Systematic review with meta-analysis: the incidence and prevalence of eosinophilic oesophagitis in children and adults in population-based studies

BACKGROUND

The recognition of eosinophilic oesophagitis (EoE) has risen sharply, but its current epidemiology is still under debate.

AIM

To estimate accurately the prevalence and incidence rates of EoE, by a systematic review and meta-analysis.

METHODS

MEDLINE, EMBASE and SCOPUS databases were searched for population-based studies on the epidemiology of EoE. Pooled incidence and prevalence rates, male:female and children:adult ratios, and geographical and temporal variations were calculated with random-effects models.

RESULTS

The search yielded 1334 references; the final quantitative summary included 13 population-based studies from North America, Europe and Australia, with the results showing high heterogeneity. The pooled EoE incidence rate was 3.7/100 000 persons/year [95% confidence interval (CI): 1.7-6.5] and was higher for adults (7; 95% CI: 1-18.3) than for children (5.1; 95% CI: 1.5-10.9). The pooled prevalence of EoE was 22.7 cases/100 000 inhabitants (95% CI: 12.4-36), rising to 28.1 (95% CI: 13-49) when studies with a lower risk of bias were considered; prevalence was higher in adults than in children (43.4; 95% CI: 22.5-71.2 vs. 29.5; 95% CI: 17.5-44.7, respectively), and in American compared to European studies. A steady rise in EoE incidence and prevalence rates was observed upon comparison of studies conducted before and after 2008. No significant publication bias was found.

CONCLUSIONS

Eosinophilic oesophagitis is an increasingly common diagnosis in North America and Europe. The population-based incidence and prevalence of eosinophilic oesophagitis vary widely across individual studies, probably due to variations in diagnosis and risk of bias of research. More prospective, large-scale, multicenter studies are needed to evaluate reported data.

Air pollution and emergency hospital admissions for cardiovascular diseases in Valencia, Spain

STUDY OBJECTIVE

To estimate the short-term association between air pollution levels and emergency hospital admissions for cardiovascular diseases in Valencia, within 1994-1996 period.

DESIGN

Daily levels of air pollution and emergency admissions for cardiovascular diseases were related to using an ecological time series design. The number of admissions was obtained from the hospital records database. Selected groups of causes were all cardiovascular diseases, heart admissions, and admissions for cerebrovascular diseases. The number of admissions for digestive diseases was used as control. Pollutants were black smoke, sulphur dioxide (SO(2)), nitrogen dioxide (NO(2)), carbon monoxide (CO) and ozone (O(3)). Magnitude of association was estimated by Poisson autoregressive regression. Estimations were calculated according the hottest (May to October) and the coldest (November to April) periods.

SETTING

City of Valencia, Spain, about 750,000 inhabitants.

PARTICIPANTS

People being admitted to the two major hospitals in the city, with a catchment area of nearly 400,000 inhabitants.

MAIN RESULTS

For the whole period, a significant association for SO(2)-24 h was found so a rise in its levels of 10 microg/m(3) was associated with an increment of 3% (95%CI 0.4 to 5.7%) in the expected number of cardiovascular admissions. A significant association for black smoke, SO(2)-24 h, SO(2)-1 h, and CO-1 h was found in the hottest semester. All these associations were verified with a lag of two days. The estimates of the associations for particles, SO(2), and CO were affected by the inclusion of the other pollutants in their models. NO(2) was independently associated with cerebrovascular admissions. There were no significant associations between air pollution and admissions for digestive diseases.

CONCLUSIONS

Current levels of air pollution and emergency cardiovascular admissions are significantly related in Valencia.

The EMECAM project: a multicentre study on air pollution and mortality in Spain: combined results for particulates and for sulfur dioxide

OBJECTIVE

The EMECAM study is a collaborative effort to evaluate the impact of air pollution on mortality in Spain. In this paper the combined results are presented for the short term effects of particulates and sulfur dioxide on both daily mortality for all and for specific causes.

METHODS

The relation between daily mortality for all causes, cardiovascular diseases, and respiratory diseases, and air pollution for particulates (daily concentrations) and SO(2) (24 and 1 hour concentrations) was assessed in 13 Spanish cities for the period 1990-6. With a standardised method, magnitude of association in each city was estimated by Poisson regression in a generalised additive model. Local estimates were obtained from both single and two pollutant analyses. Lastly, combined estimates for each cause and pollutant were obtained.

