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la fisioterapia respiratoria y un adecuado manejo de las comorbilidades asociadas<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los pacientes con enfermedades pulmonares cr&#243;nicas presentan con frecuencia s&#237;ntomas de depresi&#243;n&#44; ansiedad o ambos&#44; lo que condiciona un deterioro de la calidad de vida&#44; del funcionamiento social y del recreativo&#44; y en algunos casos afecta al cumplimiento terap&#233;utico<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; De esta manera es importante evaluar la situaci&#243;n del paciente desde el punto de vista psicol&#243;gico y apreciar c&#243;mo estos trastornos pueden interferir en la vida diaria&#46; Los pacientes con BQ&#44; como pacientes cr&#243;nicos&#44; tambi&#233;n pueden verse afectados por trastornos psicol&#243;gicos&#44; aunque los trabajos en este sentido son escasos<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a>&#46; Planteamos como hip&#243;tesis de trabajo que los pacientes con BQ no FQ podr&#237;an presentar una alta prevalencia de s&#237;ntomas de depresi&#243;n y ansiedad&#44; y que estos pueden estar relacionados con distintos par&#225;metros cl&#237;nicos&#46; El objetivo del estudio fue valorar la presencia de s&#237;ntomas de ansiedad y depresi&#243;n&#44; mediante cuestionarios de cribado psicol&#243;gico&#44; en una muestra de pacientes con BQ no FQ que acuden a una consulta monogr&#225;fica&#46; As&#237; mismo&#44; valorar c&#243;mo influyen las principales variables cl&#237;nicas y la calidad de vida en la morbilidad psicol&#243;gica&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes y m&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">En el estudio se incluyeron 70<span class="elsevierStyleHsp" style=""></span>pacientes diagnosticados de BQ mediante TCAR&#44; usando una t&#233;cnica de 1 o 1&#44;5<span class="elsevierStyleHsp" style=""></span>mm de colimaci&#243;n a intervalos de 10<span class="elsevierStyleHsp" style=""></span>mm en inspiraci&#243;n m&#225;xima seg&#250;n los criterios de Naidich et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44; que acudieron de forma consecutiva a la unidad monogr&#225;fica de bronquiectasias del Hospital Universitario de La Princesa &#40;Madrid&#41;&#46; Se excluy&#243; a los pacientes diagnosticados de FQ &#40;prueba de sudor &#62;60<span class="elsevierStyleHsp" style=""></span>mmol&#47;l o presencia de mutaciones con cl&#237;nica compatible&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44; a los enfermos con s&#237;ntomas de agudizaci&#243;n cl&#237;nica en las 3 &#250;ltimas semanas&#44; as&#237; como a los pacientes que presentaban una enfermedad con peor pron&#243;stico vital que las propias BQ o pacientes con enfermedades en situaci&#243;n terminal&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se recogi&#243; la edad&#44; el sexo&#44; el &#237;ndice de masa corporal &#40;IMC&#41; y el h&#225;bito tab&#225;quico&#44; clasific&#225;ndose en no fumador&#44; exfumador &#40;cuando el paciente llevaba un a&#241;o sin fumar&#41; y fumador activo&#46; Se establecieron las posibles etiolog&#237;as de las BQ despu&#233;s de realizar las pruebas recomendadas en el algoritmo diagn&#243;stico establecido en la Normativa SEPAR de Bronquiectasias<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Se evalu&#243; el &#237;ndice de comorbilidad de Charlson<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#44; el grado de disnea seg&#250;n la escala de <span class="elsevierStyleItalic">Medical Research Council</span> &#40;MRC&#41;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#44; la cantidad en mililitros de expectoraci&#243;n habitual estimada por el paciente en 24<span class="elsevierStyleHsp" style=""></span>h medida en cucharita de caf&#233; &#40;5<span class="elsevierStyleHsp" style=""></span>ml&#41;&#44; cuchara sopera &#40;10<span class="elsevierStyleHsp" style=""></span>ml&#41;&#44; vaso de vino &#40;100<span class="elsevierStyleHsp" style=""></span>ml&#41; o vaso de agua &#40;200<span class="elsevierStyleHsp" style=""></span>ml&#41;&#44; y el aspecto macrosc&#243;pico de las secreciones&#44; clasific&#225;ndolo en 4<span class="elsevierStyleHsp" style=""></span>grados&#58; mucoso &#40;blanquecino&#41;&#44; mucopurulento &#40;amarillo claro&#41;&#44; purulento &#40;verdoso&#41; y marron&#225;ceo&#46; Se valor&#243; la presencia de hemoptisis &#8805;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>ml&#47;d&#237;a y de sinusitis &#40;definida por s&#237;ntomas sugestivos&#58; obstrucci&#243;n nasal&#44; goteo posnasal&#44; rinorrea y dolor local y&#47;o TC de senos paranasales compatible&#41;&#46; Se realiz&#243; la funci&#243;n pulmonar pr&#243;xima a la cumplimentaci&#243;n del cuestionario mediante un espir&#243;metro &#40;Vmax Sensormedics&#41;&#46; Se clasificaron las BQ por TCAR&#44; seg&#250;n tipo &#40;cil&#237;ndricas o qu&#237;sticas&#41; y seg&#250;n la extensi&#243;n de su localizaci&#243;n&#58; localizadas&#44; si afectaban a un &#250;nico l&#243;bulo&#59; difusas&#44; si afectaban a m&#225;s de 4<span class="elsevierStyleHsp" style=""></span>l&#243;bulos &#40;valorando la l&#237;ngula como l&#243;bulo independiente&#41;&#59; unilaterales&#44; si exist&#237;an en un &#250;nico pulm&#243;n&#44; y bilaterales&#44; si se observaban en ambos pulmones&#46; Se recogi&#243; la colonizaci&#243;n bacteriana previa&#44; definida como la presencia de un mismo microrganismo en 3<span class="elsevierStyleHsp" style=""></span>muestras consecutivas con un intervalo m&#237;nimo de un mes&#44; y si recib&#237;an tratamiento antibi&#243;tico en aerosol&#46; Se evaluaron las exacerbaciones respiratorias&#44; definidas como la necesidad de tratamientos antibi&#243;ticos por incremento de los s&#237;ntomas respiratorios&#44; y las hospitalizaciones en los &#250;ltimos 2<span class="elsevierStyleHsp" style=""></span>a&#241;os por este motivo&#44; as&#237; como si recib&#237;an alg&#250;n tratamiento para la ansiedad o la depresi&#243;n&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Los enfermos cumplimentaron los siguientes cuestionarios de forma voluntaria y previa firma del consentimiento informado&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Inventario de Depresi&#243;n de Beck &#40;BDI-<span class="elsevierStyleSmallCaps">II</span>&#41;&#46;</span> Es una escala de 21 &#237;tems que se emplea para evaluar la gravedad &#40;intensidad sintom&#225;tica&#41; de la depresi&#243;n&#46; El paciente tiene que seleccionar para cada &#237;tem la alternativa de respuesta que mejor refleje su estado en el momento actual y durante la &#250;ltima semana&#46; La puntuaci&#243;n total se obtiene sumando los valores de las frases seleccionadas&#44; que van de 0 a 3&#46; El rango de la puntuaci&#243;n obtenida es de 0 a 63 puntos&#46; Los puntos de corte habitualmente aceptados para graduar la intensidad&#47;severidad son los siguientes&#58; de 