ABSTRACT Background: The self-report Psychiatric Diagnostic Screening Questionnaire PDSQ is designed to screen Axis I psychiatric disorders. We aim to determine its psychometric properties in Spanish outpatients and assess its relationship with two interviews (for psychopathology and for personality disorders) and clinical/demographic variables. Methodology: We administered the study questionnaire, the Mini International Neuropsychiatric Interview Plus (MINI-Plus), the Standardised Assessment of Personality Abbreviated Scale (SAPAS), and the List of Threatening Experiences Questionnaire (LTE-Q) to 375 patients at two public outpatient centres. Reliability of the study questionnaire was evaluated (Cronbach’s alpha, α) and known-group validity measured by comparing groups based on demographic and clinical variables (binary logistic regression analysis) and MINI-Plus diagnoses (Mann-Whitney U). The diagnostic accuracy of the study questionnaire score was analysed taking the MINI-Plus diagnoses as the gold standard (ROC analysis). Results: Internal consistency was adequate across all PDSQ scales (α >0.7; mean α=0.85). Known-group comparisons were satisfactory. Female and male patients showed higher prevalence of internalizing and externalizing diagnoses, respectively. Younger age, more life events and limitations, higher SAPAS scores, and lower economic levels were linked to a greater number of PDSQ diagnoses. Inter-group differences were found for all PDSQ scales based on the corresponding MINI-Plus diagnoses. Mean values of sensitivity, AUC, and negative predictive value were 88.7, 0.82, and 96.7, respectively. Conclusions: When applied to a sample of Spanish outpatients, the PDSQ exhibits satisfactory psychometric properties and adequate relationships with the psychopathology and personality interviews, and clinical and demographic variables. The study questionnaire is suitable for assessing comorbidity and psychopathology dimensions.

RESUMEN Fundamento: El PDSQ (Psychiatric Diagnostic Screening Questionnaire) es un cuestionario autoadministrado para el cribado de diagnósticos psiquiátricos del eje I. El objetivo es estudiar sus propiedades psicométricas en pacientes ambulatorios españoles y analizar su relación con dos entrevistas (de psicopatología y de trastornos de personalidad), y con variables clínicas y demográficas. Material y métodos: Se administraron los instrumentos PDSQ, MINI-Plus, SAPAS, y LTE-Q a 375 pacientes en dos centros ambulatorios públicos. Se estudió la fiabilidad del PDSQ (α de Cronbach). La validez de grupos-conocidos se analizó comparando sub-grupos organizados por variables demográficas y clínicas (regresión logística binaria) y por diagnósticos MINI Plus (U de Mann-Whitney). Se estudió el desempeño diagnóstico del PDSQ considerando los diagnósticos MINI Plus como gold standard (análisis ROC). Resultados:. La consistencia interna del PDSQ fue adecuada en todas las escalas (α >0,7; media=0,85). Las comparaciones entre grupos-conocidos fueron satisfactorias. Mujeres y hombres mostraron prevalencias mayores de trastornos internalizantes y externalizantes, respectivamente. Una menor edad, más sucesos vitales y limitaciones, puntuaciones mayores en SAPAS y niveles económicos más bajos se relacionaron con mayor número de diagnósticos PDSQ. Los grupos basados en los correspondienes diganósticos MINI-Plus difirieron en todas las escalas del PDSQ. Los valores medios de sensibilidad, AUC y valor predictivo negativo fueron 88,7; 0,82 y 96,7, respectivamente. Conclusiones: En su aplicación a pacientes españoles ambulatorios, el PDSQ muestra, propiedades psicométricas satisfactorias y relaciones adecuadas con entrevistas de psicopatología y personalidad, así como con variables clínicas y demográficas. El PDSQ es adecuado para evaluar comorbilidad y dimensiones de psicopatología.