RESULTS

For combined results, in single pollutant models a 10 microg/m(3) increase in the concentration of the mean of the concurrent and one day lag for black smoke was associated with a 0.8% (95% confidence interval (95% CI) 0.4 to 1.1%) increase in total mortality. The estimates for total suspended particles (TSPs) and particulate matter of aerodynamic diameter <10 microm (PM(10)) and total mortality were slightly lower. The same increase in concentrations of SO(2) was associated with a 0.5% increase in daily deaths. For groups of specific causes, higher estimations were found, specially for respiratory conditions. Peak concentrations of SO(2) showed significant associations with the three groups of mortality. When two pollutant analyses were performed, estimates for particulates, specially for black smoke, did not substantially change. The estimates for daily concentrations of SO(2) were greatly reduced, but, on the contrary, the association with peak concentrations of SO(2) did not show any change.

CONCLUSIONS

There is an association between mortality and pollution through particulates among city populations in Spain. Peak rather than daily concentrations of SO(2) were related to mortality. Results suggest that populations in Spanish cities are exposed to health risks derived from air pollution.

Association between hospital emergency visits for asthma and air pollution in Valencia, Spain

OBJECTIVE

To assess the short term effect of concentrations of black smoke, sulphur dioxide (SO2), nitrogen dioxide (NO2) and ozone (O3) in ambient air on emergency room visits for asthma in the city of Valencia, Spain during the period 1994-5.

METHODS

Ecological study with time series data and application of Poisson regression. Associations between number of daily emergency visits in a city's hospital and concentrations of air pollutants were analysed taking into account potential confounding factors by the standardised protocol of the air pollution and health: a European approach (APHEA) project.

RESULTS

Mean (range) daily number of emergency room visits for asthma was 1 (0-5). Concentrations of all pollutants studied remained within current air quality standards. The association between an increase of 10 micrograms/m3 in ambient air pollution and asthma, measured as a relative risk (RR) of emergency visits, was significant for NO2 24 hour mean (lag 0, RR 1.076, 95% confidence interval (95% CI) 1.020 to 1.134), NO2 hour maximum (lag 0, RR 1.037, 95% CI 1.008 to 1.066), and O3 hour maximum (lag 1, RR 1.063, CI 95% 1.014 to 1.114). The association was not significant for SO2 or for black smoke during the period analysed. The effects were not significantly different for the time of year, cold months (November to April), or warm months (May to October).

CONCLUSIONS

Current concentrations of ambient air pollution in Valencia are significantly associated with emergency room visits for asthma. This association is high and more consistent for NO2 and O3 than for particulate matter and SO2 (classic pollutants).

Second-trimester fetal aberrant right subclavian artery: original study, systematic review and meta-analysis of performance in detection of Down syndrome

OBJECTIVES

First, to estimate the prevalence of fetal aberrant right subclavian artery (ARSA) in our population and its association with Down syndrome. Second, to determine the feasibility of ultrasound to visualize ARSA in the three planes. Finally, to carry out a systematic review of the literature on the performance of second-trimester ARSA to identify fetuses with Down syndrome.

METHODS

ARSA was assessed by ultrasound in the axial plane and confirmed in the longitudinal and coronal planes during the second half of pregnancy in women attending our unit (from February 2011 to December 2012). A search of diagnostic tests for the assessment of ARSA was carried out in international databases. Relevant studies were subjected to a critical reading, and meta-analysis was performed with Meta-DiSc.

RESULTS

Of the 8781 fetuses in our population (mean gestational age: 24 ± 5.4 weeks), 22 had Down syndrome. ARSA was detected in the axial view in 60 cases (0.7%) and confirmed in the coronal view in 96.7% and in the longitudinal view in 6.7% (P < 0.001). Seven cases with ARSA had Down syndrome and all were in the non-isolated-ARSA group. The estimates of positive likelihood ratio (LR) were 0 for isolated ARSA and 199 (95% CI, 88.9-445.2) for non-isolated ARSA. In the systematic review, six studies were selected for quantitative synthesis. The pooled estimates of positive and negative LRs for global ARSA were, respectively, 35.3 (95% CI, 24.4-51.1) and 0.75 (95% CI, 0.64-0.87). For isolated ARSA, the positive and negative LRs were 0 (95% CI, 0.0-14.7) and 0.98 (95% CI, 0.94-1.02), respectively.

