Juan Polo

Length of the first metatarsal and hallux in hallux valgus in the initial stage

The aim of this study was to confirm whether the length of the first metatarsal and the length of the hallux are greater than normal in the initial phase of the hallux valgus deformity. In a sample of 152 radiographs (98 of normal feet and 54 of incipient hallux valgus feet), the length of the first metatarsal and the hallux was measured according to methods previously described. Comparisons were made between normal and hallux valgus feet, and between male and female feet. The results show significant differences between the two groups in the first metatarsal (P  <  0.0001) and hallux (P < 0.001). In the male feet, these differences are more marked (when comparing the length of the hallux between the female hallux valgus feet and the female normal feet, P > 0.05). This indicates that in men with hallux valgus, the excess in length of the first metatarso-digital segment is greater than in women that develop this deformity, at least in its initial phase. According to these results, the size of the first metatarso-digital segment could be involved in the development of the hallux valgus deformity.RésuméLe but de cette étude est de confirmer l’excès de longueur du premier métatarsiens et du gros orteil lors de la survenue d’une déformation en hallux valgus. Cent cinquante-deux radiographies ont été analysées, 98 pieds normaux, 54 pieds présentant un début d’hallux valgus. La longueur du premier métatarsien et de l’hallux ont été mesurées et la comparaison a été réalisée entre les deux variétés de pieds, et entre les hommes et les femmes. Les résultats de cette étude montrent qu’il existe une différence significative entre les deux groupes P < 0.0001 pour le premier métatarsien et p < 0.001 pour la longueur du gros orteil. Cette différence est beaucoup plus marquée chez l’homme que chez la femme. Cette étude montre donc que chez l’homme présentant un hallux valgus, l’excès de longueur du premier métatarsien et du gros orteil sont plus importants que chez la femme, au moins au début de la déformation. Ceci doit être pris en compte lors de la survenue d’un Hallux Valgus.

Prospective evaluation of fever of unknown origin in patients infected with the human immunodeficiency virus

The aim of this study was to determine the frequency and aetiology of fever of unknown origin (FUO) in patients infected with the human immunodeficiency virus (HIV), to assess the value of the tests used in its diagnosis, and to evaluate possible models of diagnosis for the causes found most frequently. One hundred twenty-eight (3.5%) of 3603 hospitalised HIV-positive patients evaluated from October 1992 to December 1993 had FUO, defined by established criteria. Eighty-six percent of patients with FUO had previously progressed to AIDS. The median CD4+ cell count was 46/mm3. A definite diagnosis was made in 96 (75%) of the 128 patients and a possible diagnosis in 24 (18.7%), whilst no diagnosis was made in eight cases (6.2%). Tuberculosis (48.3%), visceral leishmaniasis (16%), and infection byMycobacterium avium complex (6.9%) were the diseases found most frequently. The most useful diagnostic tests were liver biopsy (68.9%) and bone marrow aspirate/biopsy (39.7%). It is not possible to predict clinically the cases of FUO due to tuberculosis, whilst thrombocytopaenia < 100,000 cells/mm3 alone is useful for differentiating the cases of visceral leishmaniasis, with a negative predictive value of 95.2%.

Antinociceptive effect of taurine and its inhibition by naxolone.

1. We have tested the effect of taurine on nociceptive stimulation provoked by chemical agent (acetic acid) and by the hot-plate test. 2. In the acetic acid test, taurine exerts an antinociceptive effect at every dose and time assayed. The observed effect was dose-related. 3. Naxolone pretreatment antagonizes the antinociceptive effect of taurine in the acetic acid test. 4. The results obtained in hot-plate test show that taurine did not significantly affect latency time for paw licking.

Effects of sex on sleep-disordered breathing in adolescents

This study was conducted to determine the influence of puberty on features of sleep-disordered breathing (SDB) in adolescents. The study was performed in a general population sample of 226 adolescents of both sexes (aged 11–19 yrs) recruited from the secondary school population of the city of Seville, Spain. Subjects were divided into two groups: 1) postpubertal, i.e. females who had undergone menarche and males in whom axillary hair development or peak height velocity had occurred >1 yr before the study; and 2) peripubertal, i.e. females who had not undergone menarche and males who had not developed axillary hair nor reached peak height velocity, or subjects in whom these pubertal changes had appeared <1 yr before the study. All subjects answered a questionnaire on SDB and underwent overnight cardiorespiratory polygraphy. There were 50 males and 40 females (mean±sd age 13.5±1.2 yrs) in the peripubertal group, and 54 males and 82 females (age 16.3±1.7 yrs) in the postpubertal group. Males exhibited significantly higher neck circumference/height index and waist/hip index than females in both the peripubertal and postpubertal groups. In the postpubertal group, snoring and polygraphic alterations (respiratory events and oximetric parameters) were significantly more frequent in males than in females. Postpubertal adolescents showed sex differences in clinical and polygraphic parameters that were not observed at earlier pubertal stages. These findings support the influence of sex hormones on sex differences in sleep-disordered breathing.

Medial deviation of the first metatarsal in incipient hallux valgus deformity.

Background: The aim of this study was to determine whether excessive medial deviation of the first metatarsal (excessive intermetatarsal angle) is present in the initial phase of hallux valgus. Methods: The intermetatarsal angle between the first and second metatarsals (1–2 IMA) was radiographically studied in 49 normal feet and in 49 feet with mild hallux valgus deformity. Results: The results demonstrated a statistically significant difference in the mean intermetatarsal angle between the two groups (8.76 degrees in normal feet; 9.98 degrees in affected feet). However, we believe that is not clinically significant. Other authors, comparing the 1–2 IMA in patients with or without more advanced hallux valgus, reported greater differences than those obtained in this study. Conclusions: Excessive medial deviation of the first metatarsal is not a causal factor but rather a consequence of hallux valgus deformity.