ABSTRACT Bulbs were collected from a population of Famatina andina (Phil.) Ravenna in central Chile. Their chromosomes were analyzed and it was observed that the cariotypic formula and chromosomal number are identical to Famatina cisandina Ravenna. Secondary centromeric constrictions were also observed in chromosomes 1, 2 and 7, and the nucleolus organizing region (NOR) was not observed in the long arm of chromosome 7. This is the first report of secondary centromeric constrictions in South American Hippeastreae.

Introduction:the intrauterine growth restriction (IUGR) is a condition characterized by limited fetal growth potential due to heterogeneous causes and it has variable manifestations. Its importance lies not only in what it means in morbidity and mortality, but also that these children usually have multiple problems further. Objectives: to determine the incidence and frequency of associated risk factors and other conditions commonly associated with this health problem, to determine incidence of intrauterine growth restriction, to identify appropriate diagnosis and follow-up strategies by area and secondary consultation. Methods: we conducted a descriptive, retrospective and longitudinal section study of 133 pregnant women with IUGR, who were assisted at the Teaching Maternal and Child Hospital Diez de Octubre, from January 1st to July 31st, 2011. Results: 7.7 % of the infants were small for their gestational age. The uterine height decreased in only 26.3 % of our cases. The underweight in early pregnancy (32.5 %) and insufficient weight gain during pregnancy (61.2 %) were frequent situations. Few cases have been followed up in IUGR hospital consultation (10 %) and were diagnosed at birth. Conclusions: The sensitivity of the uterine height measurement and ultrasound were low to support the suspicion of this entity.

Introducción: la restricción del crecimiento intrauterino (RCIU) es una afección caracterizada por una limitación del potencial del crecimiento fetal de causa heterogénea y manifestaciones variables. Su importancia no solo radica en lo que significa en la morbilidad y la mortalidad infantil, sino también, en que estos niños tienen habitualmente múltiples problemas posteriores. Objetivos: precisar la incidencia, así como la frecuencia con que se asociaron diversos factores de riesgo y otras situaciones habitualmente relacionadas con este problema de salud. Precisar incidencia de la restricción del crecimiento intrauterino. Identificar diagnóstico y seguimiento oportunos por área y consulta del nivel secundario. Métodos: se realizó un estudio descriptivo, retrospectivo y de corte longitudinal, sobre un total de 133 gestantes con restricción del crecimiento intrauterino, atendidas en el Hospital Materno Infantil "10 de Octubre", entre el 1º de enero y el 31 de julio de 2011. Resultados: el 7,7 % de los nacidos fueron pequeños para su edad gestacional. La altura uterina se presentó disminuida solo en el 26,3 % de nuestros casos. El peso deficiente al inicio del embarazo (32,5 %), así como la insuficiente ganancia de peso durante la gestación (61,2 %) fueron situaciones frecuentes. Pocos casos habían sido seguidos en consulta de RCIU hospitalaria (10 %), se hizo el diagnóstico al nacimiento. Conclusiones: la sensibilidad de la medición de la altura uterina y del ultrasonido fueron bajas para contribuir a la sospecha de esta entidad.

Introduction and objectives: Echocardiography is considered a basic tool in the diagnosis and management of infective endocarditis. Transesophageal echocardiography is more sensitive than transthoracic echocardiography. Our aim was to describe which factors are related to the ability of transthoracic echocardiography to establish the diagnosis of infective endocarditis.The presence of this factors in a patient with a normal transthoracic echocardiography would make unnecessary to perform a transesophageal echocardiography and would suggest to seek for other diagnostic possibilities. Methods:127 consecutive patients admitted to our hospital with the diagnosis of infective endocarditis and a complete transthoracic echocardiography and transesophageal echocardiography comprised our study group. Predisposing factors and clinical, echocardiographic and microbiological variables were studied. Results: The presence of a cardiac murmur, the presence of an optimal acoustic window, degenerative valvular disease as the predisposing factor for infective endocarditis and positive blood cultures were related to the ability of transthoracic echocardiography to diagnose the existence of signs of infective endocarditis on its own. Nevertheless,only the presence of a cardiac murmur (RR 2.724; 95% CI 1.071-6.926; p 0,035) and the presence of an optimal acoustic window (RR 5.538; 95%IC 2.75-11.15; p < 0.001) were found as independent factors to detect those patients in which transthoracic echocardiography is able to diagnose signs of infective endocarditis on its own. Conclusions: The diagnostic accuracy of transthoracic echocardiography to detect echocardiographic signs of infective endocarditis is high in those patients with cardiac murmur and optimal acoustic window. In those patients with these characteristics, without prosthetic heart valves and a negative transthoracic echocardiography for infective endocarditis other diagnostic possibilities should be ruled out before performing of a transesophageal echocardiography.