CONCLUSIONS

The prevalence of ARSA seems close to 1%. The coronal plane is the most suitable for its confirmation after detection in the axial plane. Detection of isolated or non-isolated ARSA should guide decisions about karyotyping given that isolated ARSA shows a weak association with Down syndrome.

Quality of life and predictive factors in patients undergoing assisted reproduction techniques

OBJECTIVES

To evaluate the quality of life (QOL) of a cohort of women undergoing assisted reproduction techniques (ART), to compare two QOL questionnaires [Short Form 36 (SF36) and FertiQoL], and to identify the predictive factors related to QOL.

STUDY DESIGN

Women who received infertility medication from a hospital pharmacist during a one-year period were included in this study. Two standardized validated questionnaires - FertiQoL and SF36 - were used. Multivariate analyses were used to assess predictive factors for QOL.

RESULTS

Sixty-one women participated in this study. Median QOL scores ranged from 58 to 100. Comparisons between the two questionnaires revealed lower QOL scores when using FertiQoL. Most correlations between the questionnaires were positive, and significant for the majority of SF36 mental dimensions. The major predictors of QOL were: accompanied to the pharmacist's visit by partner, nationality, ART (in vitro fertilization or artificial insemination), employment status (employed or unemployed), tobacco consumption, age, number of cycles, infertility factor and treatment results (pregnancy, no pregnancy or treatment cancellation).

CONCLUSIONS

FertiQoL examines dimensions such as partner and social relationships. As such, it is recommended that FertiQoL should be used together with a short version of SF36 to investigate QOL among patients undergoing ART.

Systematic review and meta-analysis of performance of second-trimester nasal bone assessment in detection of fetuses with Down syndrome

OBJECTIVE

To review systematically the literature on diagnostic tests and performance of second-trimester sonographic assessment of nasal bone (NB) in identifying fetuses affected by Down syndrome.

METHODS

A search of studies involving screening tests for NB evaluation and measurements was carried out in the main international bibliographic databases (MEDLINE, EMBASE and CINAHL). Those considered to be relevant were then subjected to critical reading, following Critical Appraisal Skills Programme (CASP) criteria, by at least three independent observers. All data were extracted and tabulated by two independent investigators. A statistical synthesis of sensitivity, specificity and likelihood ratios was performed using specific software (Meta-DiSc).

RESULTS

From an initial list of 852 articles referring to ultrasound markers for Down syndrome, 207 relevant papers were selected. Following exclusions, 21 studies were included in the quantitative synthesis. The pooled estimates of positive and negative likelihood ratios were 40.08 (95% CI, 18.10-88.76) and 0.71 (95% CI, 0.64-0.79), respectively, for absent NB and 15.15 (95% CI, 8.15-28.16) and 0.47 (95% CI, 0.34-0.64), respectively, for hypoplastic NB. No relevant differences were found between the various means of defining nasal hypoplasia (multiples of the median (MoM) or percentiles). The biparietal diameter/nasal bone length (BPD/NBL) ratio showed somewhat higher sensitivity but lower specificity with a threshold effect.

CONCLUSIONS

NB absence or hypoplasia show high specificity and low but acceptable sensitivity in identifying fetuses with Down syndrome. Screening performance is better with NB measurements as a function of MoM or percentiles rather than as the BPD/NBL ratio. Classification of women into various risk groups for Down syndrome does not affect diagnostic performance.

[The patterns of use and factors associated with the patient admission of hospital emergencies for asthma and chronic obstructive pulmonary disease]

The aim of this study was to describe the epidemiological characteristics of emergencies caused by asthma and chronic obstructive pulmonary disease (COPD) at the Hospital Clínico Universitario of Valencia (Spain) and to analyze factors related to hospital admissions for the same causes. Emergency room medical records for 1993 to 1995 of patients older than 14 years of age were examined to identify those due to asthma or COPD, according to established protocol. Demographic variables were described, followed by Poisson regression analysis of time and seasonal factors affecting emergencies. Factors related to hospital admission were analyzed by logistic regression, taking into account age group, sex, place of residence, and the year, month, day and hour of emergency room arrival. Asthma patients amounted to 1% of emergencies, while COPD patients accounted for 2%. The admission rate for women with asthma was higher than for men (F/M ratio = 0.78), whereas the rate for men with COPD was higher than for women (F/M ratio = 3.14). The largest age groups with asthma emergencies included young people aged 15 to 24 years old and those over 60. Hospital admissions or transfers to other hospitals were ordered for 17.4% of asthma patients and 38.8% of COPD patients. Nearly a third of COPD patients and a fifth of asthma patients were readmitted within the ten days following the first emergency. Clear temporal patterns of COPD emergency were observed for month (most occurring in winter), day of the week (most on Monday) and hour of the day (most during daytime hours, with fewer at midday). The time patterns were less evident for asthma emergencies, although the likelihood of admission because of asthma varied by month and day of the week. Emergency room records may be useful for studying the patterns of respiratory disease presentation. Other possible uses are epidemiologic monitoring and evaluation of health care quality.