0 a 9&#44; no depresi&#243;n&#59; de 10 a 18&#44; depresi&#243;n leve&#59; de 19 a 29&#44; depresi&#243;n moderada&#44; y &#8805;<span class="elsevierStyleHsp" style=""></span>30 puntos&#44; depresi&#243;n grave<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; Sin embargo&#44; en pacientes con patolog&#237;as cr&#243;nicas se aconsejan puntos de cortes m&#225;s altos<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46; Por ello dividimos a los pacientes en 2<span class="elsevierStyleHsp" style=""></span>grupos&#58; &#171;sin s&#237;ntomas de depresi&#243;n&#187; &#40;&#60;<span class="elsevierStyleHsp" style=""></span>14&#41; y &#171;con s&#237;ntomas depresi&#243;n&#187; &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>14&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Cuestionario de Ansiedad Estado-Rasgo &#40;STAI&#41;&#46;</span> Es un cuestionario que est&#225; compuesto de 20<span class="elsevierStyleHsp" style=""></span>&#237;tems que valoran la &#171;ansiedad estado&#187; &#40;condici&#243;n emocional transitoria influida por los factores ambientales que protegen o generan ansiedad&#41; y otros 20 que eval&#250;an la &#171;ansiedad rasgo&#187; &#40;factor de personalidad que predispone a sufrir o no ansiedad&#41;&#46; La puntuaci&#243;n de las 2<span class="elsevierStyleHsp" style=""></span>partes clasifica a los pacientes en un percentil respecto a la poblaci&#243;n general&#46; La clasificaci&#243;n de la poblaci&#243;n general est&#225; realizada por sexo y edad<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Cuestionario Respiratorio St&#46; George &#40;SGRQ&#41;&#46;</span> Este cuestionario consta de 50<span class="elsevierStyleHsp" style=""></span>&#237;tems &#40;76<span class="elsevierStyleHsp" style=""></span>niveles&#41; repartidos en 3<span class="elsevierStyleHsp" style=""></span>escalas&#58; s&#237;ntomas&#44; actividad e impacto&#46; Se calcula una puntuaci&#243;n para cada una de las escalas y tambi&#233;n una puntuaci&#243;n total&#46; El rango de posibles puntuaciones se sit&#250;a entre 0 &#40;no alteraci&#243;n de la calidad de vida&#41; y 100 &#40;m&#225;xima alteraci&#243;n de la calidad de vida&#41;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46;</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">Los enfermos no fueron valorados por especialistas de salud mental&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">An&#225;lisis estad&#237;stico</span><p id="par0065" class="elsevierStylePara elsevierViewall">Se efectu&#243; un an&#225;lisis descriptivo de las variables cuantitativas mediante el c&#225;lculo de las medias y las desviaciones est&#225;ndar&#44; utiliz&#225;ndose el porcentaje para las variables cualitativas&#46; La normalidad de las variables se verificaba con la prueba de Kolmogorov-Smirnov&#44; y en ausencia de una distribuci&#243;n normal se usaron las pruebas no param&#233;tricas&#46; Se analizaron los subgrupos de pacientes establecidos por los cuestionarios psicol&#243;gicos &#40;percentiles de ansiedad rasgo-estado y seg&#250;n el punto de corte en depresi&#243;n&#41;&#44; con las variables cl&#237;nicas cualitativas mediante la prueba de Chi cuadrado y la prueba t de Student para hacer la comparaci&#243;n de medias cuando eran 2 los subgrupos comparados y el an&#225;lisis de la varianza cuando eran m&#225;s de<span class="elsevierStyleHsp" style=""></span>2&#46; Todos los c&#225;lculos se efectuaron con la ayuda del programa SPSS v&#46;15&#46;0&#44; y en todo los casos se consideraron como estad&#237;sticamente significativos los valores de p menores de 0&#44;05&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Caracter&#237;sticas de los pacientes con bronquiectasias</span><p id="par0070" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se muestran las caracter&#237;sticas de los pacientes y las puntuaciones de calidad de vida&#46; En cuanto a las etiolog&#237;as de las BQ&#44; 22 eran secundarias a tuberculosis&#44; 6 a infecciones en la infancia&#44; una a enfermedad de cilio inm&#243;vil&#44; una a d&#233;ficit de inmunoglobulinas&#44; una a postrasplante pulmonar y en 32<span class="elsevierStyleHsp" style=""></span>pacientes no se pudo determinar la causa&#46; Ocho enfermos ten&#237;an asma y 4&#44; EPOC&#46; El 73&#37; de los enfermos presentaban tos y disnea&#46; Respecto a la colonizaci&#243;n cr&#243;nica&#44; 21<span class="elsevierStyleHsp" style=""></span>pacientes estaban colonizados&#44; 15 &#40;71&#44;4&#37;&#41; por <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#44; 4 &#40;19&#37;&#41; por <span class="elsevierStyleItalic">Haemophilus influenzae</span>&#44; uno por <span class="elsevierStyleItalic">Moraxella catharralis</span> y uno por <span class="elsevierStyleItalic">Staphylococcus aureus&#46;</span> De los 21<span class="elsevierStyleHsp" style=""></span>pacientes colonizados de forma cr&#243;nica&#44; 16 de ellos &#40;21&#44;6&#37;&#41; recib&#237;an antibioticoterapia inhalada&#46; Once enfermos recib&#237;an tratamiento para la ansiedad y 6 para la depresi&#243;n&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Inventario de Depresi&#243;n de Beck</span><p id="par0075" class="elsevierStylePara elsevierViewall">Al analizar los resultados de depresi&#243;n de Beck seg&#250;n el punto de corte de 14&#44; el 34&#37; de los enfermos revelaron s&#237;ntomas de depresi&#243;n &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Cuestionario de Ansiedad Estado-Rasgo</span><p id="par0080" class="elsevierStylePara elsevierViewall">Los resultados obtenidos en el cuestionario STAI mostraron que 43 pacientes &#40;58&#44;1&#37;&#41; estaban por encima del percentil 50 al analizar la ansiedad estado&#44; y 42 pacientes &#40;56&#44;8&#37;&#41; en la ansiedad rasgo&#44; respecto a la poblaci&#243;n general &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Veinti&#250;n pacientes tuvieron de forma conjunta s&#237;ntomas de ansiedad y depresi&#243;n&#46; Las puntuaciones de los cuestionarios se relacionaron con las variables cl&#237;nicas de mayor relevancia&#44; como edad&#44; sexo&#44; disnea&#44; tos&#44; cantidad de expectoraci&#243;n&#44; funci&#243;n pulmonar&#44; extensi&#243;n localizada o difusa de las BQ&#44; colonizaci&#243;n cr&#243;nica&#44; exacerbaciones y hospitalizaciones en los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os previos&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Depresi&#243;n y ansiedad estado-rasgo y variables cl&#237;nicas</span><p id="par0090" class="elsevierStylePara elsevierViewall">La cantidad de expectoraci&#243;n se relacion&#243; de forma estad&#237;sticamente significativa con ansiedad rasgo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;024&#41;&#46; Igualmente se hall&#243; relaci&#243;n entre la ansiedad&#44; estado y rasgo&#44; con la colonizaci&#243;n bacteriana &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;037&#41; y espec&#237;ficamente con la colonizaci&#243;n por <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41;&#44; con ansiedad rasgo &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">tablas 2-4</a> y <a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46; Las puntuaciones de depresi&#243;n se relacionaron con el sexo&#44; siendo las mujeres las m&#225;s afectadas&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Depresi&#243;n y ansiedad estado-rasgo y calidad de vida</span><p id="par0095" class="elsevierStylePara elsevierViewall">No se hall&#243; relaci&#243;n entre los grupos establecidos por los cuestionarios de cribado psicol&#243;gico y las puntuaciones de calidad de vida &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">En los &#250;ltimos a&#241;os se han publicado varios trabajos que han valorado los trastornos psicol&#243;gicos en las enfermedades respiratorias cr&#243;nicas<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#44; hall&#225;ndose una elevada prevalencia de s&#237;ntomas ansiosos y depresivos&#46; As&#237; mismo&#44; en los pacientes con BQ&#44; aunque son muy escasos los estudios&#44; se ha observado tambi&#233;n una prevalencia de s&#237;ntomas de ansiedad y depresi&#243;n mayor que en la poblaci&#243;n general&#46; La presencia de psicomorbilidad puede asociarse a una mala adherencia terap&#233;utica<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> y&#44; consecuentemente&#44; a un peor control de la enfermedad y deterioro de la calidad de vida&#46; En Espa&#241;a solo existe un estudio publicado recientemente que incluye una poblaci&#243;n mixta de pacientes con BQ&#44; FQ y no FQ&#44; pero con una mediana de edad m&#225;s baja &#40;32<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41; que los enfermos que normalmente vemos en la pr&#225;ctica cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; Por ello nos pareci&#243; interesante explorar la psicomorbilidad exclusivamente en enfermos con BQ sin FQ&#44; abord&#225;ndola mediante 2<span class="elsevierStyleHsp" style=""></span>cuestionarios validados en castellano y espec&#237;ficos para cribado de depresi&#243;n y de ansiedad&#44; respectivamente&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En la literatura m&#233;dica existen pocos estudios sobre este tema&#44; y es destacable el que hemos referido de Olveira el al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; En este trabajo se analiza la prevalencia de s&#237;ntomas de ansiedad y depresi&#243;n mediante la <span class="elsevierStyleItalic">Hospital Anxiety and Depression Scale</span> &#40;HADS&#41; y se valora la calidad de vida en pacientes con BQ &#40;con y sin FQ&#41;&#46; Los autores indican que el 20&#37; de los enfermos presentan puntuaciones elevadas para depresi&#243;n y el 38&#37; para ansiedad&#46; La edad se relacion&#243; con s&#237;ntomas tanto de ansiedad como de depresi&#243;n&#44; y la ansiedad se relacion&#243; con exacerbaciones frecuentes&#46; Una vez controladas las variables de confusi&#243;n&#44; demogr&#225;ficas &#40;edad y sexo&#41; y cl&#237;nicas &#40;exacerbaciones&#44; producci&#243;n diaria de esputo&#44; etiolog&#237;a y valores de espirometr&#237;a&#41;&#44; ambas&#44; la depresi&#243;n y la ansiedad&#44; predec&#237;an un empeoramiento de la calidad de vida&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">As&#237; mismo&#44; el trabajo de O&#8217;Leary et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> valor&#243; en 111<span class="elsevierStyleHsp" style=""></span>enfermos con una edad media de 52<span class="elsevierStyleHsp" style=""></span>a&#241;os la ansiedad y depresi&#243;n mediante la HADS y la calidad de vida mediante el SGRQ&#46; Los autores hallan s&#237;ntomas de ansiedad moderada a grave en el 17&#37; de los casos y de depresi&#243;n en el 9&#37;&#44; relacion&#225;ndose ambos&#44; con la calidad de vida&#46; Ni la ansiedad ni la depresi&#243;n se relacionaron con la extensi&#243;n de las BQ en el TCAR&#44; la funci&#243;n pulmonar&#44; PaO<span class="elsevierStyleInf">2</span>&#44; ni el sexo&#46; La depresi&#243;n se relacion&#243; con la disnea&#44; la fatiga f&#237;sica y mental y la tolerancia al ejercicio&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Un estudio coreano realizado en enfermos ambulatorios &#8212;84 con EPOC&#44; 33 con BQ y 7 con asma&#8212; evaluados con los mismos cuestionarios empleados en nuestro trabajo &#40;BDI-<span class="elsevierStyleSmallCaps">II</span> y STAI&#41;&#44; describi&#243; en los pacientes con BQ un 55&#37; de depresi&#243;n &#40;similar a los EPOC&#41; y un 39&#37; de ansiedad &#40;mayor que en los EPOC y asm&#225;ticos&#41;&#46; Se concluy&#243; que los enfermos con BQ m&#225;s afectados por los s&#237;ntomas psicol&#243;gicos eran los de mayor obstrucci&#243;n bronquial y con historia de tabaquismo<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">En el presente trabajo se observa que m&#225;s de la mitad de los enfermos presentaban puntuaciones por encima del percentil 50 en ansiedad&#44; estado y rasgo&#44; y un tercio depresi&#243;n&#46; En nuestro trabajo&#44; a diferencia de los otros&#44; solo se hall&#243; que la cantidad de expectoraci&#243;n y la colonizaci&#243;n bacteriana&#44; espec&#237;ficamente por <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#44; se relacionaba con ansiedad&#46; La mujeres tuvieron puntuaciones m&#225;s altas de depresi&#243;n&#44; hallazgo no coincidente con los estudios mencionados&#44; aunque s&#237; con los datos referidos en la poblaci&#243;n general que describen una prevalencia 2 o 3<span class="elsevierStyleHsp" style=""></span>veces mayor de depresi&#243;n en mujeres<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46; No encontramos relaci&#243;n entre la calidad de vida y la morbilidad psicol&#243;gica&#44; aunque lo enfermos con depresi&#243;n tuvieron las puntuaciones m&#225;s altas&#44; pero en ninguna escala fue significativa&#46; Ello pudo ser debido a que los pacientes no tuvieron puntuaciones muy elevadas en SGRQ y que pudieron ser otros factores &#8212;como la edad&#44; la obligaci&#243;n de realizar un tratamiento diario&#44; as&#237; como algunos aspectos no contemplados&#44; como el estado civil o factores sociales&#8212; los que pudieran haber motivado la alta prevalencia de s&#237;ntomas de ansiedad y depresi&#243;n&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Es relevante destacar la proporci&#243;n de pacientes con s&#237;ntomas de depresi&#243;n y ansiedad existentes en nuestro trabajo&#46; Estas diferencias pudieron ser debidas en una parte&#44; a la mayor edad de los enfermos incluidos&#44; pero principalmente&#44; a las diferencias de sensibilidad de los cuestionarios&#44; ya que en los trabajos precedentes se emple&#243; la HADS&#44; y en este&#44; la STAI y BDI-<span class="elsevierStyleSmallCaps">II</span>&#46; De esta manera&#44; en el estudio coreano los porcentajes se aproximaron m&#225;s a los nuestros&#46; BDI-<span