BackgroundDysmenorrhea is a frequent and misdiagnosed symptom affecting the quality of life in young women. A working ability, location, intensity, days of pain, dysmenorrhea (WaLIDD) score was designed to diagnose dysmenorrhea and to predict medical leave.MethodsThis cross-sectional design included young medical students, who completed a self-administered questionnaire that contained the verbal rating score (VRS; pain and drug subscales) and WaLIDD scales. The correlation between scales was established through Spearman test. The area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, and likelihood ratio (LR +/−) were evaluated to diagnose students availing medical leave due to dysmenorrhea; moreover, to predict medical leave in students with dysmenorrhea, a binary logistic regression was performed.ResultsIn all, 585 students, with a mean age of 21 years and menarche at 12 years, participated. Most of them had regular cycles, 5 days of menstrual blood flow and 1–2 days of lower abdominal pain. The WaLIDD scale presented an adequate internal consistency and strong correlation with VRS subscales. With a cutoff of >6 for WaLIDD and 2 for VRS subscales (drug subscale and pain subscale) to identify students with dysmenorrhea, these scales presented an area under the curve (AUC) ROC of 0.82, 0.62, and 0.67, respectively. To identify students taking medical leave due to dysmenorrhea, WaLIDD (cutoff >9) and VRS subscales (cutoff >2) presented an AUC ROC of 0.97, 0.68, and 0.81; moreover, the WaLIDD scale showed a good LR +14.2 (95% CI, 13.5–14.9), LR −0.00 (95% CI, undefined), and predictive risk (OR 5.38; 95% CI, 1.78–16.2).ConclusionThis research allowed a comparison between two multidimensional scales regarding their capabilities, one previously validated and a new one, to discriminate among the general population of medical students, among those with dysmenorrhea or those availing medical leave secondary to dysmenorrhea. WaLIDD score showed a larger effect size than the pain and drug score in the students. In addition, this study demonstrated the ability to predict this combination of events.
Objetivo: evaluar la relación entre apoyo social y la frecuencia de pacientes con complicaciones agudas de la diabetes tipo 2. Materiales y métodos: se realizó un estudio de corte transversal en pacientes con diabetes mellitus tipo 2 que ingresaron a una clínica de tercer nivel entre 2014 y 2015. Se midió la percepción de apoyo social (media, ic 95%) con el cuestionario del estudio de desenlaces médicos de apoyo social (MOS, por su sigla en inglés) en los pacientes con y sin complicaciones agudas de la diabetes; se aplicó un modelo de regresión logística para identificar variables predictoras de complicaciones agudas. Resultados: se incluyeron 205 pacientes, de edad media 66 años, 51,2% mujeres, 56,6% de los pacientes eran casados, 50,7% con complicaciones agudas, la mayoría con apoyo social (83,6%; ic 95%, 76,1%-91,2%); la media de apoyo social global en pacientes sin complicaciones agudas fue 78,9 (76,8-88,1), con complicaciones 70,8 (68,3-73,2) para una diferencia entre grupos de 8,2 (ic 95%, 4,9-11,4). La falta de apoyo social (β:3,581), el intervalo de glucometrías entre 177 y 309 al ingreso (β:2,930), estar casado (β:1,845) o en tratamiento con insulina (β:1,672) fueron predictores de las complicaciones agudas de la diabetes. Conclusión: los pacientes con complicaciones agudas presentaron puntajes más bajos de apoyo social. La falta de apoyo social se relacionó con otras variables sociodemográficas y clínicas para predecir el riesgo de complicaciones agudas. Debe explorarse al apoyo social como una opción para mejorar las estrategias de tratamiento en los pacientes diabéticos.
El presente trabajo describe tres casos con Síndrome Febril Prolongado (SFP) con diagnóstico definitivo de enfermedad reumatológica, el primero, hombre de 29 años con picos febriles de 40°C, mialgias y adenopatías cervicales; único antecedente, viaje 30 días previos a región tropical, lo que hizo pensar en etiología infecciosa, sin embargo, tras persistencia de fiebre a pesar de cubrimiento antimicrobiano, se extienden estudios paraclínicos con hallazgo de ferritina en 2208 μg/l sugestivo de Enfermedad de Still del adulto al décimo día de estancia. El segundo es un hombre de 19 años, con clínica de dolor abdominal asociado a temperatura de 40°C sin antecedentes de importancia; ecografía abdominal evidencia hepatomegalia y derrame pleural; durante la estancia, presentó convulsiones tónico-clónicas y pancitopenia con anemia hemolítica, posterior a descartar cuadro infeccioso y neoplasia maligna, se solicitó perfil inmunológico con ANAS y Anticoagulante Lúpico positivos y se orienta diagnóstico hacia Lupus Eritematoso Sistémico al onceavo día de hospitalización, con mejoría posterior al manejo inmunomodulador. Por último, paciente femenina de 14 años con historia de artralgias, adenopatías cervicales/submaxilares, exantema morbiliforme y fiebres fluctuantes (38-39,9°C) de un mes de evolución que persistía pese a policultivos negativos y antibioticoterapia de amplio espectro por lo cual se amplían estudios de laboratorio encontrando ferritina de 3156 μg/l al día noveno de estancia y se diagnostica Enfermedad de Still del niño. La prevalencia de enfermedades reumatológicas en el SFP, ha venido en aumento permitiendo la aproximación precisa a otras etiologías antes no consideradas entre sus causas.
Background: Daily dietary calcium intake below the requirements has been related to lowlevels of vitamin D (Vit-D) and osteoarticular diseases. Objective: To determine the prevalence of Vit-D deficiency in the general population living in Bogotá, its relationship to dietary calcium intake, and the influence of socio-demographic factors and sunlight exposure. Materials and methods: In a pro-spective cohort of the general population (randomly selected), excluding individuals with conditions affecting calcium absorption or adequate Vit-D action, the prevalence of hypovitaminosis D (95 % ci) and regular consumption of calcium (rci, mg/day) is measured according to socio-demographic, anthropometric, biochemical, and sunlight exposure variables. A multiple regression model is implemented (no intercept) to predict Vit-D concentration based on the factors described. Results: Ninety-seven patients are included, 61 % of which are women, with a median age of 23 years, a weight of 65 kg (iqr: 55.2–70.5), a height of 165 cm ± 8.9, and bmi of 22.8 kg/m2 (iqr: 21.2–25.2). The rci was 393.7 mg/day, less than the benchmark for Colombian adults (p < 0.001); serum calcium concentration was 9.7 mg/dL. The mean Vit-D concentration (95 % ci) was 23.7 ng/mL (22.6–24.7); hypovitaminosis D was identified in 87 % of the sample (80.6–94.7 %), 24.7 % were classified as poor (15.6–33.8 %) and 62.9 % as insufficient (52.8–73 %). Vit-D concentration was predicted in a quadratic function by the interaction between sex, sunlight exposure, and rci (R2 > 90 %). Conclusion: The suspected high prevalence of Vit-D deficiency is confirmed in the general Colombian adult population as a result of low dietary calcium intake, demographic factors, and sunlight exposure.
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