[Particulate air pollution and health in Valencia [Spain] 1994-1996]

OBJECTIVE

To estimate the short-term association between levels of air pollution due to suspended particulates and several indicators of morbidity and mortality in the city of Valencia, Spain.

METHODS

We performed an ecological time-series study. Daily levels of air pollution from black smoke were related to indicators of mortality, hospital admissions, and visits to emergency departments in the city of Valencia between 1994 and 1996. The magnitude of the association was estimated through Poisson autoregression using generalized additive models. The form of the relationship, the delayed effect of pollution, and the possible modification of this effect by other pollutants or periods of the year were assessed.

RESULTS

A significant association was found between levels of suspended particulates and several of the indicators analyzed in Valencia. The form of this relationship was linear. An increment of 10 microg/m3 in the daily levels of black smoke was associated with an increase of 1.8% (95% confidence interval: 0.9-2.7%) in the number of deaths on the following day. The same increment in pollutant levels was associated with an increase of 1.5% (0.1-2.8%) in deaths from all cardiovascular causes, an increase of 1.3% (0.0-2.6%) in admissions for all cardiovascular diseases and in an increase of 5.4% (0.6-10.4%) in the number of emergency visits for asthma. This association was not confounded by levels of other pollutants. Black smoke was not associated with mortality from respiratory diseases, with hospital admissions for cerebrovascular diseases, or with emergency visits for chronic obstructive pulmonary disease.

CONCLUSIONS

This study provides evidence that levels of suspended particles in Valencia are associated with emergency visits for asthma, hospital admissions for cardiovascular diseases, and daily deaths. The association found is consistent with the results of previous studies and fits with recent knowledge of psychopathological mechanisms.

[Spinal anesthesia versus general anesthesia in the surgical treatment of inguinal hernia. Cost-effectiveness analysis]

OBJECTIVE

To compare the costs related to the clinical effectiveness of general anesthesia versus spinal anesthesia in inguinal hernioplasty ambulatory surgery.

MATERIAL AND METHODS

An observational, retrospective cohort study measurement and analysis of cost-effectiveness, in the ambulatory surgery unit of a general hospital. All patients over 18 years of age diagnosed with primary inguinal hernia and scheduled for unilateral hernioplasty between January 2010 and December 2011 were included. Duration of anesthetic induction, length of stay in both the operating room, and in the post-anesthesia care unit, the anesthetic effectiveness (the incidence of adverse effects and the patient's comfort level), and variable economic costs associated with the use of drugs, as well as the use of human resources, were compared.

RESULTS

The final analysis included 218 patients, 87.2% male, with a mean age of 53 years (range: 18-85 years). Of these, 139 (63.76%) received subarachnoid anesthesia and 79,(36.2%) general anesthesia. The length of time a patient remained in the post-anesthesia care unit was 337.6±160.2min in the subarachnoid anesthesia group, and 210.0±97.5min for the general anesthesia group (P<.001). Costs of drugs for general anesthesia were higher than that for subarachnoid anesthesia (86.2±8.3 vs. 18.7±7.2). The total cost difference between the 2 techniques was €115.8 more for subarachnoid anesthesia (P<.001).

CONCLUSIONS

Both techniques showed similar effectiveness. The overall costs for subarachnoid anesthesia were greater than for the general. The cost-effectiveness of general anesthesia is better for outpatient inguinal hernia repair surgery.

