May Measurement Month 2018: an analysis of blood pressure screening results from Ecuador.

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative by the International Society of Hypertension (ISH) aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2018. A volunteer cross-sectional survey was carried out in May 2017 across 33 health centres. Blood pressure measurement, the definition of hypertension (HTN) (mean of the 2nd and 3rd BP measurement ≥ 140/90 mmHg or who were medicated for high BP), and statistical analysis followed the standard MMM protocol. In total, 11 922 individuals (53.7% female) were screened during MMM18. After multiple imputation, 4563 (38.3%) had HTN. Of individuals not receiving antihypertensive medication, 1302 (15.0%) were hypertensive. Of individuals receiving antihypertensive medication, 933 (28.6%) had uncontrolled BP. MMM18 was the largest BP screening campaign done in Ecuador. Hypertension was detected in 38.4% of those screened and almost 4 out of 10 were either not on treatment or were not controlled to the BP goal. These results suggest that appropriate screening can help to identify a significant number of people with high BP. These data should attract the attention of doctors and health care system in Ecuador.

Diagnostic stability in bipolar disorder: a systematic review.

INTRODUCTION: Stability of a diagnosis over time represents the best evidence to validate psychiatric diagnoses and helps to predict the course of a disorder. The diagnosis of bipolar disorder shows large variability over time and only a few numbers of investigations have evaluated the impact of the diagnostic stability vs the change. MATERIAL AND METHODS: A systematic review was made through a literature search in Pubmed, Medline and Web of Science of the articles published in the last 10 years (2008- 2018). We used the following key words; "stability diagnosis", AND "bipolar disorders", AND "mood disorders". We selected those studies conducted in patients who presented affective and/or psychotic clinic where the stability of the diagnosis was studied over time. RESULTS: The initial search showed a total of 140 articles, 13 of which met inclusion criteria. In this review we have found that, compared to other mental disorders, Bipolar Disorder has in its favor a greater construct validity and longterm stability. CONCLUSIONS: Initial phases of Bipolar Disorder constitute a real diagnostic and therapeutic challenge. Despite this, it is considered, added to schizophrenia as one of the most stable diagnostic categories (60% of patients who receive this initial diagnosis remain it during time). The absence of reliable and valid instruments for diagnosis is considered as a limitation so it would be convenient that in the next classifications of mental disorders they continue striving so that the nosological entities have greater construct validity possible.

May Measurement Month 2017: analysis of the blood pressure screening results in Ecuador-Americas.

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. Previous hypertension surveys in Ecuador, showed that there was a prevalence of 28% of adults with hypertension in 1999, 53% in adults between 60 and 75 years in 2010, and. 9.3% in people between 18 and 59 years in 2012 [Freire WB, Ramírez-Luzuriaga MJ, Belmont P, Mendieta MJ, Silva-Jaramillo MK, Romero N, Sáenz K, Piñeiros P, Gómez LF, Monge R. Tomo I: Encuesta Nacional de Salud y Nutrición de la población ecuatoriana de cero a 59 años. ENSANUT-ECU 2012. Ministerio de Salud Pública/Instituto Nacional de Estadísticas y Censos. Quito-Ecuador 2014]. The May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP that can temporarily address the lack of screening programmes worldwide. Verbal informed consent was obtained from respondents. We enrolled 16 sites for the measurement of arterial BP and completion of the MMM17 questionnaire, the most important sites being: Guayaquil, Quito, Cuenca, Milagro, Esmeraldas, Duran, Naranjito, and Machala. We administered the MMM17 survey on 6984 people, of which 50.5% of them were men and 48.4% were women. Mean age was 46.62 ± 17.71 SD. The crude mean BP was 115/74 mmHg. Of the 6984 people who completed the survey, we had 1522 that were already taking anti-hypertensive treatment. The number of people with hypertension (≥140 or ≥90 or on treatment for hypertension) was 1968/6982 (28.2%) persons. The number of people with hypertension of those not receiving treatment was 446/5460 (8.2%) and the number of people receiving treatment but with controlled and uncontrolled BP was 1136/1522 (74.6%) and 386/1522 (25.4%), respectively. MMM17 was the largest BP screening campaign undertaken in Ecuador. We identified 446 people with hypertension that were not receiving any treatment and 386 people with uncontrolled hypertension. These results suggest that opportunistic screening can identify significant numbers with raised BP.

