Incidence, characteristics, and predictive factors of post-colonoscopy colorectal cancer.

BACKGROUND: Post-colonoscopy colorectal cancer (PCCRC) is colorectal cancer (CRC) diagnosed after a colonoscopy in which no cancer is found. OBJECTIVE: As PCCRC has become an important quality indicator, we determined its rates, characteristics, and index colonoscopy-related predictive factors. METHODS: We carried out a multicenter, observational, retrospective study between 2015 and 2018. Rates were calculated for PCCRC developing up to 10 years after colonoscopy. PCCRC was categorized according to the most plausible explanation using World Endoscopy Organization methodology. Our PCCRC population was compared to a control cohort without CRC matched 1:4 by sex, age, index colonoscopy date, indication, endoscopist, and hospital. RESULTS: One hundred seven PCCRC and 2508 detected CRC were diagnosed among 101,524 colonoscopy (0.1%), leading to rates of 0.4%, 2.2%, 3.1%, and 4.1% at 1, 3, 5, and 10 years, respectively. PCCRC was in right (42.4%), left (41.4%), and transverse (16.4%) colon with 31.5% at stage I, 24.7% stage II, 32.6% stage III, and 11.2% stage IV. Twenty point three percent were classified as incomplete resection, 5.4% as unresected lesions, 48.6% as missed lesions with adequate colonoscopy, and 25.7% as missed lesions with inadequate colonoscopy. The median time from colonoscopy to PCCRC was 42 months. Previous inadequate preparation (OR 3.05, 95%CI 1.73-5.36) and piecemeal polypectomy (OR 19.89, 95%CI 8.67-45.61) were independently associated with PCCRC. CONCLUSIONS: In our population, 4.1% of CRC cases were PCCRC. Most of these lesions were in right colon and attributable to lesions not visualized despite adequate bowel cleansing. Previous inadequate cleansing and piecemeal polypectomy were associated with PCCRC.

Relación entre la estación del año y la gravedad de los síntomas en pacientes con fibromialgia / Relationship between season of the year and severity of symptoms in patients with fibromyalgia

Antecedentes y objetivo: Es frecuente que los pacientes con fibromialgia refieran que ciertas estaciones del año agravan sus síntomas. Como objetivo primario se determinó la asociación entre síntomas claves de la fibromialgia y estación del año. Como objetivo secundario se determinó la existencia de diferencias en función de los niveles de ansiedad o depresión.Material y métodoMuestra de conveniencia formada por 471 participantes con fibromialgia evaluados antes de iniciar un tratamiento multidisciplinar. Se recogieron datos demográficos y meteorológicos y se evaluaron, mediante instrumentos estandarizados, la intensidad del dolor, la funcionalidad, la fatiga, la rigidez, la calidad del sueño, así como la ansiedad y la depresión.ResultadosLos diferentes grupos estacionales fueron homogéneos en edad, género, nivel educativo, estado marital y situación laboral. No se encontraron diferencias significativas en intensidad del dolor (F=1,334; p=0,265), funcionalidad (F=0,402; p=0,669), fatiga (F=0,714; p=0,490), rigidez (F=0,299; p=0,741), ansiedad (F=0,376; p=0,687), depresión (F=0,608; p=0,545), distrés psicológico (F=0,261; p=0,770), duración del sueño (F=1,507; p=0,223) o el índice de problemas de sueño (F=0,343; p=0,710).ConclusionesNo se han encontrado diferencias en la intensidad de los síntomas de la fibromialgia ni en los porcentajes de gravedad entre las distintas estaciones del año. La ansiedad ha sido más prevalente que la depresión, posiblemente debido a las propias características de la muestra, con mayoría de pacientes con perfil disfuncional. (AU)

