Clinic In Madrid Research Articles

Reducing Sexual Risk Behavior Among Steady Heterosexual Serodiscordant Couples in a Testing and Counseling Program

To assess the effect of an HIV counseling and testing program targeting steady heterosexual serodiscordant couples. We studied 564 couples who attended a sexually transmitted infections/HIV clinic in Madrid in the period 1989 to 2007 and participated in couples counseling and testing. Sociodemographic, epidemiologic, clinical, and behavioral information of both partners was obtained before testing the nonindex partner. Sexual practices reported in the first (preintervention) and second visit were compared, as well those reported in 4 additional visits. Among the 399 couples who returned for a second visit (71%), the median number of sexual risk practices in the previous 6 months decreased (26.9-0; P <0.001) and the percentage of couples who had not engaged in sexual risk behavior increased (46.1-66.7; P <0.001). This reduction was maintained by the 143 couples who had 4 return visits. The diagnosis of HIV-infection in the index case previous to entering the program was associated with a lower frequency of sexual risk behavior. Independent predictors of postintervention risky sexual behavior included preintervention sexual risk behavior (odds ratio [OR]: 2.8, 95% confidence interval: 1.7-4.4), index case aged over 35 (OR: 2.0, 1.2-3.3), and a recent pregnancy (OR: 3.1, 1.6-6.3). The incidence of HIV seroconversion was 3.9 per 1000 couple-years (1.4-9.7). The diagnosis of HIV-infection and counseling appears to provide complementary reductions in sexual risk behaviors among serodiscordant steady heterosexual couples at follow-up, but the risk of transmission was not totally eliminated.

Liver Complications Have Reached a Plateau as Cause of Hospital Admission and Death in HIV Patients in Madrid

Hospital admissions and deaths due to liver-related complications as result of chronic viral hepatitis are globally on the rise in HIV patients. However, a steady decline in liver-related hospitalizations and deaths has occurred at our HIV clinic in Madrid since year 2003. Hepatic complications are currently still responsible for 8.7% of all hospital admissions and one-third of in-hospital deaths, with hepatitis C virus infection by far the leading etiologic agent.

Increase of Non-B Subtypes and Recombinants Among Newly Diagnosed HIV-1 Native Spaniards and Immigrants in Spain

Although HIV-1 clade B variants are predominant in Western Europe, non-B subtypes are rapidly spreading, mainly due to immigration from endemic regions. All newly diagnosed HIV-1-infected individuals at a HIV/AIDS clinic in Madrid from 2000 to 2007 were identified. Subtype assignment was based on phylogenetic analysis of pol sequences from plasma specimens collected at first visit. A total of 1,430 newly diagnosed HIV-1 individuals were identified: 902 Spaniards, 232 South Americans, and 162 Africans, among others. The proportion of South-Americans and Africans among diagnosed HIV-1 patients increased from 2000 to 2007 (from 17% to 22% and from 4% to 21%, respectively). Half of diagnosis of HIV-1 in 2007 was in foreigners whereas in previous years Spaniards were predominant. Non-B variants were found in 157 (24%) of the 649 subjects who could be subtyped: 11A, 6C, 2D, 1F2, 13G, 4H, 1J, 3CRF01_AE, 64CRF02_AG, 2CRF03_AB, 3CRF06_cpx, 3CRF10_CD, 7CRF11_cpx, 9CRF12_BF, 9CRF14_BG, 1CRF18_cpx, 1CRF19_cpx, 2CRF31_BC, 10 URF and 5 outgroups. They represented 93%, 14% and 4% of newly-diagnosed HIV-1 Africans, South-Americans and native Spaniards, respectively. Non-B subtypes increased from 9% in 2000 to 32% in 2007, specially among South-Americans (from 11% to 20%) and native Spaniards (from 4% to 10%). Most (75%) were recombinant viruses. The highest number and diversity of HIV-1 variants among natives was observed in 2007. HIV-1 non-B subtypes are increasingly present among newly diagnosed HIV-1 individuals in Madrid, representing a third of cases in 2007, whereas 10% of newly diagnosed HIV-1 native Spaniards had non-B viruses.

