María A. Lazo

Validation of the Spanish Center for Epidemiological Studies Depression and Zung Self-Rating Depression Scales: A Comparative Validation Study

Background Depressive disorders are leading contributors to burden of disease in developing countries. Research aiming to improve their diagnosis and treatment is fundamental in these settings, and psychometric tools are widely used instruments to support mental health research. Our aim is to validate and compare the psychometric properties of the Spanish versions of the Center for Epidemiological Studies Depression Scale (CES-D) and the Zung Self-Rating Depression Scale (ZSDS). Methodology/Principal Findings A Spanish version of the CES-D was revised by 5 native Spanish speaking psychiatrists using as reference the English version. A locally standardized Spanish version of the ZSDS was used. These Spanish versions were administered to 70 patients with a clinical diagnosis of DSM-IV Major Depressive Episode (MDE), 63 without major depression but with clinical diagnosis of other psychiatric disorders (OPD), and 61 with no evidence of psychiatric disorders (NEP). For both scales, Cronbachs alpha (C-α) and Hierarchical McDonald Omega for polychoric variables (MD-Ω) were estimated; and receiver operating characteristics (ROC) analysis performed. For the CES-D and ZSDS scales, C-α was 0.93 and 0.89 respectively, while MD-Ω was 0.90 and 0.75 respectively. The area under the ROC curve in MDE+OPD was 0.83 for CES-D and 0.84 for ZSDS; and in MDE+NEP was 0.98 for CES-D and 0.96 for ZSDS. Cut-off scores (co) for the highest proportions of correctly classified (cc) individuals among MDE+OPD were ≥29 for CES-D (sensitivity (ss) = 77.1/specificity (sp) = 79.4%/(cc) = 78.2%) and ≥47 for ZSDS (ss = 85.7%/sp = 71.4%/cc = 78.9%). In the MDE+NEP, co were ≥24 for the CES-D (ss = 91.4%/sp = 96.7%/cc = 93.9%) and ≥45 for the ZSDS (ss = 91.4%/sp = 91.8%/cc = 91.6%). Conclusion Spanish versions of the CES-D and ZSDS are valid instruments to detect depression in clinical settings and could be useful for both epidemiological research and primary clinical settings in settings similar as those of public hospitals in Lima, Peru.

Elevada frecuencia de dislipidemia y glucemia basal alterada en una población Peruana de altura

We performed a cross sectional study in Lari (3600 m), a highland rural community from Arequipa, Peru. We evaluated a body mass index (BMI), glycemia and lipid profile in 74 over 18 year persons. The mean age was 51.7 ± 18.0 years, 62.2% were women, mean of BMI was 25.6 ± 3.7. Prevalence of hypercholesterolemia was 40.6%, “low HDL” in 77% of the population (93.5% in women vs 50% in men, p <0.001) and elevated level of LDL was 71.7%. The prevalence of impaired fasting glycemia was 27%. In conclusion, we found high prevalence of impaired fasting glycemia, hypercholesterolemia and especially “low HDL” in high altitude rural natives. These findings must be considered to realize interventions in high altitude populations to avoid future cardiovascular complications.

Diabetic Peripheral Neuropathy in Ambulatory Patients with Type 2 Diabetes in a General Hospital in a Middle Income Country: A Cross-Sectional Study

Aim We aimed to estimate the morbidity rate and associated factors for diabetic peripheral neuropathy (DPN) in a low-middle income country setting. Methods Cross-sectional study, data was gathered at Perus Ministry of Health national specialized hospital for endocrinological conditions through standardized interviews, anthropometric measurements and blood tests for glycated haemoglobin (HbA1c). DPN was evaluated using two techniques: the Semmes-Weinstein monofilament test and the diabetic neuropathy symptom score. Overall prevalence and 95% confidence intervals (95% CI) were calculated. Potential factors related to DPN explored included body mass index, years with disease (<10 vs. ≥10 years), glycaemic control (HbA1c <7% vs. ≥7%), microalbuminuria, retinopathy, and current pharmacological treatment. Multivariable analysis was performed using Poisson analysis to calculate prevalence ratios. Results DPN was observed in 73/129 (56.6%) patients. In multivariable analysis adjusted by age and sex, the prevalence ratio of neuropathy was 1.4 times higher (95% CI 1.07–1.88) in patients who took insulin plus metformin compared to patients who used one treatment alone, and 1.4 higher (95% CI 1.02–1.93) in patients with ≥10 years of disease compared to those with a shorter duration of disease. Also we found some characteristics in foot evaluation associated to neuropathy such as deformities (p<0.001), onychomycosis (p = 0.012), abnormal Achilles reflex (p<0.001), pain perception (p<0.001) and vibration perception (p<0.001). Conclusion DPN is highly frequent among patients with diabetes in a national specialized facility from Peru. Associated factors to DPN included being a diabetic patient for over ten years, and receiving insulin plus metformin