Introducción y objetivos: Actualmente se considera que los hallazgos ecocardiográficos son un componente esencial en el diagnóstico de la endocarditis infecciosa. La ecocardiografía transesofágica es más sensible que el estudio transtorácico para el diagnóstico de la endocarditis infecciosa y sus complicaciones. El objetivo del presente trabajo fue analizar qué factores estaban asociados a una mayor sensibilidad del ecocardiograma transtorácico en el diagnóstico de endocarditis infecciosa. La presencia de dichos factores en un paciente con ecocardiograma transtorácico normal haría poco necesaria la realización de un estudio transesofágico y orientaría al clínico a buscar localidades infecciosas alternativas en localizaciones diferentes al corazón. Métodos: 127 pacientes consecutivos ingresados en el hospital con el diagnóstico de endocarditis infecciosa fueron evaluados, analizándose variables clínicas, microbiológicas, factores de riesgo, datos evolutivos, complicaciones y ventana acústica del ecocardiograma transtorácico. Resultados: En el análisis univariado, la existencia de ventana acústica adecuada, la presencia de un soplo, valvulopatía degenerativa y hemocultivos positivos se asociaban de forma estadísticamente significativa a una mayor incidencia de ecocardiograma transtorácico positivo.Sin embargo, en el análisis multivariado sólo la presencia de soplo (RR 2.724; IC95% 1.071-6.926; p 0.035) y la existencia de una ventana acústica adecuada (RR 5.538; IC95% 2.75- 11.15; p < 0.001) fueron predictores independientes de mayor sensibilidad del estudio transtorácico. Conclusiones: La utilidad diagnóstica del estudio transtorácico es particularmente elevada en aquellos pacientes con presencia de soplo y adecuada ventana acústica. El aumento de la sensibilidad del ecocardiograma transtorácico cuando las imágenes son de buena calidad permite que en pacientes sin prótesis valvular, con baja sospecha clínica y estudio ecocardiográfico transtorácico negativo puedan buscarse focalidades infecciosas alternativas con seguridad.

