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The purpose of this study is to determine whether there are some differences in the treatment responses to a multidisciplinary fibromyalgia (FM) treatment related with the baseline body mass index (BMI) of the participants. Inclusion criteria consisted of female sex, a diagnosis of FM (American College of Rheumatology criteria), age between 18 and 60 years, and between 3 and 8 years of schooling. Baseline BMI was determined, and patients were randomly assigned to one of the two treatment conditions: conventional pharmacologic treatment or multidisciplinary treatment. Outcome measures were pain intensity, functionality, catastrophizing, psychological distress, health-related quality of life, and sleep disturbances. One hundred thirty patients participated in the study. No statistical significant differences regarding pre-treatment outcomes were found among the different BMI subgroups, and between the two experimental conditions for each BMI category. General linear model analysis showed a significant interaction group treatment × time in pain intensity (p < .01), functionality (p < .0001), catastrophizing (p < .01), psychological distress (p < .0001), sleep index problems (p < .0001), and health-related quality of life (p < .05). No significant interactions were found in BMI × time, and in BMI × group treatment × time. There are not differences among normal weight, overweight and obese patients with FM regarding their response to a multidisciplinary treatment programme for FM which combines pharmacological treatment, education, physical therapy and cognitive behavioural therapy.

Objective: Multidisciplinary treatments of fibromyalgia (FM) have demonstrated efficacy. Nevertheless, they have been criticized for not maintaining their benefits and for not being studied for specific populations. Our objectives were to determine the efficacy of a multidisciplinary treatment for FM adapted for patients with low educational levels and to determine the maintenance of its therapeutic benefits during a long-term followup period., Methods: Inclusion criteria consisted of female sex, a diagnosis of FM (using American College of Rheumatology criteria), age between 18 and 60 years, and between 3 and 8 years of schooling. Patients were randomly assigned to 1 of the 2 treatment conditions: conventional pharmacologic treatment or multidisciplinary treatment. Outcome measures were functionality, sleep disturbances, pain intensity, catastrophizing, and psychological distress. Analysis was by intent-to-treat and missing data were replaced following the baseline observation carried forward method., Results: One hundred fifty-five participants were recruited. No statistically significant differences regarding pretreatment measures were found between the 2 experimental groups. Overall statistics comparison showed a significant difference between the 2 groups in all of the variables studied (P < 0.0001). Mixed linear model analysis demonstrated the superiority of the multidisciplinary treatment in all of the studied variables at posttreatment. The differences were maintained at 12-month followup in sleep disturbances (P < 0.0001), catastrophizing (P < 0.0001), and psychological distress (P < 0.01)., Conclusion: Multidisciplinary treatment adapted for individuals with low educational levels is effective in reducing key symptoms of FM. Some improvements were maintained 1 year after completing the multidisciplinary treatment., (Copyright © 2013 by the American College of Rheumatology.)

Objectives: The objectives of this study were to assess the prevalence of transmitted HIV-1 drug resistances (TDR) and HIV-1 subtypes in recently infected patients in Catalonia between 2003 and 2005 and to describe the characteristics of these patients according to the presence or absence of TDR and HIV-1 subtype., Methods: After application of the Serological Testing Algorithm for Recent HIV Seroconversion (STARHS), residual aliquots of serum samples from recently infected antiretroviral-naïve individuals were genotyped. FASTA sequences were analyzed using the HIVDB Program. The World Health Organization 2009 List of Mutations for Surveillance of Transmitted HIV-1 Drug Resistant HIV Strains was used to estimate the prevalence of TDR., Results: Of 182 recently infected patients, 14 (7.7%) presented TDR. Seven (3.8%) had genotypic evidence of TDR against non-nucleoside reverse transcriptase inhibitors, 6 (3.3%) against nucleoside reverse transcriptase inhibitors, 3 (1.6%) against protease inhibitors (PIs), and only 2 individuals (1.1%) presented TDR against more than one class of drugs. Thirty-five (19.2%) patients were infected with a non-B HIV-1 subtype., Conclusion: This is the first study to estimate the prevalence of TDR in recently infected patients in Catalonia. The results are similar to those of studies performed in other Spanish regions. Correct monitoring of these parameters requires systematic epidemiologic surveillance of transmitted resistance., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