Burnout, depression and suicidal ideation in dental students

Objectives: To investigate the prevalence, gender influence, and relationships between burnout, depression and suicidal ideation within the last year among second, fourth and fifth-year dental students. Study Design: A cross-sectional study was carried out in 212 dental students enrolled in the second, fourth and fifth years at the School of Dentistry of Seville using the Maslach Burnout Inventory-Student Survey and the MBI-Human Services Survey, the “Patient Health Questionnaire-2”, and the “Questions about Suicidal Ideation and Attempted Suicide”. Results: The response rate among dental students was 80%. Burnout prevalence in dental students was higher in second and fourth years than in fifth year (p= 0.059 and p= 0.003, respectively). Depression prevalence in the fourth year approached significance (p= 0.051). Prevalence of suicidal ideation within the past year was higher, yet not reaching significance, in fourth year. No gender-related differences were found. A significant association was observed between burnout and depression, and between depression and suicidal ideation (p< 0.001), but no association was found between burnout and suicidal ideation. Conclusions: This study has brought our attention to the high prevalence of burnout and depression, and reported for the first time the prevalence of suicidal ideation among dental students in preclinical and clinical years. Key words:Burnout, depression, suicidal ideation, dental students.

Utility of neuropsychiatric tools in the differential diagnosis of dementia with Lewy bodies and Alzheimer's disease: quantitative and qualitative findings

BACKGROUND Discerning dementia with Lewy bodies (DLB) from Alzheimers disease (AD) is one of the most common and challenging differential diagnoses at the memory clinic. Although the neuropsychiatric manifestations have been widely reported as one of the main key points in the differential diagnosis between these two diseases, to date no neuropsychiatric questionnaire has been specifically devised for this purpose. METHODS We administered the Neuropsychiatric Inventory (NPI) and the Columbia University Scale for Psychopathology in Alzheimers Disease (CUSPAD) to a memory clinic sample of 80 patients with probable DLB and 85 age- and severity-matched patients with probable AD. Diagnosis of probable DLB was supported with a positive dopamine transporter SPECT scan. We examined the usefulness of these two neuropsychiatric tools designed for AD in the differential diagnosis between DLB and AD. We also investigated the correlations between psychotic symptoms and measures of cognitive and functional decline. RESULTS Auditory hallucinations were very specific of DLB and were usually preceded by visual hallucinations. Misinterpretation of real visual stimuli (illusions) was more frequent in DLB. Delusions were both quantitatively and qualitatively different between DLB and AD: delusional misidentifications were significantly more characteristic of DLB, while paranoid delusions did not show specificity for DLB. CONCLUSIONS Neuropsychiatric tools are useful to discriminate DLB from AD. Hallucinations and delusions are not only more frequent in DLB than in AD but also have distinct qualitative characteristics and patterns of progression that can help clinicians to make a more accurate differential diagnosis.

The influence of the preoperative immune response on blood transfusion requirements in patients undergoing cardiac surgery.

OBJECTIVE The purpose of this study was to evaluate the influence of preoperative type I and II immune responses on blood transfusion requirements. DESIGN A prospective and observational trial. SETTING A postcardiac surgery unit of a university hospital. PARTICIPANTS Seventy-one consecutive patients undergoing elective cardiac surgery. INTERVENTIONS Blood samples drawn for laboratory analysis and immunologic study. MEASUREMENTS AND MAIN RESULTS Patients were divided into 2 groups according to blood transfusion requirements: < or = 2 units (n = 35) and >2 units of red blood cells (n = 36). The preoperative immune response was assessed by flow cytometry, measuring the proportion of CD4+ T helper cells producing cytokines, including Th1 response (interferon-gamma and tumor necrosis factor-alpha [TNF-alpha]) and Th2 response (interleukin 4 and 10). Two logistic regression analyses (including and not including immunologic variables) were used to select and weight perioperative variables associated with an increased risk of transfusion. Three variables were found to be independent predictors of transfusion requirements when immunologic variables were not included: preoperative platelet count, preoperative hemoglobin, and hypertension. When all the variables were included, preoperative hemoglobin, cardiopulmonary bypass time, and the preoperative proportion of CD4+ T cells producing TNF-alpha were associated with an increased risk of transfusion (Hosmer-Lemeshow, 0.33; c-index, 0.93), but preoperative platelet count and hypertension were not. CONCLUSIONS A low preoperative Th1 immune response, as assessed by the proportion of CD4+ T-helper-producing TNF-alpha, was associated with a higher blood transfusion rate.

Estudio prospectivo, aleatorizado y controlado para evaluar la utilidad de la radiopelvimetría en la inducción de parto en primigrávidas

Resumen Introduccion Existen muy pocos estudios publicados en la literatura cientifica que evaluen la utilidad real de la radiopelvimetria (RPM). Las recomendaciones actuales acerca de su empleo estan basadas en un unico metaanalisis que incluye tan solo 4 estudios con muy escaso nivel de evidencia cientifica. Objetivos Evaluar la utilidad de la RPM en la induccion del parto en mujeres primiparas para el diagnostico de la desproporcion pelvico-cefalica y analizar su influencia en la duracion del parto, la mortalidad neonatal y la tasa de cesareas. Material y metodos Se ha realizado un estudio observacional prospectivo, aleatorizado y doble ciego en una poblacion de 264 gestantes primigestas en las que estaba indicada la induccion del parto. Resultados La RPM no influye en la tasa de cesareas ni en los resultados perinatales y presenta un valor predictivo bajo como factor pronostico de la via del parto.