Background and objective: Fibromyalgia patients often report that certain seasons aggravate their symptoms. The main objective was to determinate the association between key symptoms of fibromyalgia and the season of the year. A secondary objective was to determinate the existence of differences based on levels of anxiety or depression.Material and methodConvenience sample made up of 471 participants with fibromyalgia evaluated before starting multidisciplinary treatment. Demographic and meteorological data were collected. Clinical data were assessed with standardized instruments of pain intensity, functionality, fatigue, stiffness, sleep quality, anxiety and depression.ResultsThe different groups of participants were homogeneous for age, gender, educational level, marital status and employment situation. No significant differences were found in pain intensity (F=1.334; P=.265), functionality (F=.402; P=.669), fatigue (F=.714; P=.490), stiffness (F=.299; P=.741), anxiety (F=.376; P=.687), depression (F=.608; P=.545), psychological distress (F=.261; P=.770), sleep quantity (F=1.507; P=.223) or sleep disturbances (F=.343; P=.710).ConclusionsNo differences were found in the intensity of fibromyalgia symptoms, nor in the percentages of severity among the different seasons of the year. Anxiety was more prevalent than depression, possibly due to the characteristics of the sample itself, with the majority of patients with a dysfunctional profile. (AU)

[Relationship between season of the year and severity of symptoms in patients with fibromyalgia]. / Relación entre la estación del año y la gravedad de los síntomas en pacientes con fibromialgia.

BACKGROUND AND OBJECTIVE: Fibromyalgia patients often report that certain seasons aggravate their symptoms. The main objective was to determinate the association between key symptoms of fibromyalgia and the season of the year. A secondary objective was to determinate the existence of differences based on levels of anxiety or depression. MATERIAL AND METHOD: Convenience sample made up of 471 participants with fibromyalgia evaluated before starting multidisciplinary treatment. Demographic and meteorological data were collected. Clinical data were assessed with standardized instruments of pain intensity, functionality, fatigue, stiffness, sleep quality, anxiety and depression. RESULTS: The different groups of participants were homogeneous for age, gender, educational level, marital status and employment situation. No significant differences were found in pain intensity (F=1.334; P=.265), functionality (F=.402; P=.669), fatigue (F=.714; P=.490), stiffness (F=.299; P=.741), anxiety (F=.376; P=.687), depression (F=.608; P=.545), psychological distress (F=.261; P=.770), sleep quantity (F=1.507; P=.223) or sleep disturbances (F=.343; P=.710). CONCLUSIONS: No differences were found in the intensity of fibromyalgia symptoms, nor in the percentages of severity among the different seasons of the year. Anxiety was more prevalent than depression, possibly due to the characteristics of the sample itself, with the majority of patients with a dysfunctional profile.

Body mass index and response to a multidisciplinary treatment of fibromyalgia.

The purpose of this study is to determine whether there are some differences in the treatment responses to a multidisciplinary fibromyalgia (FM) treatment related with the baseline body mass index (BMI) of the participants. Inclusion criteria consisted of female sex, a diagnosis of FM (American College of Rheumatology criteria), age between 18 and 60 years, and between 3 and 8 years of schooling. Baseline BMI was determined, and patients were randomly assigned to one of the two treatment conditions: conventional pharmacologic treatment or multidisciplinary treatment. Outcome measures were pain intensity, functionality, catastrophizing, psychological distress, health-related quality of life, and sleep disturbances. One hundred thirty patients participated in the study. No statistical significant differences regarding pre-treatment outcomes were found among the different BMI subgroups, and between the two experimental conditions for each BMI category. General linear model analysis showed a significant interaction group treatment × time in pain intensity (p < .01), functionality (p < .0001), catastrophizing (p < .01), psychological distress (p < .0001), sleep index problems (p < .0001), and health-related quality of life (p < .05). No significant interactions were found in BMI × time, and in BMI × group treatment × time. There are not differences among normal weight, overweight and obese patients with FM regarding their response to a multidisciplinary treatment programme for FM which combines pharmacological treatment, education, physical therapy and cognitive behavioural therapy.

Tipología clínica del síndrome de fatiga crónica: hipótesis clasificatoria / Clinical typology of chronic fatigue syndrome: Classificatory hypothesis

No disponible

Efficacy of a multidisciplinary fibromyalgia treatment adapted for women with low educational levels: a randomized controlled trial.

