores moduladores de la adherencia farmacológica en hipertensión arterial: estudio exploratorio

El presente estudio tiene como objetivo caracterizar la falta de adherencia farmacológica en una muestra de hipertensos identificando los factores implicados en la misma. Se trata de un estudio exploratorio de carácter descriptivo transversal sobre 104 pacientes diagnosticados de hipertensión, 59 de los cuales pertenecen al ámbito de Atención Primaria y 45 pacientes a la Unidad de Hipertensión de un hospital. A todos se les aplicó un instrumento de evaluación diseñado específicamente en el que se recogió información sobre los siguientes aspectos: características demográficas, valores de presión arterial, tratamiento farmacológico prescrito, adherencia farmacológica autoinformada y, por último, factores relacionados con la falta de adherencia en el tratamiento de la hipertensión arterial. Los resultados apuntan hacia una peor adherencia farmacológica de los pacientes de Atención Primaria. Los factores que más se relacionan con una mala adherencia farmacológica son: olvido, aparición de efectos secundarios, ausencia de síntomas, actitud negativa al consumo de fármacos, sentirse poco amenazado por la enfermedad y estar de vacaciones. Se discuten las implicaciones asistenciales y de investigación que estos resultados aportan (AU)