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Placido Paias R.,Medico Residente de Pediatria | Marquez Armenteros A.M.,Complejo Hospitalario Universitario Of Badajoz
Pediatria Integral

When we detect a splenomegaly, we must rule out many entities like oncohaematological, autoimmune, metabolic, infectious, pharmacological or genetics diseases. We present the clinical case of a 13-yearsold girl, previously healthy, who is referred to our department to study a massive splenomegaly and a leukothrombocytopenia as the only manifestations of an uncommon disease. © 2011 Sociedad Española de PEDIATRÍA Extrahospitalaria y Atención Primaria (SEPEAP). Source

Carrasco Cubero C.,Complejo Hospitalario Universitario Of Badajoz | Chamizo Carmona E.,Servicio de Reumatologia
Reumatologia Clinica

Systemic mastocytosis (SM) is a clonal disease of mast cell progenitors from the bone marrow. The clinical picture varies from asymptomatic forms (indolent) to a highly aggressive form with a very short (mast cell leukemia) survival. Between 28-34% of patients with SM are related to bone condition at the time of diagnosis and 16% have symptomatic fractures. The presentation of SM as clinical vertebral fractures in young men is rare. Here, we describe a case of established osteoporosis as the only manifestation of SM. © 2016 Elsevier España, S.L.U. y Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. Source

Fernandez-Ruiz M.,Institute Investigacion Hospital 12 Of Octubre I12 | Silva J.T.,Complejo Hospitalario Universitario Of Badajoz | San-Juan R.,Institute Investigacion Hospital 12 Of Octubre I12 | De Dios B.,Institute Investigacion Hospital 12 Of Octubre I12 | And 4 more authors.
Medicine (United States)

Aspergillus tracheobronchitis (AT) is an infrequent but severe form of invasive pulmonary aspergillosis in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree. We reviewed 8 cases of AT diagnosed in our tertiary care center during an 18-year period, as well as 148 cases previously reported in the English literature from 1985 to July 2011. The demographic, clinical, imaging, bronchoscopic, and outcome characteristics of every eligible patient were excerpted, and predictors of inhospital mortality were identified by logistic regression. Solid organ transplantation (SOT) (44.2%), hematologic malignancy (21.2%), neutropenia (18.7%), and chronic obstructive pulmonary disease (15.4%) were the most common underlying conditions reported. Most cases occurred in patients receiving long-term corticosteroid treatment (71.8%) or chemotherapy (25.0%). Fever and respiratory complaints (cough, dyspnea, stridor, or wheezing) were the most frequent symptoms; one-third of patients developed acute respiratory distress at presentation, and 15.1% were asymptomatic at the time of diagnosis. Initial imaging studies were not informative in 47.4% of the cases. Aspergillus fumigatus was the predominant species (74.4%). The pseudomembranous form was the most commonly observed (31.9% of cases) and was more frequent in neutropenic patients (p = 0.007), whereas ulcerative AT (31.2%) was associated with SOT (p = 0.001). The most frequent antifungal monotherapy regimens were amphotericin B deoxycholate (23.1%) and itraconazole (18.6%), whereas combined therapy was administered in 35.9% of the cases. Overall inhospital mortality was 39.1%, with neutropenia (odds ratio [OR], 20.47; p < 0.001) and acute respiratory distress at presentation (OR, 9.54; p = 0.002) as independent prognostic factors. Our pooled analysis of the literature shows that AT remains a rare opportunistic infection with a nonspecific presentation and a variable course depending on the nature of the predisposing factor. Copyright © 2012 by Lippincott Williams &Wilkins. Source

Inchausti F.,Complejo Hospitalario Universitario Of Badajoz | Prieto G.,University of Salamanca | Delgado A.R.,University of Salamanca
Revista de Psiquiatria y Salud Mental

Introduction The clinical use of mindfulness has increased recently, and the Mindful Attention Awareness Scale (MAAS) has become one of the most used tools to measure it. The aim of this study was to test the effectiveness of mindfulness training and analyzing the psychometric properties of the MAAS scores in a clinical sample using the Rasch Model. Methods One hundred and ninety-nine participants with mood-anxiety clinical symptoms were recruited. The experimental group (n = 103) received mindfulness training, and the control group (n = 96) a conventional outpatient treatment for the same duration. The pre-post MAAS scores were analyzed to test the effectiveness of training, the psychometric properties of the scores, and differential item functioning (DIF) using the Rating Scale Model (RSM). Results Misfit in items 9 and 12, DIF in item 9, and Spanish translation problems in the items 5, 9 and 12 were observed. The repetition of the analysis without these items was decided. Appropriate dimensionality, fit and reliability values were obtained with the short version, MAAS-12. Conclusions Contrary to previous studies, the MAAS was sensitive to treatment-associated change. However, the commonly used MAAS has some translation and metric problems, and should be revised. MAAS-12 is a better scale than MAAS but suffers from construct under-representation. Constructing tools from a coherent theoretical perspective is suggested, so that all mindfulness facets are represented. © 2012 SEP y SEPB. Publicado por Elsevier Espana, S.L. Todos los derechos reservados. Source

Gutierrez-Casares J.R.,Complejo Hospitalario Universitario Of Badajoz | Canas F.,Hospital Rodriguez Lafora | Rodriguez-Morales A.,Group Medical Affairs Manager of Psychiatry and Dermatology | Hidalgo-Borrajo R.,Medical Affairs Manager of Psychiatry | Alonso-Escolano D.,Medical Education Manager of Psychiatry
CNS Spectrums

Aim: To assess the degree of compliance and adherence to treatment during the follow-up of schizophrenic outpatients after a new therapeutic strategy had been initiated. Methods: A multicenter, retrospective, prospective, observational study of 1,848 outpatients with schizophrenia or schizoaffective disorders (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) was conducted. Patients were treated either with oral or injectable conventional or second generation antipsychotics, and were followed up for 3 months at mental health centers. Patient compliance with the pharmacological treatment was assessed by the use of questionnaires, scales, medication accountability, and the Medication Event Monitoring System. Patients were considered compliant if they reported a high compliance rate (≥80%). Results: At baseline only 29% of patients on oral medication were compliant compared with 79% of patients on injectable medication (injection counting) (OR= 9.11; 95% CI 6.02-13.77; P<.0001). At the 3 month visit, 84% of patients had changed their treatment and in these, the compliance rate of those on injectable medication was 94% versus 87% of patients taking oral medication (OR= 2.47; 95% CI 1.21-5.05; P=.022). Conclusion: The use of long-acting injectable antipsychotics, which improves compliance rates and patient follow-up, should facilitate the management of Spanish patients with schizophrenia in mental health centers. © MBL Communications Inc. Source

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