OBJECTIVE: Multidisciplinary treatments of fibromyalgia (FM) have demonstrated efficacy. Nevertheless, they have been criticized for not maintaining their benefits and for not being studied for specific populations. Our objectives were to determine the efficacy of a multidisciplinary treatment for FM adapted for patients with low educational levels and to determine the maintenance of its therapeutic benefits during a long-term followup period. METHODS: Inclusion criteria consisted of female sex, a diagnosis of FM (using American College of Rheumatology criteria), age between 18 and 60 years, and between 3 and 8 years of schooling. Patients were randomly assigned to 1 of the 2 treatment conditions: conventional pharmacologic treatment or multidisciplinary treatment. Outcome measures were functionality, sleep disturbances, pain intensity, catastrophizing, and psychological distress. Analysis was by intent-to-treat and missing data were replaced following the baseline observation carried forward method. RESULTS: One hundred fifty-five participants were recruited. No statistically significant differences regarding pretreatment measures were found between the 2 experimental groups. Overall statistics comparison showed a significant difference between the 2 groups in all of the variables studied (P < 0.0001). Mixed linear model analysis demonstrated the superiority of the multidisciplinary treatment in all of the studied variables at posttreatment. The differences were maintained at 12-month followup in sleep disturbances (P < 0.0001), catastrophizing (P < 0.0001), and psychological distress (P < 0.01). CONCLUSION: Multidisciplinary treatment adapted for individuals with low educational levels is effective in reducing key symptoms of FM. Some improvements were maintained 1 year after completing the multidisciplinary treatment.

Colecistitis hemorrágica y hemofilia: dos complicaciones infrecuentes del lupus eritematoso sistémico / Hemorrhagic cholecystitis and hemobilia: two infrequent complications of systemic lupus erythematosus

Introducción: los pacientes afectos de lupus eritematoso sistémico (LES) sufren con frecuencia síntomas gastrointestinales. Debe incluirse en su diagnóstico diferencial la patología de la vesícula biliar. Presentamos el caso de una paciente con colecistitis alitiásica y hemobilia. Caso clínico: mujer de 24 años diagnosticada de LES en tratamiento con Sintrom®, Dacortin® y Dolquine® que presentó cuadro de colecisititis aguda litiásica y hemobilia, con presencia de cálculo enclavado en papila. Se realizó colecistectomía y apertu - ra del colédoco, lo que permitió confirmar la hemobilia y extracción del cálculo. Discusión: el tratamiento de la colecistitis en los pacientes con LES es controvertido ya que, aunque la mayoría de los casos revisados se han resuelto con la colecistectomía, otros lo han hecho mediante tratamiento conservador con corticosteroides. En nuestra opinión, la presencia de colelitiasis en un paciente con LES, dolor en hipocondrio derecho y sospecha analítico-ecográfica de colecistitis precisa un tratamiento quirúrgico ya que la causa de la colecistitis puede ser vascular por su enfermedad de base, pero también litiásica o mixta. Además, las posibles complicaciones no responderán al tratamiento farmacológico(AU)

Introduction: the patients affected by systemic lupus erythematosus (SLE) often suffer gastrointestinal symptoms. The differential diagnosis should contemplate pathology of the gall bladder. We present the case of a patient with hemorrhagic lithiasic cholecystitis and hemobilia. Case report: 24 year old female diagnosed with SLE under treatment with Sintrom®, Dacortin® and Dolquine® that presented acute lithiasic cholecystitis and hemobilia with a distal calculus. Cholecystectomy and aperture of the ductus choledochus were performed allowing to confirm the hemobilia and to extract the calculus. Discussion: the treatment of cholecystitis in the patients with SLE is controversial due to the fact that most reviewed cases have been solved with cholecystectomy, or in other cases with conservative treatment with corticosteroids. We believe that the presence of cholelithiasis in a patient with SLE with pain on the right hypochondrium and ultrasound confirming the suspicion of cholecystitis demands a surgical treatment since the cause may be vascular, lithiasic or combined. Besides, the possible complications will not respond to pharmaceutical treatment(AU)

Brain edema dynamics in patients with overt hepatic encephalopathy A magnetic resonance imaging study.

