Taponamiento cardíaco como presentación inicial de hipotiroidismo primario

Introducción: el derrame pericárdico es una complicación poco frecuente del hipotiroidismo; su evolución al taponamiento suele ser subdiagnosticado debido a la baja sospecha clínica causando demora en el tratamiento y complicaciones fatales. Objetivo: identificar pacientes con signos de electrocardiográficos de taponamiento como: alternancia eléctrica, bajo voltaje, sumado a bradicardia, y una radiografía de tórax con cardiomegalia, lo que permite pensar en hipotiroidismo como etiología subyacente. Presentación del caso: paciente masculino de 41 años quien ingresó por síndrome edematoso y disnea, con hallazgos clínicos y paraclínicos sugestivos de derrame pericárdicos masivo y signos de taponamiento cardiaco, manejado con drenaje pericárdico y levotiroxina. Discusión: las causas de la disnea en el paciente que consulta a urgencias son innumerables. La anamnesis y los hallazgos semiológicos durante le evaluación clínica son el punto de partida para su estudio. Con relación al hipotiroidismo y la disnea de origen cardiaco, esta tiene un sustento en cuya base confluyen varios aspectos fisiopatológicos. Conclusión: la identificación de individuos con factores de riesgo para HP, su diagnóstico y tratamiento impactan positivamente en la reducción de síntomas y complicaciones

Estudo de associação entre o transtorno de déficit de atenção e hiperatividade em adultos (TDAHA) e polimorfisos do gene da dopamina-beta-hidroxilase

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Correction : Chaparro et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J. Clin. Med. 2021, 10, 2885

The authors wish to make the following corrections to this paper [...]

Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain : Large-Scale Epidemiological Study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery

100 años investigando el mar. El IEO en su centenario (1914-2014).

Se trata de un libro que pretende divulgar a la sociedad las principales investigaciones multidisciplinares llevadas a cabo por el Instituto Español de Oceanografía durante su primer siglo de vida, y dar a conocer la historia del organismo, de su Sede Central y de los nueve centros oceanográficos repartidos por los litorales mediterráneo y atlántico, en la península y archipiélagos.Kongsberg 20

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Geodivulgar: Geología y Sociedad 2018

Depto. de Geodinámica, Estratigrafía y PaleontologíaFac. de Ciencias GeológicasFALSEsubmitte

Associações entre transtornos internalizantes e externalizantes com transtornos por uso de substâncias

Há evidências robustas de que os transtornos psiquiátricos externalizantes (Ext) são fortemente associados aos transtornos por uso de substâncias (TUS), porém o papel das comorbidades internalizantes (Int) é complexo e pouco claro, o que pode levar a equívocos em situações envolvendo prevenção ou tratamento de TUS. Assim, esta tese tem como objetivo examinar a natureza das inter-relações entre transtornos Ext, Int e Ext-Int com TUS. No primeiro estudo (Artigo 1), apresentamos uma contribuição para o debate em psiquiatria no sentido de melhor abordar as relações entre Int e TUS. No Artigo 2, verificamos se Int isolado ou associado ao Ext se relaciona com uma frequência mais baixa, neutra ou mais alta de TUS em uma amostra clínica de adultos com transtorno de déficit de atenção/hiperatividade (TDAH) e em uma amostra da população geral. Indivíduos adultos com TDAH (n=631), diagnosticados de acordo com os critérios do DSM-5 foram classificados em grupos de acordo com suas comorbidades: (1)TDAH puro; (2)Ext - presença de transtorno opositor desafiador, transtorno de conduta ou transtorno de personalidade antissocial; (3) Int - presença de transtornos de humor ou ansiedade; e (4) Ext-Int - indivíduos com Ext e Int. O grupo Ext-Int incluiu pacientes com Transtorno Bipolar. Um agrupamento semelhante foi aplicado à amostra da população geral (n=1849). Na amostra de indivíduos com TDAH, os grupos TDAH puro, Ext e Ext-Int apresentaram frequências comparáveis de TUS, enquanto o grupo Int apresentou uma taxa significativamente mais baixa. Na amostra da população geral, o grupo Ext-Int foi associado a uma maior frequência de TUS. Assim, conclui-se que o diagnóstico de transtornos Int pode ter consequências clínicas muito diferentes na predisposição para SUD, dependendo da presença de Ext. No momento da estimativa de risco de TUS em pacientes Int é importante investigar a presença de características ou diagnósticos ExtThere is robust evidence that externalizing psychiatric disorders (Ext) are strongly associated with substance use disorders (SUD), but the role of internalizing comorbidities (Int) is complex and unclear, which could lead to misunderstandings in prevention or treatment of SUD. Thus, this Thesis aims to examine the nature of the interrelationships between Ext, Int and Ext-Int disorders with TUS. In the first study (Article 1), we presented a contribution to the psychiatric debate on the relationship between Int and TUS. Article 2 checked whether Int alone or associated with Ext relates to a lower, neutral or higher frequency of SUD in a clinical sample of adults with attention-deficit/hyperactivity disorder (ADHD) and in general population sample. Adult individuals with ADHD (n = 631) diagnosed with the DSM-5 criteria were classified into groups according to their comorbidities: (1) pure ADHD; (2) Ext - presence of oppositional defiant disorder, conduct disorder or antisocial personality disorder; (3) Int - presence of mood or anxiety disorders; and (4) Ext-Int - individuals with Ext and Int. The Ext- Int group included patients with Bipolar Disorder. A similar grouping was applied to the general population sample (n = 1849). In ADHD sample, pure ADHD, Ext and Ext-Int groups had similar frequencies of SUD, while the Int group had a significantly lower rate. In the general population sample, the Ext-Int group was associated with a higher frequency of SUD. Thus, we conclude that the diagnosis of Int disorders may present very different clinical consequences in SUD predisposition, depending on the presence of Ext. When estimating the risk of TUS in Int patients, it is important to investigate the presence of Ext characteristics or diagnoses