Liver cirrhosis in HIV‐infected patients: prevalence, aetiology and clinical outcome

Liver disease is frequently seen in HIV+ patients as a result of coinfection with hepatitis B (HBV) or C (HCV) viruses, alcohol abuse and/or exposure to hepatotoxic drugs. The aim of this study was to assess the prevalence of liver cirrhosis, its main causes and clinical presentation in HIV+ patients. Observational, cross-sectional, retrospective study of all HIV+ individuals followed at one reference HIV outpatient clinic in Madrid. Liver fibrosis was measured in all cases using transient elastometry (FibroScan). All 2168 HIV+ patients on regular follow-up (76% males, 46% injecting drug users) were successfully examined by FibroScan) between October 2004 and August 2006. Liver cirrhosis was recognized in 181 (overall prevalence, 8.3%), and the main aetiologies were HCV, 82.3%; HBV, 1.6%; dual HBV/HCV, 2.8%; and triple HBV/HCV/ hepatitis delta virus (HDV) infection, 6.6%. The prevalence of cirrhosis differed among patients with distinct chronic viral hepatitis: HCV, 19.2%; HBV, 6.1%; HBV/HCV, 41.7%; and HBV/HCV/HDV, 66.7%. In 12 patients with cirrhosis (6.7%), no definite aetiology was recognized. Overall, cirrhotics had lower mean CD4 counts than noncirrhotics (408 vs 528 cells/microL respectively; P = 0.02), despite similar proportion of subjects with undetectable viraemia on highly active antiretroviral therapy. Clinical manifestations of liver cirrhosis were: splenomegaly, 61.5%; oesophageal varices, 59.8%; ascites, 22.6%; encephalopathy, 12.1%; and variceal bleeding, 6.1%. Liver cirrhosis and hepatic decompensation events are relatively frequent in HIV+ individuals. Chronic HCV and alcohol abuse, but not chronic HBV, play a major role. Transient elastometry may allow the identification of a significant number of HIV+ individuals with asymptomatic liver cirrhosis.

Infección por el VIH en inmigrantes: diferencias clínico-epidemiológicas con la población autóctona en un área de salud de la Comunidad de Madrid (2001-2004)

To describe the incidence and characteristics of immigrant patients attended in a dedicated HIV Unit in Madrid (Spain). Cross-sectional study including all patients whose first visit to our HIV Unit took place between January 2001 and December 2004. Among a total of 516 new patients seen during the study period, 101 (19.6%) were immigrants (59% from Latin America, 27% from sub-Saharan Africa). Considering only patients who had not received previous clinical care in other centers (n = 298), 25.5% were immigrants. As compared to Spanish patients, there was a higher proportion of women among the immigrant population (40% vs. 26%: P = 0.008), age was lower (35 vs. 38 years; P = 0.003), and educational level was higher (39% vs. 13% secondary or higher education; P < 0.0001), with no statistical differences regarding employment (37% vs. 27% were unemployed; P = 0.07). Sexual transmission was more frequent among immigrants (85% vs. 37%; P < 0.0001), but the main sexual route of infection in both groups was heterosexual contact (71% and 66%). There were no differences in the baseline clinical, immunological, or virological status. A large number of new patients attended for the first time in a dedicated HIV Clinic in Madrid were immigrants. Although these patients showed some differences in demographic characteristics and the mechanism of HIV transmission, no significant differences were found in their clinical or immunological characteristics as compared to Spanish patients.

Oral complication risks after invasive and non‐invasive dental procedures in HIV‐positive patients