UNLABELLED: The aim of our study was to investigate the dynamics of brain water content assessed by magnetic resonance imaging (MRI) applications in patients with cirrhosis and overt episodic hepatic encephalopathy (HE). METHODS: Twenty-four patients with cirrhosis and overt HE, 9 healthy controls and 9 controls with cirrhosis but without HE were included. All patients underwent laboratory analysis, MRI and (1)H MRS in the first 24h after the diagnosis of encephalopathy. Five of them were studied again 5days after the resolution of HE. RESULTS: The values of glutamine/glutamate (Glx) increased progressively (healthy controls: 1.8; cirrhotic controls: 2.4; HE: 4.4; p=0.0001). Values of myo-inositol were lower among cirrhotics than in healthy controls (healthy: 0.6; cirrhotic: 0.3; HE: 0.4; p=0.01). Patients with overt HE showed a decrease in MTR in several brain locations. A significant correlation was observed between MTR values and Glx/creatine ratios (r=-0.54; P=0.004). Five days after the resolution of HE, there were no changes in brain Glx/Cr or MTR but a significant decrease of median ADC in parietal grey matter was observed (acute HE: 121.9 vs. 5days later: 100.5; p<0.05). CONCLUSIONS: Cirrhotic patients with overt HE have a disturbance in the brain osmolyte homeostasis, reflecting a low-grade brain edema. Shortly after the clinical resolution of the episode of HE low-grade brain edema still persists, but there is a decrease in the ADC value in the parietal grey matter, suggesting water flux from extracellular to intracellular compartments and the existence of a vasogenic brain edema.

Effect of antisecretory drugs and nitrates on the risk of ulcer bleeding associated with nonsteroidal anti-inflammatory drugs, antiplatelet agents, and anticoagulants.

OBJECTIVES: After the withdrawal of some cyclooxygenase-2 (COX-2) selective inhibitors, traditional nonsteroidal anti-inflammatory drug (NSAID) use has increased, but without additional prevention strategies against upper gastrointestinal (GI) complications in many cases. Here, we report the effect of antisecretory drugs and nitrates on the risk of upper GI peptic ulcer bleeding (UGIB) associated with nonselective NSAIDs, aspirin, antiplatelet agents, and anticoagulants. METHODS: This case-control study matched 2,777 consecutive patients with UGIB (confirmed by endoscopy) with 5,532 controls (2:1). Adjusted relative risks (RR) of UGIB are reported. RESULTS: Proton pump inhibitors (PPIs) (RR 0.33, 95% confidence interval [CI] 0.27-0.39), H2-receptor antagonists (H2-RAs) (RR 0.65, 95% CI 0.50-0.85), and nitrates (RR 0.52, 95% CI 0.38-0.70) reduced UGIB risk. PPI use was associated with greater reductions among both traditional NSAID (RR 0.13, 95% CI 0.09-0.19 vs RR 0.30, 95% CI 0.17-0.53 with H2-RAs; RR 0.48, 95% CI 0.19-1.24 with nitrates) and low-dose aspirin users (RR 0.32, 95% CI 0.22-0.51 vs RR 0.40, 95% CI 0.19-0.73 with H2-RA; RR 0.69, 95% CI 0.36-1.04 with nitrates), and among patients taking clopidogrel (RR 0.19, 95% CI 0.07-0.49). For patients taking anticoagulants, use of nitrates, H2-RA, or PPIs was not associated with a significant effect on UGIB risk. CONCLUSION: Antisecretory agent or nitrate treatment is associated with reduced UGIB RR in patients taking NSAID or aspirin. Only PPI therapy was associated with a marked, consistent risk reduction among patients receiving all types of agents (including nonaspirin antiplatelet agents). Protection was not apparent in patients taking anticoagulants.

[Normality tables in the Spanish population for psychometric tests used in the diagnosis of minimal hepatic encephalopathy]. / Tablas de normalidad de la población española para los tests psicométricos utilizados en el diagnóstico de la encefalopatía hepática mínima.

BACKGROUND AND OBJECTIVE: Minimal hepatic encephalopathy (MHE) induces an impairment in the quality of life and has been found as the first stage in hepatic encephalopathy syndrome. Psychometric Hepatic Encephalopathy Score (PHES) is a psychometric test battery widely utilized in the diagnosis of MHE which requires correction by age and education. POPULATION AND METHOD: Eight-hundred and eighty four healthy people were included. Trailmaking test-A (TMT-A), TMT-B, digit symbol test (DST), serial dotting (SDT) and line drawing test (LDT) were performed. Age, education, gender, alcohol consumption and hospitalization were recorded. T-student and Pearson correlation were utilized in univariate analyses. A multiple linear regression was performed to detect independent variables associated with psychometric test score. Using the equation from the multiple linear regression, normality tables were built. RESULTS: Age and education were associated with all 5 tests. An alcohol consumption higher than 10 g per day was associated with a lower score in DST and SDT. A gender influence was seen in TMT-A and TMT-B. Moreover, some differences were found in SDT, TMT-B and LDT according to hospital procedence. In multivariate analyses using multiple linear regression, age and education were independently associated with all five tests. CONCLUSIONS: Normality tables of the PHES allow investigating MHE in cirrhotics avoiding local control groups. Taking in mind normality tables, PHES could become a gold standard test to analyze further diagnostic methods and to evaluate drugs efficacy in MHE. Normality tables are freely available at http://www.redEH.org.