OBJETIVO: Avaliar o prognóstico clínico dos doentes coronários submetidos a revascularização percutânea com implantação de stents revestidos com fármacos na descendente anterior proximal. MÉTODOS: Cento e setenta doentes consecutivos, com idade média de 65 anos, 49 (29%) mulheres, receberam implante de pelo menos um stent revestido com fármaco, no nosso centro. O número total de stents revestidos com fármaco implantados foi 189, dos quais 115 (61%) de sirolimus (CYPHER®) e 74 (39%) de paclitaxel (TAXUS®). Em 100 (60%) dos casos, estava presente doença coronário multivaso. Em 61 (36%) dos doentes tratou-se outro segmento coronário para além da descendente anterior proximal. Efetuou-se um seguimento clínico durante um tempo médio de 11 ± 5 meses e controle angiográfico entre os seis e os nove meses. Obteve-se um endpoint final composto por morte, infarto agudo do miocárdio e pela necessidade de reintervenção sobre a descendente anterior. Analisou-se secundariamente a ocorrência de reestenose, a necessidade de reintervenção sobre o segmento proximal da descendente anterior e a trombose de stent. RESULTADOS: O procedimento teve êxito angiográfico imediato em todos os doentes. Registraram-se duas mortes, dois infartos agudos do miocárdio, e duas reintervenções coronárias percutâneas por trombose de stent no período intra-hospitalar. Aos seis meses de seguimento, observou-se mais uma morte cardíaca e identificaram-se três infartos do miocárdio; houve necessidade de três novos procedimentos de revascularização. Até ao final do seguimento, verificaram-se mais três mortes, três infartos do miocárdio e oito revascularizações da descendente anterior, duas delas por cirurgia. A sobrevivência livre de eventos cardíacos adversos maior foi de 91%. A mortalidade cardíaca foi de 3%. A reestenose binária no segmento proximal da descendente anterior foi de 4,1%. A sobrevivência livre de revascularização do vaso alvo foi de 94%. Não se observaram casos de trombose tardia de stent. CONCLUSÃO: A revascularização percutânea da descendente anterior proximal com a implantação de stents revestidos com fármacos constitui uma estratégia terapêutica segura e muito eficaz em curto e longo prazos.

OBJECTIVE: To assess the clinical prognosis of patients with coronary artery diseases undergoing percutaneous revascularization with drug-eluting stent implantation in the proximal left anterior descending coronary artery. METHODS: One hundred and seventy consecutive patients with mean age of 65 years, 49 of them females (29%), undergoing implantation of at least one drug-eluting stent in our medical center. The total number of drug-eluting stents implanted was 189, of which 115 (61%) were sirolimus-eluting (CYPHER TM) and 74 (39%) were paclitaxel-eluting stents (TAXUS TM). In 100 (60%) of the cases, multivessel coronary artery disease was present. In 61 (36%) patients another coronary artery segment was treated in addition to the proximal left anterior descending coronary artery. The mean clinical follow-up period was 11 ± 5 months, and angiographic controls were performed between 6 and 9 months. The final endpoint was a composite of death, acute myocardial infarction and need for reintervention on the anterior descending. The secondary endpoint included the occurrence of restenosis, need for reintervention on the proximal segment of the left anterior descending and stent thrombosis. RESULTS: The procedure achieved immediate angiographic success in all patients. Two deaths, two acute myocardial infarctions, and two percutaneous coronary reinterventions due to stent thrombosis were recorded during in-hospital stay. At the sixth month of follow-up, an additional cardiac death and three myocardial infarctions were observed; three repeat revascularization procedures were required. Up to the end of the follow-up, three additional deaths, three myocardial infarctions and eight revascularization procedures of the anterior descending, two of them surgical, were verified. Survival free from major adverse cardiac events was 91%. Cardiac mortality was 3%. Binary restenosis in the proximal segment of the left anterior descending coronary artery was 4.1%. Target vessel revascularization-free survival was 94%. No cases of late stent thrombosis were observed. CONCLUSION: Percutaneous revascularization of the proximal left anterior descending coronary artery with implantation of drug-eluting stents is a safe and very efficient therapeutic strategy in the short and long terms.

