¿Debemos redefinir la población diana en el cribado de cáncer cervical con la técnica de Papanicolaou? / Should we redefine the target population in cervical cancer screening with the Pap test?

Objetivo: Conocer los resultados de las citologías realizadas en un centro de salud en un año, así como cuál es el manejo de las alteraciones detectadas. Material y método: Estudio transversal, realizado en un centro de salud urbano. Se incluyeron 1.314 mujeres citadas para realización de citología vaginal entre el 1 de marzo de 2011 y el 29 de febrero de 2012. A partir de la información incluida en la historia clínica se registró: fecha de nacimiento, nacionalidad, fecha de citas y asistencia, resultado de citología, tratamiento por médico de familia o ginecólogo, cumplimiento de criterios de inclusión en este servicio (SESCAM), y uso de anticoncepción. Resultados: La mediana de edad de las mujeres citadas era 40 años (rango: 17-82). Se analizaron 1.028 citologías. El 81,9% eran normales. Presentaron alguna alteración inflamatoria/infecciosa 166, en 7 se detectó ASCUS, y en 6 y en 4 SIL de bajo y alto grado, respectivamente. Precisaron valoración por ginecología 30 mujeres, 3 de las cuales fueron sometidas a biopsia (resultados: normal, CIN I y CIN III). De las 1.254 mujeres en que se registró el criterio de inclusión, 29% no cumplían los establecidos en la cartera de servicios del SESCAM. Conclusiones: Algo más de la cuarta parte de las mujeres que toman cita para realización de citología no reúnen criterios de inclusión en el mismo. Los hallazgos patológicos son muy infrecuentes. Estas circunstancias deben hacernos reconsiderar las condiciones de prestación del servicio

Objective: To identify the results of the Pap tests performed in a health center in a 1-year period and the management of the changes detected. Material and methods: This cross-sectional survey, carried out in an urban health center, included 1314 women with an appointment for a Pap smear between March 1, 2011 and February 29, 2012. Based on information in the medical history, we recorded date of birth, nationality, date of appointment and attendance, Pap result, medical treatment by the family physician or gynecologist, whether the patient met the criteria for inclusion in this service (SESCAM), and contraception use. Results: The median age of the women was 40 years (range: 17-82). We analyzed 1028 Pap tests; 81.9% were normal. Some inflammatory/infectious alterations were detected in 166 women, ASCUS was detected in 7, low-grade SIL in 6, and high-grade SIL in 4. Thirty women were referred to a gynecologist and a biopsy was performed in 3 (results: normal, CIN I and CIN III). Of the 1254 women with recorded inclusion criteria, 29% did not meet those of the SESCAM. Conclusions: Just over a quarter of the women attending appointments for Pap smears did not meet the criteria for this test. Pathological findings were infrequent. These findings indicate the need to reconsider the conditions for this service

Capacidad funcional, características del dolor y tratamiento farmacológico en pacientes con artrosis de rodilla / Functional capacity, pain characteristics and drug therapy in patients with knee osteoarthritis

Introducción. El objetivo de este estudio es valorar las características del dolor, la capacidad funcional y el tratamiento farmacológico de pacientes con gonartrosis que acuden a consultas de medicina familiar, así como los factores asociados con los mismos. Material y métodos. Se diseñó un estudio transversal. Por muestreo consecutivo fueron seleccionados pacientes mayores de 50 años que acudieron a consulta por dolor de rodilla y que cumplían criterios diagnósticos de gonartrosis (Sociedad Española de Reumatología), desde febrero a noviembre de 2011. A través de un protocolo específicamente diseñado se registraron variables sociodemográficas, clínicas, cuestionarios WOMAC y Lequesne, escala analógica visual de dolor, realización de radiografía de rodillas, y uso de fármacos. Resultados. Se incluyeron 86 pacientes, 70,9% mujeres, con rango de edad de 52-93 años (media: 73,7). El 96,5% tenía otras enfermedades crónicas. Tomaban analgésicos regularmente 83, con 87,9% (IC 95%:80,3-95,6) en el primer escalón analgésico de la Organización Mundial de la Salud (OMS). Los pacientes en los escalones 2 y 3 puntuaban significativamente más alto en la escala analógica visual que aquellos en el estadio 1 o que no tomaban analgésicos (media: 7,9 vs 5,9; p = 0,01). Con relación al cuestionario WOMAC existían diferencias significativas solo para 2 ítems: todos los que tomaban opioides tenían dificultad para levantarse de la cama (p = 0,001), y el 90% para levantarse del retrete (p = 0,005). El índice de Lequesne mostró un valor medio de 13,1 (DE: 4,1; rango: 3-21). Conclusiones. La gran mayoría de los pacientes con artrosis de rodilla que consultan en Atención Primaria tienen dolor fundamentalmente con el movimiento, lo que limita severamente su capacidad funcional. Los analgésicos se utilizan poco, por lo que queda un amplio margen terapéutico en estos pacientes (AU)