Thyroid cancer patients receiving an interdisciplinary team-based care approach (ITCA-ThyCa) appear to display better outcomes: Program evaluation results indicating a need for further integrated care and support.

BACKGROUND: Thyroid cancer (ThyCa) is generally associated with a favorable prognosis and excellent surgical outcomes. Consequently, its treatment is medically focused and current guidelines recommend interdisciplinary care including access to a nurse for complex cases alone. To date, no studies have evaluated the need for and impact of an Interdisciplinary Team-based Care Approach (ITCA-ThyCa) for general thyroid cancer patients, including a dedicated nurse as part of a larger interdisciplinary team, as well as patient-reported outcomes, as is recommended worldwide in cancer care. Our aim was to evaluate such a program. METHODS: The ITCA-ThyCa was evaluated within a quasi-experimental design using the Centers for Disease Control Framework for Program Evaluation, including process and outcome measures. Patients eligible were adults with a biopsy indicating confirmed or highly suspicious ThyCa (TNM-Classification + Bethesda score of V/VI). The intervention group (IG) received ITCA-ThyCa and the comparison group (CG), usual care alone. RESULTS: In our sample comprised of 200 participants (122 IG; 78 CG), ITCA-ThyCa patients appeared to show significantly better outcomes than CG patients, namely, higher levels of overall well-being (P = .001) and fewer physical (P = .003) and practical (P = .003) issues and concerns. More satisfied with their overall care (P = .028), including care coordination (P = .049), they reported their health care provider as more approachable (P = .007), respectful (P = .005), and trustworthy (P = .077; trend) and were more likely to recommend their hospital (P = .02). Ninety-eight percent of IG patients recommended ITCA-ThyCa. CONCLUSION: Data from our program illustrates that hospital resources should not be allocated based on medical trajectory alone and challenges the idea that ThyCa is "straightforward." ThyCa patients seem to experience symptom distress at a level comparable to-or exceeding-that of general oncological patients despite their promising medical outcomes, indicating that better integrated care and support are in order.

A journey through heart valve surgery.

It is evident that valvular surgeries have made countless advances since the first valve surgery in 1925 when Dr Henry Souttar operated on a woman with mitral stenosis. Patients in the 21st century have a better chance of surviving as a result of these advances. In addition to providing high-quality health care to patients, educating patients and their families regarding the disease processes, symptoms, diagnosis, types of valve surgeries, different approaches, complications, nonsurgical care, recovery, and lifestyle changes is an instrumental component to a successful recovery.

Potencial abuso y dependencia de tianeptina. Revisión a propósito de un caso / Potential tianeptine abuse and dependence: a case review

OBJETIVO: Señalar, mediante la exposición de un caso clínico, la necesidad de tener en cuenta el riesgo de abuso o dependencia de un antidepresivo de reciente aparición en nuestro país: la tianeptina. CASO CLÍNICO: Se presenta el caso de un varón de 47 años con diagnósticos de trastorno bipolar tipo ii, trastorno límite de personalidad y trastorno por uso sustancias, que presentaba una dependencia a tianeptina, de la que llegó a consumir 1.125mg al día. RESULTADOS: Durante la búsqueda bibliográfica apenas se encontraron revisiones de casos centrados en el potencial abuso o dependencia de tianeptina. Se halló que, por la modulación de los sistemas de neurotransmisión opioidérgico (activación de los receptores μ), su uso a dosis altas se relaciona con un mayor riesgo. CONCLUSIONES: Ciertas características personales y enfermedades, como pueden ser los trastornos de personalidad o un abuso de sustancias previo, implican una mayor probabilidad de abuso o dependencia de tianeptina