Limited published scientific evidence is available to provide guidance to clinicians on possible increased risks of invasive oral procedures associated with the human immunodeficiency virus (HIV) status of the patient. The aim of this study was to assess post-procedural complications in patients infected with HIV. This was a retrospective cross-sectional study of the records of 101 consecutive HIV patients treated at the School of Dentistry of Madrid Complutense University and Sandoval STD Clinic in Madrid between January 2003 and February 2005. Data were gathered by an experienced dental practitioner using a structured epidemiological questionnaire for information on gender, age, HIV transmission category, medical history, hepatitis B virus (HBV) or hepatitis C virus (HCV) coinfection and other diseases, TCD4+ and TCD8+ count, HIV viral load (VL), platelet count, neutrophil count, international normalized ratio and haemoglobin level; tobacco and alcohol intake, highly active antiretroviral treatment and presence of oral lesions. Information was also collected on complications related to dental treatment (invasive or non-invasive) during the previous 6 months. Chi-squared test and Fisher's exact test were used to establish statistical significance. Data were gathered on 314 dental procedures in 101 patients. The overall complication rate was 2.2% (7/314); in 147 invasive procedures, seven complications (4.8%) were documented (one persistent pain, two prolonged bleeding, three infections, one bone sequestrum) including extractions, periodontal scaling, endodontic treatment and biopsy. No differences were found in TCD4+, TCD8+, platelet count, HBV or HCV co-infections or HIV VL between patients with and/or without complications. Patients with complications were mainly in B stage of HIV disease (P=0.020). Oral lesions and smoking habit>20 cig day-1 were documented in 83.3% (P=0.086) and 50% (P=0.060), respectively, of patients with complications. The complication rate was 2.2% overall and 4.8% after invasive dental procedures. Presence of oral lesions, smoking habit or HIV clinical stage B may be predictive factors for oral complications in HIV patients. No relationship was found between complications and virological, immunological or other laboratory values. Studies with wider samples and negative control group are warranted to confirm the absence of an association between HIV positivity and higher risk of oral complications.

Epidemiology of musculoskeletal pain in primary care

Aims: (1) To determine the proportion of children evaluated for musculoskeletal pain in a paediatric primary care clinic over a three year period; (2) to describe the number of office...

Condiciones sociolaborales, conductas de riesgo y prevalencia de infecciones de transmisión sexual en mujeres inmigrantes que ejercen la prostitución en Madrid

ObjectiveTo describe the sociodemographic characteristics, work conditions, sexual behavior, and prevalence of HIV, hepatitis B (HBV), and hepatitis C (HCV) infection and of other sexually transmitted infections among a group of female immigrant prostitutes in Madrid. MethodsWe performed a descriptive study of a group of immigrant women who worked as prostitutes and who attended a sexually transmitted diseases (STD) clinic in Madrid in 1999 and 2000. Information was collected on sociodemographic characteristics, work conditions, use of injected drugs, and sexual practices with their clients and in their private lives. The services provided included screening for the main STDs and serological studies for HIV, HBV and HCV. ResultsA total of 579 female immigrants were analyzed. The mean age was 28.7 years. Ninety-six percent were from Latin America. None reported having consumed injected drugs. They began to work as prostitutes at a mean age of 27.4 years and 93.3% of them began in Spain. In the previous month, 98% had always used condoms for vaginal and anal penetrations with their clients and 17.6% had used them in their private sexual relations. Thirty percent reported condom breakage during intercourse. The prevalence of HIV and HCV infection was 0.2 and 0.9%, respectively; 8.1% showed HIV anticore antibodies and 0.5% showed surface antigens. An ulcerative STD was diagnosed in 2.1% and a non-ulcerative STD was diagnosed in 16%. ConclusionsCondoms are generally used with clients although the frequency of breakage is high. Condom use in prostitutes’ personal lives is dramatically lower. The prevalence of markers for HIV, HBV and HCV is low and the frequency of STD is moderate.

Nivel socioeconómico y consumo de recursos sanitarios en atención primaria

To determine the influence of socioeconomic status on healthcare demand and resource consumption in our population. We performed a cross sectional, retrospective study of socioeconomic status and healthcare and pharmaceutical consumption in randomly selected patients from five primary care pediatric clinics in Madrid. The chi-square test was used to compare percentages. For the remaining analyses, nonparametric tests were used after confirming that the data followed non-normal distribution. We compared 684 questionnaires. Patients in the most disadvantaged socioeconomic levels consumed a greater number of drugs than those in more privileged levels (mean 0.79 vs. 0.47, p = 0.04). The mean pharmacological expenditure was also higher in the lowest socioeconomic levels than in the highest levels (5.28 Euros vs. 2.21 Euros, respectively; p = 0.001). No significant differences were found among socioeconomic levels in the number of consultations or diagnostic tests requested. The number of consultations was higher in younger patients (p < 0.001) or in those with chronic diseases (p = 0.001). Drug consumption was increased in the most disadvantaged levels (p = 0.002) and in patients with chronic diseases (p < 0.001). Lastly, pharmacological expenditure expressed in Euros was also higher in the lowest socioeconomic levels (p = 0.001) and in patients with chronic diseases (p < 0.001) but was lower if one of the parents was a foreigner (p = 0.031). We found a relationship between socioeconomic level and drug consumption and its attributable cost. These data should be confirmed by broader studies.