Introduction. Our objective was to assess the characteristics of pain, functional capacity, and pharmacological treatment in patients with knee osteoarthritis attending primary care centers and the factors associated with these characteristics. Material and methods. A cross-sectional study was performed in which patients over 50 years old consulting for knee pain and meeting diagnostic criteria for knee osteoarthritis (Spanish Rheumatology Society) were selected by consecutive sampling from February to November 2011. The following variables were recorded using a specifically designed protocol: sociodemographic and clinical variables, the WOMAC and Lequesne questionnaires, visual analog pain scale, radiographs of the knees, and drug use. Results. We included 86 patients, of whom 70.9% were women. Age ranged from 52 to 93 years (mean: 73.7) and 96.5% had other chronic diseases. Eighty three patients took analgesics regularly and 87.9% (95% CI: 80.3-95.6%) were in the first step of the World Health Organization (WHO) analgesic ladder. Patients in steps 2 and 3 scored significantly higher on the visual analog scale than those in stage 1 or not taking analgesics (mean: 7.9 vs 5.9, p = .01). The WOMAC scale showed significant differences in only two items: all those taking opioids had difficulty getting out of the bed (p = .001), and 90% had difficulty in rising from the toilet (p = .005). The Lequesne index showed a mean value of 13.1 (SD: 4.1; range 3-21). Conclusions. Most patients with knee osteoarthritis attending primary care essentially have pain on movement, severely limiting their functional capacity. Analgesics are used to a limited extent, leaving a wide therapeutic margin in these patients (AU)

Prevalencia de depresión en adolescentes / Depresión prevalence in adolescents

Introducción. El objetivo del estudio es conocer la prevalencia de manifestaciones depresivas en adolescentes, así como las variables sociodemográficas asociadas con las mismas.Método. Diseño: estudio observacional descriptivo transversal. Emplazamiento: tres centros de enseñanza urbanos. Participantes: 389 alumnos de enseñanza secundaria obligatoria entre los 12 y 16 años que contestaron de forma libre y anónima el cuestionario. Mediciones: Cuestionario de Depresión para Niños (CDS), autocumplimentable, validado en su adaptación española para su aplicación individual y colectiva. Cuestionario APGAR familiar. Variables relativas a circunstancias sociodemográficas, rendimiento académico y presencia de enfermedades crónicas.Resultados. Se excluyeron 10 sujetos que contestaron de forma incompleta. En los 379 sujetos a estudio, 39 presentaron puntuaciones del CDS en rango depresivo (decatipo >= 8): 10,29 % (IC 95 %: 7,2-13,3 %). En el análisis bivariante sólo encontramos diferencias para la presentación de manifestaciones depresivas en relación con la existencia de disfunción familiar diagnosticada por el test de APGAR: 24,4 frente a 6,1 % (p < 0,0001). En el análisis de regresión logística el modelo que mejor predice la presencia de un diagnóstico de depresión incluye las variables disfunción familiar, con una OR de 4,27 (IC 95 %: 1,98-9,21) para disfunción leve y OR de 14,44 (IC 95 %: 4,61-45,17) para disfunción grave, y número de hermanos con OR de 0,56 (IC 95 %: 0,33-0,93).Conclusiones. La prevalencia de manifestaciones depresivas entre adolescentes es elevada, siendo más frecuente en miembros de familias disfuncionantes, mientras que un mayor número de hermanos tendría un efecto protector