class="elsevierStyleSmallCaps">II</span> es m&#225;s sensible que HADS&#44; ya que eval&#250;a un amplio espectro de s&#237;ntomas depresivos&#44; aunque al incluir s&#237;ntomas no solo de la esfera cognitiva &#40;&#237;tems 1-14&#41;&#44; sino tambi&#233;n de la esfera som&#225;tica &#40;&#237;tems 15-21&#41;&#44; estos podr&#237;an solaparse con los de la propia enfermedad&#44; sobreestimando la prevalencia de depresi&#243;n&#46; Para evitar esto incrementamos el punto de corte&#44; seg&#250;n lo recomendado en la literatura para pacientes cr&#243;nicos&#46; As&#237; mismo&#44; el cuestionario STAI facilita m&#225;s informaci&#243;n que la HADS&#44; ya que con sus 2<span class="elsevierStyleHsp" style=""></span>subescalas permite diferenciar entre ansiedad transitoria &#40;estado&#41; y personalidad ansiosa &#40;rasgo&#41;&#46; Por otro lado&#44; las caracter&#237;sticas de los enfermos o las variables analizadas fueron distintas&#44; y ello pudo influir igualmente en la divergencia de los resultados&#46; Por ello es necesario realizar trabajos con un mayor n&#250;mero de pacientes empleando unos mismos cuestionarios para perfilar estas diferencias&#46; Est&#225; claro que cualquier trastorno psicol&#243;gico puede traer consecuencias en el cumplimiento terap&#233;utico&#44; y de esta manera en la evoluci&#243;n de la enfermedad&#44; y por ello su diagn&#243;stico es de gran relevancia&#46; Los cuestionarios validados de cribado psicol&#243;gico nos pueden ayudar&#44; en la pr&#225;ctica cl&#237;nica habitual&#44; a seleccionar a los pacientes que debemos derivar a los especialistas de salud mental&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Los estudios de prevalencia de psicomorbilidad en los enfermos con BQ con FQ son algo m&#225;s numerosos y muestran&#44; tambi&#233;n&#44; una prevalencia elevada&#44; aunque al analizar la relaci&#243;n con las variables cl&#237;nicas no todos coinciden en sus resultados&#44; como sucedi&#243; en nuestro caso&#46; Mientras algunos encuentran concordancia entre las exacerbaciones y la ansiedad&#44; no todos demuestran una relaci&#243;n entre la funci&#243;n pulmonar o extensi&#243;n de las lesiones en TCAR con los s&#237;ntomas de ansiedad o depresi&#243;n<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23-25</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">El actual trabajo tiene algunas limitaciones&#58; la primera&#44; el n&#250;mero de pacientes incluidos&#59; la segunda&#44; no haber empleado&#44; adem&#225;s de los cuestionarios referidos&#44; la HADS&#44; con la que existe experiencia previa en los pacientes con BQ&#44; y la tercera&#44; no haber remitido a todos los pacientes para entrevistas regladas psicol&#243;gicas y haber podido establecer la sensibilidad y la especificidad de los cuestionarios&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Podemos concluir que existe una elevada prevalencia de s&#237;ntomas de depresi&#243;n y ansiedad en los pacientes con BQ no FQ&#44; por lo que es necesario valorarla para realizar un manejo adecuado y evitar las consecuencias de la psicomorbilidad&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0145" class="elsevierStylePara elsevierViewall">Los autores declaran no tener conflictos de intereses&#46;</p></span></span>"
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          "identificador" => "xres277899"
          "titulo" => array:5 [
            0 => "Resumen"
            1 => "Introducci&#243;n"
            2 => "Pacientes y m&#233;todos"
            3 => "Resultados"
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          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Introduction"
            2 => "Patients and methods"
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          "titulo" => "Pacientes y m&#233;todos"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "An&#225;lisis estad&#237;stico"
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          "titulo" => "Resultados"
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            0 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Caracter&#237;sticas de los pacientes con bronquiectasias"
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            1 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Inventario de Depresi&#243;n de Beck"
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            2 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Cuestionario de Ansiedad Estado-Rasgo"
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            3 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Depresi&#243;n y ansiedad estado-rasgo y variables cl&#237;nicas"
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              "identificador" => "sec0045"
              "titulo" => "Depresi&#243;n y ansiedad estado-rasgo y calidad de vida"
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          "titulo" => "Discusi&#243;n"
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          "titulo" => "Conflicto de intereses"
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          "titulo" => "Bibliograf&#237;a"
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    "fechaRecibido" => "2012-11-04"
    "fechaAceptado" => "2013-01-26"
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          "clase" => "keyword"
          "titulo" => "Palabras clave"
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          "palabras" => array:7 [
            0 => "Fibrosis qu&#237;stica"
            1 => "Ansiedad"
            2 => "Depresi&#243;n"
            3 => "Calidad de vida"
            4 => "<span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>"
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            0 => "Cystic fibrosis"
            1 => "Anxiety"
            2 => "Depression"
            3 => "Health-related quality of life"
            4 => "<span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>"
            5 => "Beck Depression Inventory"