Length of stay in a hospital emergency room due to asthma and chronic obstructive pulmonary disease: implications for air pollution studies

The aim of this paper is to model the length of stay following hospital emergency due to asthma and chronic obstructive pulmonary disease (COPD) as well as those factors relating to its duration. Clinical records of all those hospital emergencies for asthma and COPD in people aged over 14 at the Hospital Clinico Universitario of Valencia (HCUV) during years 1993-1995 were reviewed. Data were analysed by entry and discharge time, sex, age and destination. Parametric survival models (exponential, Weibull and log-normal) were used for each diagnostic. Percentiles and relative percentiles were calculated; 1369 asthma emergencies and 2734 cases COPD were observed. The mean length of stay was 5.21 hours for asthma and 6.32 for COPD log-normal model was the best parametric model. Lengths of stay are greater for those hospital admitted. Stays, in cases of asthma, were shorter during months of August and November, with no differences for other variables. Also a shorter duration of stay for the month of August was found. Women are seen to stay for longer periods than men. Time modelling of emergency admission for asthma and COPD permits its use in the determining of the dates of incidence for episodes of asthma and COPD based on hospital admissions data, as seeing a median of delay in emergency rooms greater than 6 hours. For studies on air pollution impact these results imply that all those admissions during the early hours of the morning should be categorised as events of the previous day.

Long-term results after treatment of pertrochanteric femoral fractures with percutaneous compression plate (PCCP)

OBJECTIVE

This study sought to evaluate the long-term osteosynthesis results for AO/OTA 31.A1-A2 pertrochanteric fractures treated with the percutaneous compression plate (PCCP).

MATERIALS AND METHODS

This investigation was a retrospective observational descriptive study of 335 patients, with a minimum follow-up of 2 years and a maximum follow-up of 8 years (2004-2011).

RESULTS

The average post-operative hospital stay was 6.2 days, and the average decrease in haemoglobin levels after the intervention was 2.7 mg/dL, with transfusion required for one-third of the patients. Complications related to the implant were observed in 4.2 % of patients; the most notable complication was cut-out (2.4 % of patients), and 3 cases involved pseudarthrosis with breakage of the implant (0.9 % of patients).

CONCLUSIONS

From the results obtained in this study and an analysis of previously published work, we believe that the PCCP may be the implant of choice for AO/OTA 31.A1-A2 fractures.

[The effects of air pollution on health: an introduction]

In recent years, major progress has been made as regards the knowledge and understanding which has been gained of the impact of air pollution. In this study, the basic concepts are set out regarding this subject, and the different possible approaches as far as methodologies are concerned are reviewed. Among the epidemiological studies, the time series studies are those most often used for assessing the short-term impact of air pollution. The most important factors leading to confusion in this type of study are the seasonal and weekly changes, the tendency, the weather variables and the serious illnesses of a seasonal pattern, such as the flu. The main short-term impact of air pollution on human health range from a rise in the overall death rate resulting from respiratory and cardiovascular diseases to the worsening of lung function and other symptoms, including a rise in the number of doctor visits and hospital admissions. Despite a widespread consensus existing with regard to the harmful impact of air pollution, there are a number of questions currently in the need of further research.

Effects of time, temperature and blood cell counts on levels of lactate in heparinized whole blood gas samples

OBJECTIVE

To investigate whether lactate levels may vary in relation to time, substrate concentration and blood cells counts.

METHODS

In this study 110 samples from the daily clinical routine blood samples were collected. Determinations of lactate were made at different times where the samples had not been left for more than 120 min at room temperature (24 degrees C) or in the fridge (4 degrees C). The influence of glucose and blood cells on lactate production was also estimated. The rate in change of concentration (slope) and the increase expected at the beginning (intercept) were estimated through linear regression using a longitudinal marginal method.

RESULTS

The time-related change in lactate was significantly higher at room temperature (0.012 mmol L(-1) min(-1)) than at 4 degrees C (0.0035 mmol L(-1) min(-1)) (p<0.0001). There was a significantly positive relationship between blood cells (mainly leucocytes) and the rate of reaction at room temperature.

CONCLUSIONS

A delay in the processing of a whole blood sample of more than 15 min at room temperature or an hour in the fridge entails an important overestimation of the initial lactate levels. Pronounced leucocytosis (higher than 6 x 10(10)/L) meaningfully cut down the stability period (10 min).

[Microbiological study of infectious endophthalmitis with positive culture within a 13 year-period]

INTRODUCTION

Our objectives are to describe the microbial spectrum and antimicrobial susceptibility of isolates from patients with culture-proven endophthalmitis.

MATERIAL AND METHODS

Retrospective study of patients with microbiological diagnosis of endophthalmitis treated at the Ophthalmology Department of the General Hospital La Mancha Centro in the period 1996-2008. The identification of isolates was performed using the automated VITEK-2® and Api galleries (bioMérieux, Spain SA). The antimicrobial susceptibility was performed by the VITEK-2® system (bioMérieux, Spain SA), E-test strips (MIC Test Strip, Liofilchem, Italy) and Sensititre® YeastOne trading system (Trek Diagnostic Systems, Ohio, USA) for Candida species.