Introduction. This study aimed to know the prevalence of depressive manifestations in adolescents and the sociodemographic variables associated with them.Method. Design: observational, descriptive, cross-sectional study. Location: three urban teaching centers. Participants: 389 students of obligatory secondary education from 12 to 16 years who answered the questionnaire freely and anonymously. Measurements: Questionnaire of Depression for Children (CDS), self-applicable, validated in their Spanish adaptation for their individual and collective administration. Family APGAR questionnaire. Variables regarding sociodemographic, academic yield and presence of chronic illnesses circumstances.Results. 10 children were excluded because they answered in an incomplete way. In the 379 study subjects, 39 had a score on the CDS in the depressive range (decatype >= 8): 10.29 % (95 % CI: 7.2 %-13.3 %). In the bivariate analysis, we only found differences for the presentation of depressive symptoms in connection with the existence of family dysfunction diagnosed by the APGAR test: 24.4 % versus 6.1 % (p < 0.0001). In the logistic regression analysis, the model that best predicts the presence of one diagnosis of depression includes the family dysfunction variable, with an OR = 4.27 (95 % CI: 1.98- 9.21) for mild dysfunction and OR = 14.44 (95 % CI: 4.61- 45.17) for serious dysfunction, and sibling number with OR 0.56 (95 % CI: 0.33-0.93).Conclusions. Prevalence of depressive manifestations among adolescents is high, being more frequent in members of dysfunctional families, while a greater number of siblings would have a protective effect

Depression prevalence in adolescents.

INTRODUCTION: This study aimed to know the prevalence of depressive manifestations in adolescents and the sociodemographic variables associated with them. DESIGN: observational, descriptive, cross-sectional study. LOCATION: three urban teaching centers. PARTICIPANTS: 389 students of obligatory secondary education from 12 to 16 years who answered the questionnaire freely and anonymously. MEASUREMENTS: Questionnaire of Depression for Children (CDS), self-applicable, validated in their Spanish adaptation for their individual and collective administration. Family APGAR questionnaire. Variables regarding sociodemographic, academic yield and presence of chronic illnesses circumstances. RESULTS: 10 children were excluded because they answered in an incomplete way. In the 379 study subjects, 39 had a score on the CDS in the depressive range (decatype > or = 8): 10.29 % (95 % CI: 7.2 %-13.3 %). In the bivariate analysis, we only found differences for the presentation of depressive symptoms in connection with the existence of family dysfunction diagnosed by the APGAR test: 24.4 % versus 6.1 % (p < 0.0001). In the logistic regression analysis, the model that best predicts the presence of one diagnosis of depression includes the family dysfunction variable, with an OR = 4.27 (95 % CI: 1.98- 9.21) for mild dysfunction and OR = 14.44 (95 % CI: 4.61- 45.17) for serious dysfunction, and sibling number with OR 0.56 (95 % CI: 0.33-0.93). CONCLUSIONS: Prevalence of depressive manifestations among adolescents is high, being more frequent in members of dysfunctional families, while a greater number of siblings would have a protective effect.

Extirpación de carcinomas no palpables de mama mediante el sistema ABBI. Estudio anatomopatológico de la glándula mamaria circumlesional / Extirpation of nonpalpable breast carcinomas using the Advanced Breast Biopsy Instrumentation (ABBI) system. Pathological study of the circumlesional mammary gland

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[Detection of bulimia nervosa in primary health care consultations]. / Detección de bulimia nerviosa en las consultas de Atención Primaria.