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    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con bronquiectasias &#40;BQ&#41;&#44; como enfermos cr&#243;nicos&#44; pueden verse afectados por trastornos psicol&#243;gicos&#46; El objetivo del trabajo fue valorar la presencia de s&#237;ntomas de ansiedad y depresi&#243;n&#44; mediante cuestionarios validados&#44; en pacientes con BQ controlados en una unidad monogr&#225;fica&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">De forma consecutiva se incluyeron en el estudio pacientes diagnosticados de BQ&#44; no relacionadas con fibrosis qu&#237;stica&#44; mediante una tomograf&#237;a axial computarizada de alta resoluci&#243;n&#46; Los enfermos estaban en fase estable en las &#250;ltimas 3<span class="elsevierStyleHsp" style=""></span>semanas y cumplimentaron los cuestionarios Inventario de Depresi&#243;n de Beck&#44; Escala de Ansiedad Estado-Rasgo y Cuestionario Respiratorio St&#46; George&#44; despu&#233;s de firmar el consentimiento informado&#46; Los pacientes fueron clasificados seg&#250;n las puntuaciones obtenidas en los cuestionarios de cribado psicol&#243;gico y sus resultados se compararon con las variables cl&#237;nicas&#44; radiol&#243;gicas y funcionales y con las puntuaciones de calidad de vida&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Setenta enfermos&#44; 48 de ellos mujeres y 22 hombres&#44; con una edad media de 64&#44;19<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; respondieron de forma voluntaria a los cuestionarios&#46; El 34&#37; de los pacientes mostraron s&#237;ntomas de depresi&#243;n&#44; y alrededor del 55&#37; puntuaciones por encima del percentil 50 en ansiedad &#40;rasgo y estado&#41;&#46; La cantidad de expectoraci&#243;n se relacion&#243; con la ansiedad rasgo&#46; La colonizaci&#243;n bacteriana se relacion&#243; con la ansiedad &#40;rasgo y estado&#41;&#44; especialmente la colonizaci&#243;n por <span class="elsevierStyleItalic">Pseudomonas aeruginosa&#46;</span> El sexo femenino mostr&#243; mayor riego de depresi&#243;n&#46; No existi&#243; relaci&#243;n entre las clasificaciones establecidas de ansiedad y depresi&#243;n y las puntuaciones de calidad de vida&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con BQ muestran en un alto porcentaje presencia de s&#237;ntomas de ansiedad&#44; rasgo y estado&#44; as&#237; como de depresi&#243;n&#46; Los m&#225;s afectados por ansiedad son los m&#225;s expectoradores y los colonizados por bacterias&#44; y por depresi&#243;n&#44; las mujeres&#46; Creemos que es necesario valorar la presencia de psicomorbilidad asociada&#44; especialmente en este perfil de enfermos&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Patients with chronic bronchiectasis &#40;BQ&#41; may suffer from psychological disorders&#46; The objective of this study was to assess the presence of anxiety and depression in patients from a specialised BQ Unit&#44; using validated questionnaires&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We included patients consecutively diagnosed with BQ &#40;unrelated to cystic fibrosis&#41; by high resolution computed tomography in the study&#46; Patients were clinically stable in the previous three weeks and voluntarily completed the Beck Depression Inventory&#44; State-Trait Anxiety Inventory and St&#46; George&#39;s Respiratory Questionnaire&#44; after signing the informed consent&#46; They were classified according to their scores on the psychological screening questionnaires&#44; and their results were compared with the clinical&#44; radiological and functional parameters and Quality of Life&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Seventy patients were included&#44; 48 women and 22 men&#44; with a mean age of 64&#46;19<span class="elsevierStyleHsp" style=""></span>years&#46; Thirty-four percent &#40;34&#37;&#41; of patients showed symptoms of depression&#44; and around 55&#37; had scores above the 50th percentile in trait and state anxiety&#46; The amount of sputum was associated with trait anxiety&#46; Bacterial colonization was related to anxiety &#40;trait and state&#41;&#44; especially <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> colonization&#46; Female patients showed a higher risk of depression&#46; There was no relationship between the Quality of Life scores and the established classifications of anxiety and depression&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A high percentage of patients with BQ presented anxiety &#40;trait and state&#41; and depression&#46; The daily sputum production and bacterial colonization &#40;especially with <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&#41; were the variables most related to anxiety&#59; depression was more common in women&#46; We believe that the presence of psychological disorders should be evaluated&#44; especially in patients with this profile&#46;</p>"
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Mujeres adultas</td><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Ansiedad estado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Ansiedad rasgo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Ansiedad estado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Ansiedad rasgo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">P 50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">P 75&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">P 85&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">P 99&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t">51&#47;23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">IMC &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41; &#40;<span class="elsevierStyleSmallCaps">X</span></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24&#44;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;81&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">H&#225;bito tab&#225;quico &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No fumadores&#47;Exfumadores&#47;Fumadores activos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">&#205;ndice de Charlson&#40;<span class="elsevierStyleSmallCaps">X</span></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Grado 1&#47;Grado 2 de disnea MRC &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">47&#44;3&#47;27&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>ml&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5-30<span class="elsevierStyleHsp" style=""></span>ml&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mucosa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mucopurulenta&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Purulenta&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Marron&#225;cea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hemoptisis &#8805;100</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ml&#47;d&#237;a&#47;sinusitis &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">&#37;FVC</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#44;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Bronquiectasias qu&#237;sticas&#47;difusas &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#47;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#47;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Exacerbaciones respiratorias &#40;<span class="elsevierStyleSmallCaps">X</span></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;46&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hospitalizaciones &#40;<span class="elsevierStyleSmallCaps">X</span></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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Original
Trastornos psicológicos y calidad de vida en pacientes con bronquiectasias no relacionadas con fibrosis quística
Presence of Anxiety and Depression in Patients With Bronchiectasis Unrelated to Cystic Fibrosis
Rosa María Girón Moreno
Corresponding author
rngiron@gmail.com

Autor para correspondencia.