In-stent restenosis (ISR) has an incidence between 20% and 30% using bare metal stents. ISR late regression phenomenon (ISRLR) has been previously described, but clinical variables related with this phenomenon remain unclear. The aim of the study was to identify the variables related with ISRLR. Methods: We identified from our data base 30 patients between November 1995 and September 2002 that fulfilled the following criteria: 1) Documented ISR at follow-up angiography (CA-1); 2) treated medically; and 3) Referred for a second follow-up angiography (CA-2) at least 3 months after CA-1. ISRLR was defined as a > 0.2 mm increase in MLD between CA-1 and CA-2, calculated as the 2-fold of our inter-observer variability. ISR late progression was defined as a > 0.2 mm decrease in minimum lumen diameter (MLD) between CA-1 and CA-2. Results: At the time of CA-2 only 2 patients (6.7%) had symptoms related with the previously stented vessel. We found a mean MLD of 1.03 ± 0.34 mm and 1.54 ± 0.48 mm at CA-1 and CA-2 respectively (ΔMLD = 0.51 ± 0.34 mm; p < 0.001). Twenty four patients (80.0%) had ISRLR. Two variables were related to the presence or absence ISRLR: Current smoking at the time of coronary stenting (70.8% vs 20.0% respectively, p = 0.026) and acute coronary syndrome as clinical indication for coronary stenting (and 83.5% vs 40.0% respectively, p = 0.029). Conclusion: ISRLR is afrequent phenomenon in patients with ISR treated medically, probably contributing to the benign long-term clinical outcome that has been previously described in patients with asymptomatic or mildly symptomatic ISR. Current smoking at the time of coronary stenting and acute coronary syndrome as clinical indication for coronary stenting are associated with this phenomenon.

La reestenosis intrastent (RIS) tiene una incidencia del 20 al 30% cuando se utilizan stents convencionales. El fenómeno de regresión tardía de (RTRIS) ha sido descrito previamente, pero no se han identificado variables relacionadas con dicho fenómeno. El objetivo del estudio fue identificar variables relacionadas con la RTRIS. Métodos: Identificamos en nuestra base de datos 30 pacientes con los siguientes criterios: 1) RIS identificada durante el seguimiento angiográfico (AC-1); 2) sujetos que permanecieron con tratamiento médico; 3) referidos para una angiografía de seguimiento (AC-2) al menos 3 meses posteriores a la AC-1. RTRIS fue definida como un incremento del diámetro lumi-nal mínimo (DLM) > 0.2 mm entre la AC-1 y AC-2, calculado a partir del doble del valor de nuestra variabilidad interobservador. La progresión tardía de la RIS, se definió como un decremento en el DLM 0.2 mm entre AC-1 y AC-2. Resultados: Al momento de la AC-2 sólo 2 pacientes (6.7%) tenían síntomas relacionados con el vaso blanco del tratamiento. Encontramos una media de DLM de 1.03 ± 0.34 mm y 1.54 ± 0.48 mm en AC-1 y AC-2 respectivamente (p < 0.001; ΔDLM = 0.51 ± 0.34 mm). Del total de 30 pacientes, 24 (80.0%) tenían RTRIS. Existieron dos variables relacionadas con la presencia o ausencia de RTRIS: Fumar concordantemente con el tiempo de la implantación del stent (70.8% vs 20.0% respectivamente, p = 0.026) y la existencia de un síndrome coronario agudo (SICA) como indicación para el tratamiento inicial (83.5% vs 40.0% respectivamente, p = 0.029). Conclusión: La RTRIS es un fenómeno frecuente en pacientes con RIS que permanecen con tratamiento médico, hecho que probablemente contribuye con la evolución clínica benigna que ha sido previamente descrita, en pacientes con RIS asintomáticos o con escasa sintomatología. Sujetos fumadores al momento de la implantación del stent así como SICA como indicación al tratamiento inicial, son situaciones asociadas con la presentación de RTRIS.