Caffeinated clues from epidemiology of Parkinson's disease.

Although there is a growing interest in the genetic determinants of Parkinson’s disease (PD), the low concordance for clinical disease among monozygotic twins clearly indicates the etiologic importance of nongenetic factors.1 On top of the list of potential candidates is cigarette smoking. For many years, researchers have been intrigued by the strong inverse association between cigarette smoking and risk of PD, but despite extensive investigation it remains unclear whether nicotine or some other component of cigarette smoke reduces the risk of PD or whether people predisposed to PD have an early aversion to smoking.2 More recently, coffee and caffeine consumption have emerged as powerful predictors of risk of PD. Here we will review the epidemiologic evidence supporting this association and discuss the contribution of epidemiologic studies in clarifying the potential biologic mechanisms. Whereas the inverse association between cigarette smoking and risk of PD has been known for decades, relatively few early studies examined the potential role of coffee or caffeine consumption. Questions on coffee and tea consumption and risk of PD were included in some of the case-control studies on smoking3,4⇓ or environmental factors5 and risk of PD, but published results were not adjusted for smoking and thus were difficult to interpret. The first smoking-adjusted analysis of coffee consumption and PD was reported by Jimenez-Jimenez et al.,6 who studied 128 patients with PD (60 women) attending a movement disorder clinic in Madrid and 256 control subjects attending the emergency room of the same hospital for non-neurologic disorders. The data supported a 30% lower risk of PD among coffee drinkers (coffee drinking was reported as yes/no only) as compared with nondrinkers in men and women, but the results were not significant and received little attention. More detailed analyses of coffee consumption and risk of PD …

Prevalencia de infección por el virus de la hepatitis B y necesidades de vacunación en colectivos de alto riesgo

We aimed to evaluate the serological status of hepatitis B virus (HBV) and the vaccination's needs among high risk populations. Cross sectional study of subjects first attending a HIV diagnosis clinic in Madrid during 2000-2002. Patients who had not been vaccinated for HBV were classified according to the serological markers as active infection (HBsAg+), past infection (anti-HBc+ and HBsAg) or susceptible (anti-HBc). A total of 7,827 patients were analyzed: 5.2% injecting drug users, 21% homosexual men, 38% female sex workers, and 34% subjects with other heterosexual risks. 50% were from countries other than Spain. HIV prevalence was 4.1%. 10.4% had completed or initiated the vaccination. The prevalence of HBsAg was 1.2% and it was associated with age over 30 years and an origin country in Africa or eastern Europe. 76% were susceptible to HBV and this status was independently associated with male sex, age lower than 30 years, heterosexual risk, Spaniard or Latin American origin, and HIV seronegative. Vaccination should be intensified in health care settings commonly attended by these population groups.

Deshabituación tabáquica y bupropión: la ansiedad y la depresión como índices de eficacia terapéutica

Smoking and depression are related. Bupropion, the first non-nicotinic drug that is an effective treatment in smoking cessation, is a tricyclic antidepressant that inhibits neuronal uptake of serotonin, dopamine and norepinephrine in the thalamic nuclei. To assess if certain personality factors (anxiety or depression) might predict the efficacy of bupropion for smoking cessation. The study was carried out in two smoking cessation clinics in Madrid and Barcelona. Fifty patients (21 men) declaring the desire to quit smoking were enrolled. Their mean age was 43.6 years (SD 8.75). The patients were treated with 300 mg of bupropion per day for one month and expired CO was monitored for 6 months. Personality factors were assessed on a hospital anxiety and depression scale (HADS). We evaluated whether there was a significant difference in HADS scores for patients who were still not smoking after 6 months and those who had not managed to quit. The 50 patients were smokers of a mean 39 packs per year (SD 17.82) and had mean scores of 7.4 (SD 4.15) for anxiety and 5.8 (SD 3.93) for depression. Four patients (8%) were unable to complete the study. After one month, 28% of the patients smoked, after 3 months 56% smoked and after 6 months 58% still smoked. The patients who smoked during the first month had higher depression scores than did the non-smokers (p = 0.03). After 3 and 6 months the patients who had managed to continue not smoking were those who had higher anxiety scores than did those who still smoked (p = 0.0052 at 3 months and p = 0.017 at 6 months). Patients who responded better to treatment with bupropion after 6 months of follow-up were those with higher anxiety scores on the HADS. Depression levels influenced outcome only during the first month.