, Gilda Fernandes Vasconcelos, Carolina Cisneros, Rosa Mar Gómez-Punter, Gonzalo Segrelles Calvo, Julio Ancochea
Servicio de Neumología, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Hace aproximadamente 2<span class="elsevierStyleHsp" style=""></span>d&#233;cadas las bronquiectasias &#40;BQ&#41; no asociadas a la fibrosis qu&#237;stica &#40;FQ&#41; fueron consideradas por Barker &#40;1988&#41; como una &#171;enfermedad hu&#233;rfana&#187;&#58; hu&#233;rfana de estudios de investigaci&#243;n&#44; de datos epidemiol&#243;gicos y de inter&#233;s por la industria farmac&#233;utica<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Pero hay que decir que la situaci&#243;n est&#225; cambiando y las BQ representan actualmente una patolog&#237;a m&#225;s frecuente de lo esperado&#44; con un gran impacto sanitario y capaz de causar una importante morbimortalidad respiratoria&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Veinte a&#241;os despu&#233;s seguimos con pocos datos sobre la incidencia y la prevalencia de las BQ&#44; aunque se estima que estas son bajas en pa&#237;ses desarrollados y mayores en pa&#237;ses en v&#237;as de desarrollo&#46; De este modo&#44; en la poblaci&#243;n nativa de Alaska la prevalencia oscila entre 10-20&#47;1&#46;000 habitantes&#44; mientras que en Estados Unidos se calcula que puede ser de unos 53 casos&#47;100&#46;000 adultos<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; No obstante&#44; son varios los datos que nos hacen considerar que su prevalencia sigue aumentado como consecuencia de los trasplantes&#44; el tratamiento inmunosupresor&#44; la epidemia del virus de la inmunodeficiencia humana&#44; el regreso de la tuberculosis&#44; una mayor esperanza de vida y&#44; sobre todo&#44; la cronicidad de las enfermedades respiratorias&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Sin lugar a duda&#44; la causa del mayor n&#250;mero de diagn&#243;sticos de BQ se debe a la implantaci&#243;n de la tomograf&#237;a computarizada de alta resoluci&#243;n &#40;TCAR&#41;&#44; que ha permitido ver mejor el par&#233;nquima pulmonar&#44; demostrando que las BQ son m&#225;s frecuentes de lo previsto y que incluso las formas cil&#237;ndricas son capaces de modificar el pron&#243;stico de las enfermedades que las generan<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Los estudios de calidad de vida en los pacientes con BQ son importantes para determinar la situaci&#243;n cl&#237;nica&#44; que a veces difiere de la funci&#243;n pulmonar o extensi&#243;n radiol&#243;gica&#44; as&#237; como para valorar la respuesta general de los tratamientos<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; En los &#250;ltimos a&#241;os se ha conseguido una mejor&#237;a de la calidad de vida de los pacientes con BQ gracias a un diagn&#243;stico precoz por la TCAR&#44; una mejor&#237;a notable en el tratamiento&#44; la fisioterapia respiratoria y un adecuado manejo de las comorbilidades asociadas<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los pacientes con enfermedades pulmonares cr&#243;nicas presentan con frecuencia s&#237;ntomas de depresi&#243;n&#44; ansiedad o ambos&#44; lo que condiciona un deterioro de la calidad de vida&#44; del funcionamiento social y del recreativo&#44; y en algunos casos afecta al cumplimiento terap&#233;utico<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; De esta manera es importante evaluar la situaci&#243;n del paciente desde el punto de vista psicol&#243;gico y apreciar c&#243;mo estos trastornos pueden interferir en la vida diaria&#46; Los pacientes con BQ&#44; como pacientes cr&#243;nicos&#44; tambi&#233;n pueden verse afectados por trastornos psicol&#243;gicos&#44; aunque los trabajos en este sentido son escasos<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a>&#46; Planteamos como hip&#243;tesis de trabajo que los pacientes con BQ no FQ podr&#237;an presentar una alta prevalencia de s&#237;ntomas de depresi&#243;n y ansiedad&#44; y que estos pueden estar relacionados con distintos par&#225;metros cl&#237;nicos&#46; El objetivo del estudio fue valorar la presencia de s&#237;ntomas de ansiedad y depresi&#243;n&#44; mediante cuestionarios de cribado psicol&#243;gico&#44; en una muestra de pacientes con BQ no FQ que acuden a una consulta monogr&#225;fica&#46; As&#237; mismo&#44; valorar c&#243;mo influyen las principales variables cl&#237;nicas y la calidad de vida en la morbilidad psicol&#243;gica&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes y m&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">En el estudio se incluyeron 70<span class="elsevierStyleHsp" style=""></span>pacientes diagnosticados de BQ mediante TCAR&#44; usando una t&#233;cnica de 1 o 1&#44;5<span class="elsevierStyleHsp" style=""></span>mm de colimaci&#243;n a intervalos de 10<span class="elsevierStyleHsp" style=""></span>mm en inspiraci&#243;n m&#225;xima seg&#250;n los criterios de Naidich et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44; que acudieron de forma consecutiva a la unidad monogr&#225;fica de bronquiectasias del Hospital Universitario de La Princesa &#40;Madrid&#41;&#46; Se excluy&#243; a los pacientes diagnosticados de FQ &#40;prueba de sudor &#62;60<span class="elsevierStyleHsp" style=""></span>mmol&#47;l o presencia de mutaciones con cl&#237;nica compatible&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44; a los enfermos con s&#237;ntomas de agudizaci&#243;n cl&#237;nica en las 3 &#250;ltimas semanas&#44; as&#237; como a los pacientes que presentaban una enfermedad con peor pron&#243;stico vital que las propias BQ o pacientes con enfermedades en situaci&#243;n terminal&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se recogi&#243; la edad&#44; el sexo&#44; el &#237;ndice de masa corporal &#40;IMC&#41; y el h&#225;bito tab&#225;quico&#44; clasific&#225;ndose en no fumador&#44; exfumador &#40;cuando el paciente llevaba un a&#241;o sin fumar&#41; y fumador activo&#46; Se establecieron las posibles etiolog&#237;as de las BQ despu&#233;s de realizar las pruebas recomendadas en el algoritmo diagn&#243;stico establecido en la Normativa SEPAR de Bronquiectasias<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Se evalu&#243; el &#237;ndice de comorbilidad de Charlson<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#44; el grado de disnea seg&#250;n la escala de <span class="elsevierStyleItalic">Medical Research Council</span> &#40;MRC&#41;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#44; la cantidad en mililitros de expectoraci&#243;n habitual estimada por el paciente en 24<span class="elsevierStyleHsp" style=""></span>h medida en cucharita de caf&#233; &#40;5<span class="elsevierStyleHsp" style=""></span>ml&#41;&#44; cuchara sopera &#40;10<span class="elsevierStyleHsp" style=""></span>ml&#41;&#44; vaso de vino &#40;100<span class="elsevierStyleHsp" style=""></span>ml&#41; o