INTRODUCTION: To estimate the prevalence of bulimia nervosa and bulimic behavior in women who come to Primary Health Care consultations, using the DSM-IV criteria. DESIGN: Descriptive, observational study Setting. Primary Health Care. PARTICIPANTS: Women over 14 years who come to general medicine consultations. Selection by systematic sampling of 175 women (proportion expected: 4%; confidence index: 95%; accuracy: 3%). MAIN MEASURES: Examination, by semi-structured interview, of diagnostic criteria of bulimia (recurrent binge eating, compensatory behaviors and excessive concern about weight or body image), socio-demographic variables and variables on morbidity (health problems according to CIPSAP-2-defined). RESULTS: Prevalence of bulimia was 5.3% (95% CI: 2.4-9.7), there being recurrent binge-eating in 23.4%. Among the compensatory behaviors, fasting (13.5%), intense exercise (8.2%) and self-induced vomiting (4.7%) were the most frequent. In women with bulimia, a background of anorexia and establishment of goals to lose weight appeared more frequently (p <0.05). Their average age was significantly lower (p <0.05) (31.2 14.7 SD). By logistic regression, the associated variables with the presence of bulimia were age (OR: 0.94), existence of previous psychiatric morbidity (OR: 9.0) and having previously set goals to lose weight (OR:7.3). CONCLUSIONS: In the women who came to the Primary Health Care consultations, prevalence of bulimia is greater than that described in the general female population. This disorder is more frequent in younger women and in those who present a background of psychiatric morbidity. Examination of the diagnostic criteria makes its detection easy in Primary Health Care consultations.

Diferencias bioquímicas entre los quistes de mama benignos tipo II únicos y asociados a tipo I / Biochemical differences between single benign type ii breast cysts and those associated with type ii breast cysts

Introducción. Los quistes mamarios tipo II se caracterizan por presentar en el líquido altas concentraciones de Na+, albúmina, pH y cloruros (Cl-) y parecen corresponder al estadio más avanzado de la enfermedad macroquística. En el presente estudio hemos querido analizar la posible influencia de la coexistencia de quistes tipo I, reflejo de la actividad de la enfermedad, sobre las características bioquímicas de los quistes tipo II. Pacientes y métodos. El grupo estudio incluyó 124 líquidos de quistes tipo II (Na+/K+ > 1,5), de los cuales 72 fueron únicos y 52 asociados a quistes tipo I. En ellos determinamos las concentraciones de Na+, K+, Cl-, glucosa, albúmina, pH y volumen. Resultados. Los quistes tipo II únicos presentaron mayores valores de pH (p = 0,0306) e índice Na+K+ (p = 0,0205), así como menores de K+ (p = 0,0313) y volumen (p = 0,0014). No se constataron diferencias entre ambos grupos en las mujeres en fase folicular, pero sí en las de fase luteínica y menopáusicas. Cuando el dintel clasificador de los quistes fue establecido en una relación Na+/K+ > 3, observamos que los quistes tipo II únicos presentaban valores mayores de pH y menor volumen. Conclusiones. Los resultados anteriores indican que los quistes tipo II únicos presentan unas características bioquímicas distintas de cuando se asocian con quistes tipo I, de tal modo que en esta situación adquieren ciertas propiedades de estos últimos, lo cual puede ser el exponente de una fase más activa de la enfermedad (AU)

Estudio de las concentraciones del antígeno prostático específico en líquidos quísticos benignos mamarios. Correlación con otros parámetros clinicobiológicos / Study of prostate specific antigen levels in benign breast cyst fluids: correlation with other clinical and biological parameters