Sustitución de medicamentos de marca por genéricos en la consulta de atención primaria

To estimate the percentage of patients who change from current medication to generic medicine once properly informed. Observational, cross-sectional.Setting. Two primary care clinics in Madrid, one rural and the other urban.Participants. Patients who came for their consultation and who take prescribed drugs which have generic alternatives. All patients included received a standard 40 second verbal explanation about generics. Later, the researcher filled out a 18 items test. A descriptive analysis was done taking into account frequencies and applying a bivariable analysis comparing the variable <<accepted change>> with the others. 71% of the patients accepted the change to generic medicine, 29% did not. Of the latter, 67.4% said that they preferred to consult with the prescribing physician; 45.1% were of the opinion that it would not have the same effect; a 16.1% said that if it was cheaper, it must be of a worse quality; and another 16.1% said that they would only accept the change if it meant saving some money.The researcher perceived distress and discomfort in 23.4% of the patients. He himself felt satisfied in 83.9% of the cases, indifferent in 12.9% and unsatisfied in 3.2%. Providing the adequate information and letting the patients decide for themselves about the substitution of brand for generic drugs resulted in almost three quarters of the cases opting for the change. And this with a minimal professional effort and the added benefit of improving the patient-practioner relationship.

Seasonal variations of 25-hydroxyvitamin d in young and old people in Buenos Aires

calcidiol that increase serum parathyroid hormone (PTH). It is unknown, however, the level at which serum calcidiol can influence bone mineral density (BMD). This study aims to determine the serum calcidiol levels that influence BMD in PMW. Moreover, we studied the prevalence of hypovitaminosis D in this population based in these calcidiol latter levels. Measurements of calcidiol and PTH in serum and bone densitometry of the spine and hip (Hologic QRD-1000) were carried out in 171 (47–66 years of age) PMW with natural menopause of 7.9 6 2 (mean 6 SD) years and no treatment, who visited an outpatient rheumatology clinic in Madrid between November and June. No correlation between calcidiol and PTH was observed. In the overall group, and in women with calcidiol .15 ng/mL, PTH was inversely related to hip and spine BMD. However, when considering PMW with levels of calcidiol at ,15 ng/mL, a direct relationship between calcidiol and BMD of the hip was observed. By performing multiple stepwise regression analysis, it was observed that calcidiol is the only factor affecting BMD of the hip in the subgroup with serum calcidiol levels ,15 ng/mL; meanwhile, in the PMW subgroup with calcidiol .15 ng/mL, PTH was the main factor influencing hip BMD. With these results, a threshold of deficiency was established at 15 ng/mL calcidiol. The prevalence of this deficiency in PMW was 64%. Concentrations of serum calcidiol of ,15 ng/mL affect BMD, regardless of PTH. Deficiency of vitamin D is a very common finding in PMW attending this outpatient rheumatology clinic. Thus, it is advisable to prescribe vitamin D supplements for this population during the winter months.