RESULTS

Forty four (70%) of 63 cases of endophthalmitis were culture positive. Gram-positive bacteria were much more common than gram-negative bacteria in both postoperative endophthalmitis (POE) and post-traumatic endophthalmitis (PTE). Staphylococcus epidermidis was predominant in POE, while Bacillus sp. predominated in the PTE; furthermore, the 75% of total fungal isolates corresponded to postraumatic cases. The isolated strains showed 100% susceptibility to vancomycin, ceftazidime and amikacin, while resistance to ciprofloxacin was greater than 15%. The empirical antifungal therapy failed in 50% of cases. The visual prognosis was significantly less favorable in the PTE.

CONCLUSIONS

Based on the susceptibility of our isolates, vancomycin, ceftazidime and amikacin are good choices for empirical treatment of endophthalmitis, unlike ciprofloxacin. We recommend conducting antifungal prophylaxis after penetrating ocular trauma in a rural environment.

A Spanish multicenter study to estimate the prevalence and incidence of chronic pancreatitis and its complications

BACKGROUND AND OBJECTIVE

No nation-wide epidemiological study on the incidence and prevalence of chronic pancreatitis (CP) had been thus far carried out in Spain. Our goal is to estimate the prevalence and incidence of CP, as well as to determine the diagnostic and therapeutic criteria used in Spanish pancreas units.

METHODS

An observational, descriptive study of hospital pancreas units in Spain. CP-related epidemiology, etiology, manifestations, diagnostic tests, functional complications, and treatments were all assessed using a structured questionnaire. Overall results were estimated by weighting cases in each site.

RESULTS

Information was collected from six pancreas units with a sample frame of 1,900,751 inhabitants. Overall prevalence was 49.3 cases per 105 population (95 % CI, 46 to 52) and incidence was 5.5 cases per 105 inhabitant-years (95 % CI, 5.4 to 5.6). Most common etiologies included tobacco and alcoholism, which were associated with three in every four cases. The most prevalent symptoms were recurring pain (48.8 %) and chronic abdominal pain (30.6 %). The most widely used diagnostic method was echoendoscopy (79.8 %), CT (computerized tomography) (58.7 %), and MRI (magnetic resonance imaging)/MRCP (magnetic resonance cholangiopancreatography) (55.9 %). Most prevalent morphologic findings included calcifications (35 %) and pseudocysts (27 %). Exocrine (38.8 %) and endocrine (35.2 %) pancreatic insufficiency had both a similar frequency. Treatments used were rather heterogeneous among sites, with enzyme replacement therapy (40.7 %) and insulin (30.9 %) being most commonly used.

CONCLUSIONS

Pancreas units amass a significant number of both prevalent and incident CP cases. Patients seen in these units share a similar typology, and differences between units are greater regarding diagnostic and therapeutic strategies.

[Two-year diagnostic stability and prognosis in acute psychotic episodes]

INTRODUCTION

The term acute psychosis represents a group of rapid-onset and recovery psychosis. The current diagnostic criteria are not uniform and represent a heterogeneous set of psychoses. Although their form of clinical presentation may be similar, their evolution and prognosis are very different. It is very important to detect the possible factors of chronicity in order to make an early intervention and thus to diminish the negative consequences of the disease.

METHODOLOGY

We conducted a 2 year prospective study in 48 patients diagnosed with acute psychosis in their first admission. Data was collected on the evolution and follow-up of the patient in the Mental Health Unit and the sociodemographic and clinical factors of the psychotic index episode that could predict a change in the diagnosis during the two years follow-up were analyzed.

RESULTS

None of the sociodemographic or clinical variables studied could predict a change in the diagnosis, except for the presence of a control delusion during the index episode. The diagnosis of schizophreniform or not otherwise specified psychotic disorders predicts an evolution towards schizophrenia or affective psychosis while a brief or substance-induced psychotic episode has a better prognosis, with a tendency to maintain the same diagnosis in the 2 years of follow-up.

CONCLUSION

After 2 years of follow-up, an significant number of the patients initially diagnosed of acute psychosis evolved towards a diagnosis of schizophrenia or affective psychosis in a difficult-to-predict way.