Introducción. El antígeno prostático específico (PSA, hK3) es una serín-proteasa no específica de la glándula prostática que puede ser detectada en los líquidos de quistes mamarios. El presente trabajo ha sido realizado con la finalidad de estudiar el comportamiento del PSA en líquidos de quistes mamarios benignos clasificados de acuerdo con la fase del ciclo menstrual, tipo de quiste y la existencia de quistes únicos o múltiples. Pacientes y métodos. Hemos determinado, mediante un fluoroinmunoanálisis (Prostatus. PSA EQM. EC&G Wallac., Finlandia), las concentraciones de PSA en 160 líquidos de quistes mamarios benignos (134 tipo I, 26 tipo II, 42 únicos y 118 múltiples), correlacionándose con las de glucosa, pH, CEA y DHEA. Resultados. Nuestros resultados fueron los siguientes: a) los quistes tipo I presentaron mayores concentraciones de PSA que los tipo II, no apreciándose diferencias cuando se consideraron la fase del ciclo menstrual y la existencia de quistes únicos o múltiples;b) en los quistes tipo I las concentraciones de PSA se correlacionaron significativamente con las de DHEA, mientras que en los quistes tipo II lo hicieron estadística y negativamente con las de glucosa, y c) en los quistes únicos no existieron diferencias en las concentraciones de PSA en función de la fase del ciclo menstrual, pero aquéllas fueron superiores estadísticamente en los quistes tipo I que en los tipo II; sin embargo, en los quistes múltiples no se constataron diferencias en las cifras de PSA cuando se consideraron el tipo y la fase del ciclo menstrual, las concentraciones de PSA fueron significativamente mayores en los quistes tipo II múltiples que en los tipos II únicos y no difirieron de las observadas en los quistes tip I únicos. Conclusiones. Nuestros resultados nos sugieren que el comportamiento del PSA en los líquidos de quistes mamarios benignos parece estar relacionado no sólo con el tipo I, sino también con la existencia de quistes múltiples (AU)

[Electrophoretic patterns of lactate dehydrogenase isoenzymes in fluid from 261 benign breast cysts]. / Estudio electroforético de las isoenzimas de la lactatodeshidrogenasa en el líquido de 261 quistes de mama benignos.

BACKGROUND: Some groups have described the presence of lactate dehydrogenase (LDH) and certain isoenzymes in breast cyst fluids, but their clinical usefulness is unknown. We have studied the behavior of LDH isoenzymes in benign breast cysts fluids with the aim of understand their clinical meaning. SUBJECTS AND METHOD: The study group included 261 benign breast cyst fluids classified, according to the Na+ / K+ ratio, as follows: type I (Na+ / K+ >/= 3): 188, and type II (Na+ / K+ > 3):73. The electrophoretic LDG isoenzymes analysis was carried out with the PARAGON system and the Appaise Junior densitometer from Beckman Instruments (U.S.A.). RESULTS: The results were as follows: a) type II was more frequently associated with the presence of LDH than type I breast cyst fluids (41/73 vs 9/188; p < 0.0001) and b) the LDH5 isoenzyme positivity was higher in type II than in type I breast cysts fluids (29/41 vs 4/188; p < 0.001) also and it correlated with higher pH, C1, carcinoembryonic antigen and Na+ / K+ ratio values. CONCLUSIONS: Our results led us to consider that LDH and LDH5 isoenzyme positivity is associated with type II breast cyst fluids, suggesting that it does not reflect a higher transformation risk, but rather that is a consequence of cyst evolution and of its lining wall.

[Absence of correlation between the concentrations of carcinoembryonic antigen (CEA) and the tumor growth factor beta 2 (TGFB2) in the two main types of breast macrocysts]. / Ausencia de correlación entre las concentraciones del antígeno carcinoembrionario (CEA) y del factor de crecimiento tumoral beta 2 (TGFB2) en los dos tipos principales de macroquistes mamarios.

In order to study the possible correlation between carcinoembryonic antigen (CEA) and cellular proliferation, we assayed the concentrations of this substance in the fluid of 77 bening macrocysts of the breast classified according to their Na+/K+ ratio and compared them with those of transforming growth factor beta 2. CEA levels correlated positively and significantly with the cationic ratio, the concentrations of albumin, glucose, Cl- and pH and were higher (range: 2.5-81.5, median 12.8 vs range: 0.4-41.5, median 3.2 ng/ml (p: 0.00000) in type 2 (Na+/K+ > 3) than in type 1 (Na+/K+ < 3) cysts. There was no correlation between CEA and TGFb2, nor between the former and dehydroepiandrosterone sulphate levels. These results led us to suggest that the high CEA concentrations in type 2 cysts seem to be the consequence of loos of cellular differentiation and disruption of the cyst wall lining as well as the acquisition of embryonary properties by the latter as a consequence of a reduced hormonal microenvironment.

[Major depression in consumers of benzodiazepines]. / Depresión mayor en consumidores de benzodiacepinas.