OBJECTIVE: Using a clinical case, the aim of this article is to point out the need to take into account the risk of abuse and / or dependence on tianeptine, an antidepressant that has recently appeared in Spain. CLINICAL CASE: The case is presented on a 47-year-old man diagnosed with type II bipolar disorder, borderline personality disorder, and substance use disorder with tianeptine dependency, consuming 1,125mg per day. RESULTS: During the bibliographic search, few reviews were found that focused on the potential abuse or dependence on tianeptine. High-dose use was found to be associated with an increased risk, explained by modulation of opioidergic neurotransmission systems (activation of μ receptors). CONCLUSIONS: Some personal characteristics and pathologies, such as personality disorders or previous substance abuse, imply a greater probability of abuse or dependence on tianeptine

Estabilidad diagnóstica en el trastorno bipolar: una revisión sistemática / Diagnostic stability in bipolar disorder: a systematic review

INTRODUCCIÓN: La estabilidad de un diagnóstico psiquiátrico en el tiempo representa la mejor prueba para validarlo y es útil para predecir el curso de un trastorno. El diagnóstico de Trastorno Bipolar presenta gran variabilidad a lo largo del tiempo y son pocas las investigaciones que han evaluado el impacto de la estabilidad diagnóstica vs su cambio. MATERIAL Y MÉTODOS: Se realizó una revisión sistemática mediante búsqueda bibliográfica en Pubmed, Medline y Web of Science de artículos publicados en los últimos diez años (2008-2018), utilizando las siguientes palabras clave: stability diagnosis, bipolar disorders y mood disorders. Se seleccionaron aquellos estudios realizados en pacientes que presentaban un cuadro afectivo y/o psicótico y en los que se estudiaba la estabilidad temporal del diagnóstico. RESULTADOS: La búsqueda inicial mostró un total de 140 artículos, de los cuales 13 cumplieron los CRITERIOS DE INCLUSIÓN: Hemos encontrado que, en comparación con otros trastornos mentales, en el Trastorno Bipolar se observa una mayor validez de constructo y estabilidad a largo plazo. CONCLUSIONES: El Trastorno Bipolar en su fase inicial constituye un desafío diagnóstico y terapéutico. Pese a ello, se considera junto con la esquizofrenia una de las categorías diagnósticas más estables (el 60% de los pacientes que reciben este diagnóstico inicial se mantiene en el tiempo). La ausencia de instrumentos fiables y válidos para el diagnóstico es considerada una limitación, por lo que sería conveniente que en sucesivas clasificaciones de los trastornos mentales sigan esforzándose en que las entidades nosológicas tengan la mayor validez de constructo posible

INTRODUCTION: Stability of a diagnosis over time rep-resents the best evidence to validate psychiatric diagnoses and helps to predict the course of a disorder. The diagnosis of bipolar disorder shows large variability over time and only a few numbers of investigations have evaluated the impact of the diagnostic stability vs the change. MATERIAL AND METHODS: A systematic review was made through a literature search in Pubmed, Medline and Web of Science of the articles published in the last 10 years (2008-2018). We used the following key words; "stability diagno-sis", AND "bipolar disorders", AND "mood disorders". We selected those studies conducted in patients who presented affective and/or psychotic clinic where the stability of the diagnosis was studied over time. RESULTS: The initial search showed a total of 140 articles, 13 of which met inclusion criteria. In this review we have found that, compared to other mental disorders, Bipolar Disorder has in its favor a greater construct validity and long-term stability. CONCLUSIONS: Initial phases of Bipolar Disorder consti-tute a real diagnostic and therapeutic challenge. Despite this, it is considered, added to schizophrenia as one of the most stable diagnostic categories (60% of patients who receive this initial diagnosis remain it during time). The absence of reliable and valid instruments for diagnosis is considered as a limitation so it would be convenient that in the next classifications of mental disorders they continue striv-ing so that the nosological entities have greater construct validity posible

Perfusión intravenosa de tiaprida en un caso de delirium resistente a tratamiento / Intravenous perfusion of tiapride in a case of treatment-resistant delirium

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