Aim: The aim of the study was to evaluate the compromise of side branches when jailed by a coronary stent implanted without balloon predilation. Patients and methods: 56 patients in which at least a coronary stent was implanted without balloon predilation and covering a side brach (58 stents, 1.04 ± 0.19 per patient) were studied. The effect of direct coronary stent implantation over side branch flow, as well as the characteristics associated were studied. Results: The main vessel was left anterior descending in 63%, left circumflex in 21%, right coronary in 14%, and left main in one case. An angiographic successful result in the main vessel was obtained in all cases. Coronary flow was TIMI 3, 2, 1, and 0 in 95%, 3%, 0%, and 2% before the procedure, in comparison with 86%, 2%, 3%, and 9% after stent implantation (p = 0.204). The incidence of side branch occlusion was 12% (7/58). In one case, the side branch was dilated across the stent struts, and thus the rate of side branch loss at the end of the procedure was 10% (6/58). In cases of side branch occlusion, there was a more severe stenosis at its origin before stent implantation (30.2 ± 31.3% vs 16.8± 11.1%, p = 0.028). Fifty percent of side branches occluded after direct coronary stent implantation and angiographically reevaluated at follow-up became patent, and 88% of side branches not affected after stent implantation remained patent at 6.2 ± 1.9 months. Conclusion: The rate of side branch occlusion after direct stent implantation in our series was 12%, that is not different from that reported for conventional stent implantation. Thus, the decision of using direct or conventional coronary stenting should not be conditioned by the presence of side branches arising from the target lesion.

Objetivo: El objetivo fue evaluar el grado de compromiso de las ramas que son enjauladas durante la implantación directa de stent. Pacientes y métodos: Se estudiaron 56 pacientes en los que se implantó al menos un stent coronario (58 stents) sin dilatación previa con balón y en los que se enjauló alguna rama secundaria. Se evaluó la tasa de pérdida de la rama, el efecto de la implantación del stent sobre el flujo de esta rama y los factores relacionados con estos hechos. Resultados: El vaso principal fue la descendente anterior en el 63%, la circunfleja en el 21%, la coronaria derecha en el 14% y el tronco principal de la coronaria izquierda en un caso. Se obtuvo éxito angiográfico sobre el vaso principal en todos los casos. Antes del procedimiento, el flujo a nivel de la rama secundaria era TIMI grado 3, 2 y 0 en 55 (95%), 2 (3%) y un caso (2%), respectivamente. Tras la implantación del stent, el flujo era TIMI grado 3, 2, 1 y 0 en 50 (86%), 1 (2%), 2 (3%) y 5 (9%) casos, respectivamente (p = 0.204). La incidencia de pérdida de la rama fue 12% (7/58); en un caso, se intentó con éxito recanalizar y dilatar ésta a través de los struts del stent, por lo que la tasa de pérdida de rama final fue 10% (6/ 58). Las ramas que se ocluyeron tenían un mayor grado de estenosis en el origen antes de la implantación del stent (30.2 ± 31.3% vs 16.8 ± 11.1%, p = 0.028). En los pacientes que se reevaluaron angiográficamente, a los 6.2 ±1.9 meses, el 50% de las ramas que se habían ocluido se encontraban permeables, y el 88% de las que no se comprometieron seguían permeables. Conclusiones: La tasa de oclusión de las ramas con la implantación directa de stent fue 12% en nuestra serie, cifra similar a la que ocurre con la implantación de stent tras dilatación con balón. Por tanto, la existencia de ramas localizadas en el segmento en el que va a implantarse el stent no tiene por qué condicionar la decisión o no de realizar una dilatación previa con balón.

Coronary artery fistula between a coronary artery and a cardiac chamber is a rare condition, especially when multiple fistulas communicate with the left ventricle. Herein we report a case of an elderly woman with multiple diffuse coronary artery-left ventricular fistulas diagnosed by angiography. Since the coronary artery-cardiac chamber communications were multiple and diffuse neither surgery nor transcatheter coil occlusion was considered in this case.

Las fístulas de las arterias coronarias que drenan a las cavidades cardíacas son una anomalía infrecuente, especialmente cuando son múltiples y drenan hacia el ventrículo izquierdo. Presentamos el caso de una mujer octogenaria con múltiples fístulas difusas que se originan de la coronaria izquierda y que drenan al ventrículo izquierdo. El hecho de que fuesen múltiples y difusas imposibilitó una intervención quirúrgica o percutánea como se recomienda en estos casos. (Arch Cardiol Mex 2004; 74:45-48).