OBJECTIVE: To determine the proportion of benzodiazepines consumers who present a mayor depressive disorder and to observe the clinical evolution after restoring an antidepressive treatment. DESIGN: An observational design with a transversal character to determine the prevalence of the depression and a pre and after intervention to observe the answer to the treatment. SETTING: Primary Care. PATIENTS: Patients of the Centro de Salud Zona IV of Albacete who consume benzodiazepines (size of the sample: 91 subjects, selected by means of a consecutive pattern in three medical offices of general practice). INTERVENTION: To install an antidepressive treatment. MEASUREMENTS AND MAIN RESULTS: We explored the presence of nuclear symptoms of depression by means of a interview. The other analyzed variables were: the cognitive state, the characteristics of the consume of benzodiazepines, the problems of health, the intake of other medicines, the frequentation, the installation of the antidepressive treatment and the sociodemographic characteristics. The patients diagnosed of mayor depression were interviewed again after one month and after three months. 37 patients presented criterion of mayor depression (40.7%) (CI 95%: 30.5-51.5). In these an antidepressive treatment was restored, corresponding to selective serotonin reuptake inhibitors in the 91.9% of the occasions. The proportion of depressive patients was higher in women (p = 0.04) and under the diagnosed people we observed a lower period of benzodiazepines consume (p = 0.02), although with a much higher daily consume (p = 0.01). Among the 37 patients who initiated the treatment, only 7 presented adverse reaction. 28 patients were appraised after one month, presenting 6 of them 5 or more nuclear symptoms of depression. CONCLUSIONS: The high proportion of mayor depressive frames can justify the systematic investigation of such disorder in benzodiazepines consumers, specially in women and in patients with a high intake. The identification of the nuclear symptoms can be considered as a useful technique to orientate a mayor depression and to evaluate also the results of an antidepressive treatment.

[Knowledge and use of contraceptive methods by the female population in a health-care district]. / Conocimiento y uso de métodos anticonceptivos por la población femenina de una zona de salud.

BACKGROUND: The use of contraceptives is related to factors including those of a demographic, social, economic, educational and ideological nature. The purpose of our study is that of ascertaining with what contraceptive methods the women of child-bearing age assigned to a given health care center are familiar, in addition to prevalence of the use thereof. METHODS: Based on the health care card listing, 389 of the 5800 women of child-bearing age (15-45 years old) assigned to the health care center in question were selected by means of a systematic sampling. After sending them a letter notifying them of the reason for this study, they were contacted by telephone to fill out the survey, which included questions regarding their knowledge and use of contraceptive methods, their sociocultural characteristics and sexual activity. Appointments at the health center were made with those women who did not have telephones. RESULTS: 178 women were contacted, 166 of whom took part in the survey (42.7% response rate). 86 of these women (51.8%; CI: 44.2-59.4%) were using some means of contraception. Nevertheless, among women at risk of unwanted pregnancies, the prevalence of use was 70.5% (CI: 62.4-78.6%), being worthy of special mention the fact that solely 45.4% of the women within the 40-45 age group were using contraceptives, revealing a frequency significantly lower than the other age groups. The methods known to the greatest degree were the condom (90.4%), oral contraceptives (89.2%) and the IUD (78.3%), the knowledge of other means being scant. CONCLUSIONS: The rate of use of contraceptive methods among women at risk of unwanted pregnancy is acceptable, although strikingly low among the women in the 40-45 age group. The methods known most were the condom, oral contraceptives and the intrauterine device.

[Effect of mexiletine on glucose and oxygen uptake in rat brain, liver and myocardial tissue in vitro (author's transl)]. / Efectos de la mexiletina sobre el consumo de oxígeno y glucosa en cerebro, hígado y miocardio de rata in vitro.

The effect of mexiletine on oxygen and glucose consumption was studied both in homogenate and slices of brain, liver and myocardium of Wistar rats. Oxygen consumption was detected by means of Warburg's manometric techniques, and glucose utilization by the enzymatic method of glucose oxidase. Whilst glucose uptake was not modified in any of the studied preparations, mexiletine promoted a significant increase of oxygen consumption in the homogenized slices, and an inhibition in the intact tissue.