Associação entre subtipos de TDAH em adultos e dimensões de temperamento

Introdução: O estudo da personalidade apresenta uma influência crescente no entendimento da heterogeneidade de transtornos psiquiátricos. O temperamento em particular parece contribuir para a grande variabilidade do TDAH. Tal associação é examinada neste estudo, fazendo parte de um projeto mais amplo que envolve desde as bases genéticas até a comorbidade e resposta a tratamento do TDAH. Artigo: Este estudo examina escores nas dimensões de temperamento do TCI em subtipos de TDAH em adultos. Cento e quarenta e seis pacientes (66 mulheres e 80 homens) foram recrutados através de informação na imprensa acerca de manifestações do TDAH para um programa de pesquisa. Os diagnósticos de TDAH foram realizados pelo DSM-IV e a avaliação do temperamento teve por base o TCI. Os pacientes foram divididos em dois subtipos de TDAH: desatento (N=52) e hiperativo/combinado (N=92). Os escores de temperamento foram então avaliados em análises de variância de dois fatores (sexo e subtipo), com correção para a idade. Os pacientes do subtipo hiperativo/combinado apresentaram escores mais altos em procura de novidades (P=0,033), enquanto os desatentos, uma tendência não significativa para escores maiores em dependência de premiação (P=0,064). Nas comparações entre os sexos, as mulheres apresentaram escores maiores em esquiva ao dano (P=0,029) e dependência de premiação (P=0,010). Foi observada uma interação significativa entre o sexo e o subtipo sobre os escores de persistência. Enquanto entre os homens o subtipo hiperativo/combinado mostrou-se associado a escores mais altos em persistência, o inverso foi observado no sexo feminino. Este estudo sugere que a avaliação do temperamento pode contribuir na compreensão da heterogeneidade clínica do TDAH. Discussão e conclusões: Os achados deste estudo são coerentes com a literatura examinada, apontando para o papel de variações do temperamento na heterogeneidade do TDAH.Introduction: Current research on personality assessment presents a growing influence on the understanding of the clinical heterogeneity of psychiatric disorders. Specifically, temperament seems to contribute to the large ADHD variability. Such association is analyzed here as part of a larger project encompassing from genetics to comorbidity and response to treatment in ADHD. Article: This study aims to evaluate temperament dimension scores of TCI in ADHD subtypes in adult subjects. One hundred forty six patients (66 females and 80 males) were self referred by press information on ADHD symptoms. The diagnosis of ADHD was confirmed using DSM-IV criteria and temperament was assessed with the TCI. Patients were separated in two ADHD subtype groups: inattentive (N=52) and hyperactive/combined ones (N=92). Temperament scores were measured by two factors ANOVA analysis (gender and subtype), with age correction. Hyperactive/combined patients scored higher in novelty seeking (P=0.033) while inattentive presented a nonsignificant trend towards higher scores in reward dependence (P=0.064). Comparing genders, females showed higher scores in harm avoidance (P=0.029) and reward dependence (P=0.010). A significant interaction between gender and subtypes was observed in persistence scores. While combined/hyperactive males presented higher persistence scores, the opposite was observed among females. This study suggests that temperament assessment can contribute to the understanding of the clinical heterogeneity in ADHD. Discussion and conclusions: The results of this investigation are coherent with the current literature, pointing towards the role of temperament variability on the heterogeneity of ADHD