Vasculitis secundaria a infección por Fasciola hepática

Se presenta el caso de un paciente varon de 38 anos, procedente de una zona endemica para fascioliasis hepatica en el Peru. Fue hospitalizado por presentar un cuadro de cuatro semanas de evolucion; con fiebre, mialgias intensas, lesiones eritematosas y dolorosas en las regiones de extension de las extremidades. La electromiografia y la velocidad de conduccion nerviosa mostraron una miopatia inflamatoria global. La biopsia de piel evidencio una vasculitis de tipo poliarteritis nodosa. En el proceso de evaluacion previa a la terapia inmunosupresora, se hallaron huevos de Fasciola hepatica en el examen coproparasitologico. El diagnostico de fascioliasis se confirmo con fas2-ELISA: 0,46 (VN <0,20). El cuadro clinico remitio luego del tratamiento con ticlabendazol. Se mantuvo contacto con el paciente durante un ano y no se evidencio recurrencia de la enfermedad, manteniendose asintomatico

Precisión de la taquipnea y las retracciones subcostales como signos clínicos para diagnóstico de neumonía adquirida en la comunidad en niños: revisión sistemática y metaanálisis

Objetivos. Evaluar si la taquipnea y las retracciones subcostales son predictoras eficientes para el diagnostico de neumonia adquirida en la comunidad (NAC) en ninos. Materiales y metodos. Se revisaron las bases de datos: PubMed, LILACS, The African Journal Database y The Cochrane Central Library. Se incluyeron estudios originales que evaluaron el rendimiento diagnostico de los criterios clinicos de taquipnea o retracciones subcostales, definidos segun los criterios de la Organizacion Mundial de la Salud (OMS) para el diagnostico de NAC en ninos de hasta cinco anos de edad con tos y fiebre. Se estimaron las razones de probabilidades (LR), el odds ratio diagnostico (DOR) y sus respectivos intervalos de confianza al 95% (IC95%) para cada prueba clinica evaluada. Resultados. Se encontraron 975 estudios, incluyendo ocho en la revision. Se enrolaron 4740 pacientes y analizaron 3584 (75%), de los cuales 916 (19%) tuvieron el diagnostico de NAC. Al combinar los datos, la taquipnea obtuvo una LR positiva de 3,16, (IC95% 2,11-4,73) y una LR negativa de 0,36 (IC95% 0,23-0,57). El DOR fue de 10,63 (IC95% 4,4-25,66, I2=93%). Al realizar el analisis para retracciones subcostales se obtuvo un LR positivo de 2,49 (IC95% 1,41-4,37) y un LR negativo de 0,59 (IC95% 0,4-0,87). El DOR fue de 5,32 (IC95% 1,88-15,05, I2=89%). Conclusiones. Se puede tomar en cuenta la presencia o ausencia de taquipnea y retracciones subcostales en el diagnostico de NAC, cabe considerar la incertidumbre relativa en su poder diagnostico y los LR relativamente modestos. La confianza en estos resultados es baja por la inadecuada calidad de la evidencia en este tema

MIOCARDITIS FULMINANTE Y ENFERMEDAD DIARREICA AGUDA POR COXSACKIE VIRUS B6

We present the case of a young woman who suffered cardiogenic due to by Coxsackie virus B6. The patient attended a private clinic with an acute gastroenteritis and after one hour of receiving hydratation,she developed hypotension and shock, severe hypoxemia and bilateral lung infiltrate. The patient entered the Intensive Care Unit, where she received hemodynamic support. Due to the clinical picture and cardiac enzymes increase, a cardiac failure was suspected and the echocardiographic findings suggested “myocarditis”. The evolution was successful and Coxsackie B6 virus infection diagnosis was made during the follow up by increase of the levels of antibodies for virus Coxsackie B6.