vaso de agua &#40;200<span class="elsevierStyleHsp" style=""></span>ml&#41;&#44; y el aspecto macrosc&#243;pico de las secreciones&#44; clasific&#225;ndolo en 4<span class="elsevierStyleHsp" style=""></span>grados&#58; mucoso &#40;blanquecino&#41;&#44; mucopurulento &#40;amarillo claro&#41;&#44; purulento &#40;verdoso&#41; y marron&#225;ceo&#46; Se valor&#243; la presencia de hemoptisis &#8805;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>ml&#47;d&#237;a y de sinusitis &#40;definida por s&#237;ntomas sugestivos&#58; obstrucci&#243;n nasal&#44; goteo posnasal&#44; rinorrea y dolor local y&#47;o TC de senos paranasales compatible&#41;&#46; Se realiz&#243; la funci&#243;n pulmonar pr&#243;xima a la cumplimentaci&#243;n del cuestionario mediante un espir&#243;metro &#40;Vmax Sensormedics&#41;&#46; Se clasificaron las BQ por TCAR&#44; seg&#250;n tipo &#40;cil&#237;ndricas o qu&#237;sticas&#41; y seg&#250;n la extensi&#243;n de su localizaci&#243;n&#58; localizadas&#44; si afectaban a un &#250;nico l&#243;bulo&#59; difusas&#44; si afectaban a m&#225;s de 4<span class="elsevierStyleHsp" style=""></span>l&#243;bulos &#40;valorando la l&#237;ngula como l&#243;bulo independiente&#41;&#59; unilaterales&#44; si exist&#237;an en un &#250;nico pulm&#243;n&#44; y bilaterales&#44; si se observaban en ambos pulmones&#46; Se recogi&#243; la colonizaci&#243;n bacteriana previa&#44; definida como la presencia de un mismo microrganismo en 3<span class="elsevierStyleHsp" style=""></span>muestras consecutivas con un intervalo m&#237;nimo de un mes&#44; y si recib&#237;an tratamiento antibi&#243;tico en aerosol&#46; Se evaluaron las exacerbaciones respiratorias&#44; definidas como la necesidad de tratamientos antibi&#243;ticos por incremento de los s&#237;ntomas respiratorios&#44; y las hospitalizaciones en los &#250;ltimos 2<span class="elsevierStyleHsp" style=""></span>a&#241;os por este motivo&#44; as&#237; como si recib&#237;an alg&#250;n tratamiento para la ansiedad o la depresi&#243;n&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Los enfermos cumplimentaron los siguientes cuestionarios de forma voluntaria y previa firma del consentimiento informado&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Inventario de Depresi&#243;n de Beck &#40;BDI-<span class="elsevierStyleSmallCaps">II</span>&#41;&#46;</span> Es una escala de 21 &#237;tems que se emplea para evaluar la gravedad &#40;intensidad sintom&#225;tica&#41; de la depresi&#243;n&#46; El paciente tiene que seleccionar para cada &#237;tem la alternativa de respuesta que mejor refleje su estado en el momento actual y durante la &#250;ltima semana&#46; La puntuaci&#243;n total se obtiene sumando los valores de las frases seleccionadas&#44; que van de 0 a 3&#46; El rango de la puntuaci&#243;n obtenida es de 0 a 63 puntos&#46; Los puntos de corte habitualmente aceptados para graduar la intensidad&#47;severidad son los siguientes&#58; de 0 a 9&#44; no depresi&#243;n&#59; de 10 a 18&#44; depresi&#243;n leve&#59; de 19 a 29&#44; depresi&#243;n moderada&#44; y &#8805;<span class="elsevierStyleHsp" style=""></span>30 puntos&#44; depresi&#243;n grave<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; Sin embargo&#44; en pacientes con patolog&#237;as cr&#243;nicas se aconsejan puntos de cortes m&#225;s altos<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46; Por ello dividimos a los pacientes en 2<span class="elsevierStyleHsp" style=""></span>grupos&#58; &#171;sin s&#237;ntomas de depresi&#243;n&#187; &#40;&#60;<span class="elsevierStyleHsp" style=""></span>14&#41; y &#171;con s&#237;ntomas depresi&#243;n&#187; &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>14&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Cuestionario de Ansiedad Estado-Rasgo &#40;STAI&#41;&#46;</span> Es un cuestionario que est&#225; compuesto de 20<span class="elsevierStyleHsp" style=""></span>&#237;tems que valoran la &#171;ansiedad estado&#187; &#40;condici&#243;n emocional transitoria influida por los factores ambientales que protegen o generan ansiedad&#41; y otros 20 que eval&#250;an la &#171;ansiedad rasgo&#187; &#40;factor de personalidad que predispone a sufrir o no ansiedad&#41;&#46; La puntuaci&#243;n de las 2<span class="elsevierStyleHsp" style=""></span>partes clasifica a los pacientes en un percentil respecto a la poblaci&#243;n general&#46; La clasificaci&#243;n de la poblaci&#243;n general est&#225; realizada por sexo y edad<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Cuestionario Respiratorio St&#46; George &#40;SGRQ&#41;&#46;</span> Este cuestionario consta de 50<span class="elsevierStyleHsp" style=""></span>&#237;tems &#40;76<span class="elsevierStyleHsp" style=""></span>niveles&#41; repartidos en 3<span class="elsevierStyleHsp" style=""></span>escalas&#58; s&#237;ntomas&#44; actividad e impacto&#46; Se calcula una puntuaci&#243;n para cada una de las escalas y tambi&#233;n una puntuaci&#243;n total&#46; El rango de posibles puntuaciones se sit&#250;a entre 0 &#40;no alteraci&#243;n de la calidad de vida&#41; y 100 &#40;m&#225;xima alteraci&#243;n de la calidad de vida&#41;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46;</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">Los enfermos no fueron valorados por especialistas de salud mental&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">An&#225;lisis estad&#237;stico</span><p id="par0065" class="elsevierStylePara elsevierViewall">Se efectu&#243; un an&#225;lisis descriptivo de las variables cuantitativas mediante el c&#225;lculo de las medias y las desviaciones est&#225;ndar&#44; utiliz&#225;ndose el porcentaje para las variables cualitativas&#46; La normalidad de las variables se verificaba con la prueba de Kolmogorov-Smirnov&#44; y en ausencia de una distribuci&#243;n normal se usaron las pruebas no param&#233;tricas&#46; Se analizaron los subgrupos de pacientes establecidos por los cuestionarios psicol&#243;gicos &#40;percentiles de ansiedad rasgo-estado y seg&#250;n el punto de corte en depresi&#243;n&#41;&#44; con las variables cl&#237;nicas cualitativas mediante la prueba de Chi cuadrado y la prueba t de Student para hacer la comparaci&#243;n de medias cuando eran 2 los subgrupos comparados y el an&#225;lisis de la varianza cuando eran m&#225;s de<span class="elsevierStyleHsp" style=""></span>2&#46; Todos los c&#225;lculos se efectuaron con la ayuda del programa SPSS v&#46;15&#46;0&#44; y en todo los casos se consideraron como estad&#237;sticamente significativos los valores de p menores de 0&#44;05&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Caracter&#237;sticas de los pacientes con bronquiectasias</span><p id="par0070" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se muestran las caracter&#237;sticas de los pacientes y las puntuaciones de calidad de vida&#46; En cuanto a las etiolog&#237;as de