Categorías de exposición y seroprevalencia del VIH en adolescentes que se realizaron voluntariamente la prueba. Madrid, 1986–2000

To describe the time-trend in exposure categories and HIV seroprevalence among adolescents who underwent to voluntary testing in the period 1986-2000. This study covered all adolescents, aged 13 to 19 years, at their first test for HIV in a sexually transmitted disease clinic in Madrid. Gender, age and HIV risk behaviours were collected. HIV diagnosis relies on ELISA test and Western blot confirmation. Time trends in HIV seroprevalence and exposure categories were analysed. A total of 1327 adolescents, 52% women and 22% under 18 years, were studied. The annual number of adolescents remained through the time, but injecting drug users (IDU) and IDU partners declined and female sex workers rose. 108 adolescents were diagnosed with HIV infection -71% were IDU-. HIV seroprevalence was 8.1% -31.3% in IDU-. It declined from 18.2% in 1986 to 1.5% in 1995, and after then it held steady under 4%. This decline involved several risk categories and was statistically significant in homo/bisexual men and female sex workers. The logistic regression analysis, adjusting for changes in exposure categories, showed an annual reduction in HIV seroprevalence (OR = 0.87; 95% CI, 0.81-0.94). HIV seroprevalence has decreased due to the fall of new young IDU and the decrease of seroprevalence within several exposure categories. HIV infections and risk behaviours continue happened among adolescents.

Low vitamin D levels in outpatient postmenopausal women from a rheumatology clinic in Madrid, Spain: their relationship with bone mineral density.

To evaluate a possible relationship between vitamin D levels and bone mineral density (BMD) and the prevalence of hypovitaminosis in a population of postmenopausal women from a rheumatologic outpatient clinic in Madrid, Spain, 171 postmenopausal women (aged 47-66 years) divided into two groups (osteoporotic and nonosteoporotic, according to WHO criteria) were studied between November and June. Liver and kidney function were normal in all subjects. Serum parathyroid hormone (PTH) and calcidiol levels were determined and bone densitometry carried out at the lumbar spine and hip level. PTH and calcidiol serum levels did not show any correlation. Serum PTH was inversely related to BMD at both hip and lumbar spine in the total group, and at the hip with calcidiol levels lower than 37 nmol/l. Calcidiol was directly related to hip BMD only when levels were lower than 37 nmol/l. Results of a stepwise multiple regression analysis showed that the single factor which affected BMD at the hip was calcidiol in the subgroup with serum calcidiol levels below 37 nmol/l, while in the subgroup with serum calcidiol levels above 37 nmol/l, the main factor affecting hip BMD was serum PTH. The prevalence of vitamin D deficiency at a cutoff of 37 nmol/l was 64%. In summary, calcidiol serum levels below 37 nmol/l seem to affect bone mass, regardless of the effect of PTH. Vitamin D deficiency is a frequent finding in the postmenopausal women who attend a rheumatology outpatient clinic in Madrid. Vitamin D supplementation should therefore be considered in this population during the winter season.

Differences in curable STDs between HIV and non-HIV populations in Spain.

The pandemic impact of HIV has changed the clinical spectrum of STDs all over the world. The incidence and frequency of STDs in the different global geographic areas demonstrate the diagnostic and treatment capabilities of various local and national health systems and is simultaneously informing about the sexual behaviours of the population. The purpose of this study was to determine the frequency of curable STDs (herpes, chlamydia, gonorrhoea, syphilis, trichomoniasis) in a hospital-based STD clinic in Madrid, Spain during a 4-year period. Patients were referred mainly from the emergency department, gynecological wards, and family planning (61%) as well as from the HIV-hospital unit (31 beds) and outpatient department (39%). The total number of patients seen was 952 (243 men, 709 women) with an annual average of 238 patients per year. Of these, 139 (14.6%) were HIV-patients and 813 (85.4%) non-HIV patients. In non-HIV patients, STDs were identified in 493 cases (54.2%). In HIV-patients, STDs were diagnosed in 108 cases (77.7%; p < or = 0.001). Two or more STDs were more prevalent in HIV than non-HIV patients. The frequency of STDs in both HIV and non-HIV patients were vulvovaginal candidiasis, 47.8%:57.2%; syphilis, 11.7%:1.4% (p < or = 0.05); gonorrhea, 5.3%:3.9%; Gardnerella vaginosis, 6.3%:4.8%; genital chlamydia, 6.3%:9.06%; trichomoniasis, 17%:6.5% (p < or = 0.05); and genital herpes, 20.2%:5.3% (p < or = 0.05).

Musculoskeletal pain in primary pediatric care: analysis of 1000 consecutive general pediatric clinic visits.