Tablas de normalidad de la población española para los tests psicométricos utilizados en el diagnóstico de la encefalopatía hepática mínima / Normality tables in the Spanish population for psychometric tests used in the diagnosis of minimal hepatic encephalopathy

Fundamento y objetivo: La encefalopatía hepática mínima (EHM) ha ganado importancia en la práctica clínica porque su presencia se asocia a un claro deterioro de la calidad de vida del paciente cirrótico y a la incapacidad de conducir automóviles, y es la antesala para el desarrollo de episodios de encefalopatía hepática clínica. La Psychometric Hepatic Encephalopathy Score (PHES), compuesta por el test de conexión numérica A (TCN-A), el test de conexión numérica B (TCN-B), el test de símbolos y números (TSN), el test de marcación seriada (TMS) y el test de la línea quebrada (TLQ), es muy útil en el diagnóstico de la EHM. El objetivo de este trabajo ha sido diseñar las tablas de normalidad de estos 5 tests para la población española. Población y método: Hemos estudiado una muestra de 884 controles sanos de Sevilla, Valencia, Alicante y Barcelona. Las personas realizaron los 5 tests incluidos en la serie PHES. Se analizaron la edad, el sexo, los años de escolarización, el área geográfica y el consumo diario de alcohol. Mediante la prueba de la t de Student y el coeficiente de correlación de Pearson se realizó el análisis univariante. Se efectuó asimismo un análisis de regresión lineal múltiple para cada test y se construyeron las tablas de normalidad. Resultados: En el análisis univariante la edad y los años de escolarización se asociaron con el rendimiento en todos los tests. El consumo de más de 10 g de alcohol al día se asoció con un deterioro en el rendimiento del TSN y TMS; el sexo influyó en el TCN-A y TCN-B, mientras que el área geográfica afectó al TMS, TLQ y TCN-B. En el análisis multivariante (regresión lineal múltiple) la edad y los años de escolarización fueron las 2 variables independientes relacionadas con el rendimiento en cada uno de los 5 tests. Conclusiones: La disponibilidad de estas tablas de normalidad de los tests psicométricos utilizados en el diagnóstico de la EHM permite contar con un método diagnóstico de referencia aplicable a los pacientes con cirrosis hepática españoles, sin la necesidad de configurar grupos controlados por edad y nivel de estudios en cada área sanitaria. Las tablas de normalidad están disponibles en http://www.redEH.org

Background and objetive: Minimal hepatic encephalopathy (MHE) induces an impairment in the quality of life and has been found as the first stage in hepatic encephalopathy syndrome. Psychometric Hepatic Encephalopathy Score (PHES) is a psychometric test battery widely utilized in the diagnosis of MHE which requires correction by age and education. Population and method: Eight-hundred and eighty four healthy people were included. Trailmaking test-A (TMT-A), TMT-B, digit symbol test (DST), serial dotting (SDT) and line drawing test (LDT) were performed. Age, education, gender, alcohol consumption and hospitalization were recorded. T-student and Pearson correlation were utilized in univariate analyses. A multiple linear regression was performed to detect independent variables associated with psychometric test score. Using the equation from the multiple linear regression, normality tables were built. Results: Age and education were associated with all 5 tests. An alcohol consumption higher than 10 g per day was associated with a lower score in DST and SDT. A gender influence was seen in TMT-A and TMT-B. Moreover, some differences were found in SDT, TMT-B and LDT according to hospital procedence. In multivariate analyses using multiple linear regression, age and education were independently associated with all five tests. Conclusions: Normality tables of the PHES allow investigating MHE in cirrhotics avoiding local control groups. Taking in mind normality tables, PHES could become a gold standard test to analyze further diagnostic methods and to evaluate drugs efficacy in MHE. Normality tables are freely available at http://www.redEH.org