The degree of adherence to anti-hepatitis C virus (HCV) therapy among HIV/HCV-coinfected patients is not known. A prospective cohort study was performed in two groups of patients: 79 HIV/HCV-coinfected patients (group 1) and 78-HCV-monoinfected patients (group 2). Patients were treated with interferon alpha-2a (3 million international units [MIU], three times per week) plus ribavirin (1000-1200 mg/day) for 48 weeks. Adherence to therapy was defined as having received +/-80% of both drug dosages for +/-80% of the expected duration of therapy. The degree of adherence to treatment was similar for patients with or without HIV coinfection (72.2 versus 80.8%). The overall sustained virological response (SVR) in patients with adherence to therapy was 41.7% as compared with only 8.1% (p = 0.0001) in patients without adherence. The difference in SVR rate according to adherence to treatment was also evident in patients of group 1 (29.8% versus 9.1%; p = 0.05) as well as in those of group 2 (52.4 versus 6.7%; p = 0.001). Adherence to anti-HCV therapy, which can be similar in mono- and coinfected patients, enhances the likelihood of achieving an increase in SVR rate. In addition to improved adherence, in coinfected patients more aggressive therapeutic strategies may be necessary to achieve SVR.

Background and Objective: To analyze the applicability of an out-patient Quick and Early Diagnostic Unit (QEDU) to evaluate patients with a potential life-threatening disorder on an out-patient basis., Patients and Method: We analyzed prospectively all patients attended in the unit for five years (1997-2001). We compared patients with lung cancer and colorectal cancer admitted to hospital for conventional study versus patients studied at the unit., Results: We attended 2,748 patients in total Main reasons for consultation were abdominal pain, asthenia-anorexia, neurologic symptoms, anemia and palpable tumors. The most frequent diagnostic category corresponded to gastroenterological diseases and neoplastic diseases. The mean interval (standard error) for the first visit was 4.9 (3.4) days and for diagnosis it was 5.7 (6.5) days. Some 95% patients displayed a high degree of satisfaction by the questionnaire. In patients with cancer of the colon studied at the QEDU, we observed a reduction in the average interval for diagnosis which was highly significant (p = 0.03). The overall costs of final diagnosis were also lower for the QEDU model., Conclusions: The QEDU unit represents an alternative to in hospital admission for diagnostic workouts, which is fully feasible in our setting. It can result in the same efficacy and a higher efficiency than hospital admission.

Background and Objective: The aim of this study was to identify the extent to which treatment decisions for medical in-patients in three hospitals in Catalunya are supported by published evidence., Patients and Method: In a retrospective, cross-sectional study, main diagnosis-treatment pairs (DTPs) were identified for 980 hospital discharges. The Cochrane library and MEDLINE from 1966 to 1998 were searched for systematic reviews or, in their absence, randomized controlled clinical trials (RCT) that supported the treatment given for each diagnosis. The level of evidence found for each DTP was classified. Descriptive analyses for patients and different DTP were performed., Results: A systematic review or RCT (level I) was found for 65.4% of the 980 patients. In 32.6% of cases, there was only non-experimental or consensus evidence (level II) and in 2% there was no good evidence for the treatment given (level III). An analysis of the 598 unique pairs reduced the percentage of cases supported by level I evidence (55.7) with a proportionate increase in level II (41%). There were some differences in the proportion of cases in each evidence level by diagnostic group., Conclusions: For about two thirds of patients and a half therapeutic decisions in these three centres, there was a published RCT or a systematic review, with variations according to diagnostic groups. More robust and objective instruments are needed to assess the degree to which scientific evidence is applied in clinical practice.