1) To determine the number of primary care clinic visits attributable to musculoskeletal pain (MSP) in children >/=3 and <15 years of age. 2) To describe the demographic characteristics of this population assessed for limb/back pain. 3) To characterize the etiology of musculoskeletal pain in an urban general pediatric clinic in Madrid, Spain. Prospective evaluation of 1000 consecutive clinic visits to an urban general pediatric clinic. Inclusion criteria were 1) age >/=3 and <15 years and 2) musculoskeletal evaluation requested by the family or patient. All consultations related to MSP were recorded via standard protocol and data record form. During the study period, 61 of 1000 (6.1%; confidence interval: 4.6-7.5) clinic visits for children >/=3 and <15 years were related to MSP. Patients' age, mean +/- SD, was 9.7 +/- 3.3 years. Musculoskeletal complaints were more frequent in boys (57.4%), although there was no statistical difference. The presenting complaints included knee arthralgias in 33%; other joint (eg, ankles, wrists, elbows) arthralgias in 28%; soft tissue pain in 18%; heel pain in 8%; hip pain in 6%; and back pain in 6%. Symptoms were attributable to trauma in 30%; overuse syndromes in 28% (eg, chondromalacia patellae, mechanical plantar fasciitis, overuse muscle pain); and normal skeletal growth variants (eg, Osgood-Schlatter syndrome, hypermobility, Sever's disease) in 18% of patients. MSP represents a frequent presenting complaint in general pediatric practice. A new heightened awareness of the frequent occurrence of MSP should be adopted when designing pediatrics continuing medical education and training programs. musculoskeletal pain, limb pain, arthralgia, children, general pediatrics, pediatric primary care.

Análisis de la supervivencia del trasplante pulmonar en la Clínica Puerta de Hierro

The objective of this study was to analyze patient survival after lung transplants performed at the Puerta de Hierro clinic in Madrid (Spain) between 1991 and 1996. Survival probability was 65% after one year and 50% after three years. We found no significant differences in survival related to sex or type of transplant. Early survival tended to be higher for the last two years analyzed (71%) than for the first two (55%) (p < 0.00001). The rate was 100% for patients with cystic fibrosis and 0% for pulmonary hypertension and lymphangiomyomatosis. Short- and medium-term lung function results were good in surviving patients who did not develop obliterating bronchiolitis. We conclude that actuarial survival after lung transplant in our program is comparable to that reported in the literature. There are no significant differences related to sex, type of transplant or period. Survival varies greatly, however, depending on disease.

Altered concentrations of appetite regulators may contribute to the development and maintenance of HIV-associated wasting.

To examine the relation of circulating appetite neuropeptides, CCK-8 sulphate (CCK-8s) and beta-endorphin, and the tumour necrosis factor-alpha (TNF-alpha) and soluble TNF receptors (sTNFR) to the anorexia and wasting associated with HIV-infection. Cross-sectional analysis. A university-based HIV/AIDS ambulatory clinic in Madrid, Spain. Thirty-six randomly selected AIDS patients without concomitant diseases or secondary infections were classified into two groups: 19 patients with wasting and 17 with normal body weight, and 18 healthy controls. Nutritional status was evaluated by anthropometry, laboratory parameters and self-report of appetite. Plasma levels of TNF-alpha and sTNFR proteins p55 (sTNFR-p55) and p75 (sTNFR-p75) were determined by enzyme immunoassay, whereas CCK-8s and beta-endorphin levels were measured by radioimmunoassay. AIDS patients with wasting had significantly higher plasma concentrations of CCK-8s, but lower levels of beta-endorphin when compared to well-nourished AIDS patients (P < 0.01) or controls (P < 0.001). Mean levels of TNF-alpha, and sTNFR-p55 and sTNFR-p75 were greater in AIDS patients with wasting than in asymptomatic AIDS patients or in controls. No significant association was observed between any of these circulating peptides and the parameters of malnutrition. An activation of the TNF system, together with reciprocal changes in plasma concentrations of two neuropeptides with opposing appetite regulation, that is increased concentrations of CCK-8s but lower levels of beta-endorphin, are associated with the presence of HIV wasting. We hypothesize that these changes may contribute to the development of HIV wasting by producing a pathological inhibition of appetite.