The association between the class I and class II histocompatibility antigens (HLA) and the severity of alcoholic liver disease was studied in 102 alcoholic patients (64 males and 38 females) with liver disease. According to histologic diagnosis 41 patients had a mild hepatic lesion (12 with minimum changes, 15 with steatosis and 14 with fibrosis) and 61 patients had severe hepatic lesion (13 with alcoholic hepatitis, 35 with cirrhosis and 13 with cirrhosis and alcoholic hepatitis). No differences were found between the two groups in regards to sex, quantity and length of alcohol consumption, although the patients with mild hepatic lesion were younger than those with severe hepatic lesion (41.2 +/- 8.2 and 47.8 +/- 11.6 years, respectively). The prevalence of the A30, B16, B47, Bw56, Cw1, Cw5 and Cw7 antigens was higher in the alcoholics than in the controls, although only the A30 (12.7% vs. 4.4%, p < 0.04) and the Bw56 antigens (3.9% vs 0.1%, p < 0.001) remained significant when the p value was corrected by the number of antigens studied. These differences were due to a greater prevalence of the A30 antigens (17.0% vs. 4.4%, p < 0.001), B16 (24.3% vs. 7.5%, p < 0.01) and Bw56 (7.3% vs 0.1%, p < 0.001) in patients with mild hepatic lesion versus the controls. In contrast, these antigens were present in similar numbers in patients with severe hepatic lesion and in the controls. On the other hand, no differences were observed regarding the prevalence of the class II HLA antigens between the alcoholics and the controls, or between the two alcoholic groups. These data suggest that the alcoholics with A30, B16 and Bw56 antigens are less susceptible to developing severe liver disease.

Objective: To assess the incidence of cases of carbon monoxide poisoning diagnosed at a General Hospital's Casualty Department, to evaluate its clinical features and diagnostic difficulties, to find data on how much information the patients had on the risk of poisoning, what measures were adopted for a technician to check the apparatus which caused the poisoning, and on re-use., Design: An observational descriptive study., Setting: Casualty Department of a County Hospital with a catchment area of 80,000 people., Participants: Included in the survey were the 27 clinical histories for the cases of poisoning attended in Casualty at Igualada General Hospital in 1993., Results: 27 poisoning cases were diagnosed (0.5/1,000 emergencies attended). Symptoms were non-specific in most cases, being mainly migraine, nausea/vomiting and feeling sick., Conclusions: Carbon monoxide poisoning is still an important cause of morbidity and mortality. Focus on the possible diagnosis during the winter months would enable new, potentially serious cases to be treated or avoided. Campaigns to warn the community and to check apparatuses causing poisoning are needed.

Among 389 consecutive chronic alcoholics in whom a liver biopsy was performed for diagnostic purposes, nine patients (2.3%) had histological changes of "alcoholic foamy degeneration" (AFD), characterized by numerous small fat droplets in the swollen hepatocytes of the centrilobular area. In five cases, there were non-specific clinical features, while the other four cases presented acute hepatic decompensation with jaundice and a reduced prothrombin activity. Seven patients had high serum lipid concentrations including hypertriglyceridemia and hypercholesterolemia, which improved after withdrawal of alcohol intake. In conclusion, AFD has a broad clinicopathological spectrum including asymptomatic patients and other cases with severe liver decompensation manifested by jaundice and reduced prothrombin activity. AFD is usually associated with hyperlipemia.

Of 2,115 persons who were submitted to a voluntary check-up, we found 10.6% suffering from hypertension and 16.2% with borderline hypertension, the latter group having been followed and the condition subsequently confirmed in 45.9% of the case. The prevalence increases with age. There were no prevailing differences found between rural and city populations. The prevalence is greater in self-employed persons that in salary workers and we would bring to the fore the higher prevalence in housewives (p less than 0.0005). 74.8% of the hypertensive patients knew of their situation but only 15.6% of them showed normal blood pressure at the following-up. Rarely 0.85% had severe hypertension and 3% had moderate hypertension.