las BQ&#44; 22 eran secundarias a tuberculosis&#44; 6 a infecciones en la infancia&#44; una a enfermedad de cilio inm&#243;vil&#44; una a d&#233;ficit de inmunoglobulinas&#44; una a postrasplante pulmonar y en 32<span class="elsevierStyleHsp" style=""></span>pacientes no se pudo determinar la causa&#46; Ocho enfermos ten&#237;an asma y 4&#44; EPOC&#46; El 73&#37; de los enfermos presentaban tos y disnea&#46; Respecto a la colonizaci&#243;n cr&#243;nica&#44; 21<span class="elsevierStyleHsp" style=""></span>pacientes estaban colonizados&#44; 15 &#40;71&#44;4&#37;&#41; por <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#44; 4 &#40;19&#37;&#41; por <span class="elsevierStyleItalic">Haemophilus influenzae</span>&#44; uno por <span class="elsevierStyleItalic">Moraxella catharralis</span> y uno por <span class="elsevierStyleItalic">Staphylococcus aureus&#46;</span> De los 21<span class="elsevierStyleHsp" style=""></span>pacientes colonizados de forma cr&#243;nica&#44; 16 de ellos &#40;21&#44;6&#37;&#41; recib&#237;an antibioticoterapia inhalada&#46; Once enfermos recib&#237;an tratamiento para la ansiedad y 6 para la depresi&#243;n&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Inventario de Depresi&#243;n de Beck</span><p id="par0075" class="elsevierStylePara elsevierViewall">Al analizar los resultados de depresi&#243;n de Beck seg&#250;n el punto de corte de 14&#44; el 34&#37; de los enfermos revelaron s&#237;ntomas de depresi&#243;n &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Cuestionario de Ansiedad Estado-Rasgo</span><p id="par0080" class="elsevierStylePara elsevierViewall">Los resultados obtenidos en el cuestionario STAI mostraron que 43 pacientes &#40;58&#44;1&#37;&#41; estaban por encima del percentil 50 al analizar la ansiedad estado&#44; y 42 pacientes &#40;56&#44;8&#37;&#41; en la ansiedad rasgo&#44; respecto a la poblaci&#243;n general &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Veinti&#250;n pacientes tuvieron de forma conjunta s&#237;ntomas de ansiedad y depresi&#243;n&#46; Las puntuaciones de los cuestionarios se relacionaron con las variables cl&#237;nicas de mayor relevancia&#44; como edad&#44; sexo&#44; disnea&#44; tos&#44; cantidad de expectoraci&#243;n&#44; funci&#243;n pulmonar&#44; extensi&#243;n localizada o difusa de las BQ&#44; colonizaci&#243;n cr&#243;nica&#44; exacerbaciones y hospitalizaciones en los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os previos&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Depresi&#243;n y ansiedad estado-rasgo y variables cl&#237;nicas</span><p id="par0090" class="elsevierStylePara elsevierViewall">La cantidad de expectoraci&#243;n se relacion&#243; de forma estad&#237;sticamente significativa con ansiedad rasgo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;024&#41;&#46; Igualmente se hall&#243; relaci&#243;n entre la ansiedad&#44; estado y rasgo&#44; con la colonizaci&#243;n bacteriana &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;037&#41; y espec&#237;ficamente con la colonizaci&#243;n por <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41;&#44; con ansiedad rasgo &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">tablas 2-4</a> y <a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46; Las puntuaciones de depresi&#243;n se relacionaron con el sexo&#44; siendo las mujeres las m&#225;s afectadas&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Depresi&#243;n y ansiedad estado-rasgo y calidad de vida</span><p id="par0095" class="elsevierStylePara elsevierViewall">No se hall&#243; relaci&#243;n entre los grupos establecidos por los cuestionarios de cribado psicol&#243;gico y las puntuaciones de calidad de vida &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">En los &#250;ltimos a&#241;os se han publicado varios trabajos que han valorado los trastornos psicol&#243;gicos en las enfermedades respiratorias cr&#243;nicas<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#44; hall&#225;ndose una elevada prevalencia de s&#237;ntomas ansiosos y depresivos&#46; As&#237; mismo&#44; en los pacientes con BQ&#44; aunque son muy escasos los estudios&#44; se ha observado tambi&#233;n una prevalencia de s&#237;ntomas de ansiedad y depresi&#243;n mayor que en la poblaci&#243;n general&#46; La presencia de psicomorbilidad puede asociarse a una mala adherencia terap&#233;utica<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> y&#44; consecuentemente&#44; a un peor control de la enfermedad y deterioro de la calidad de vida&#46; En Espa&#241;a solo existe un estudio publicado recientemente que incluye una poblaci&#243;n mixta de pacientes con BQ&#44; FQ y no FQ&#44; pero con una mediana de edad m&#225;s baja &#40;32<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41; que los enfermos que normalmente vemos en la pr&#225;ctica cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; Por ello nos pareci&#243; interesante explorar la psicomorbilidad exclusivamente en enfermos con BQ sin FQ&#44; abord&#225;ndola mediante 2<span class="elsevierStyleHsp" style=""></span>cuestionarios validados en castellano y espec&#237;ficos para cribado de depresi&#243;n y de ansiedad&#44; respectivamente&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En la literatura m&#233;dica existen pocos estudios sobre este tema&#44; y es destacable el que hemos referido de Olveira el al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; En este trabajo se analiza la prevalencia de s&#237;ntomas de ansiedad y depresi&#243;n mediante la <span class="elsevierStyleItalic">Hospital Anxiety and Depression Scale</span> &#40;HADS&#41; y se valora la calidad de vida en pacientes con BQ &#40;con y sin FQ&#41;&#46; Los autores indican que el 20&#37; de los enfermos presentan puntuaciones elevadas para depresi&#243;n y el 38&#37; para ansiedad&#46; La edad se relacion&#243; con s&#237;ntomas tanto de ansiedad como de depresi&#243;n&#44; y la ansiedad se relacion&#243; con exacerbaciones frecuentes&#46; Una vez controladas las variables de confusi&#243;n&#44; demogr&#225;ficas &#40;edad y sexo&#41; y cl&#237;nicas &#40;exacerbaciones&#44; producci&#243;n diaria de esputo&#44; etiolog&#237;a y valores de espirometr&#237;a&#41;&#44; ambas&#44; la depresi&#243;n y la ansiedad&#44; predec&#237;an un empeoramiento de la calidad de vida&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">As&#237; mismo&#44; el trabajo de O&#8217;Leary et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> valor&#243; en 111<span class="elsevierStyleHsp" style=""></span>enfermos con una edad media de 52<span class="elsevierStyleHsp" style=""></span>a&#241;os la ansiedad y depresi&#243;n mediante la HADS y la calidad de vida mediante el SGRQ&#46; Los autores hallan s&#237;ntomas de ansiedad moderada a grave en el 17&#37; de los casos y de depresi&#243;n en el 9&#37;&#44; relacion&#225;ndose ambos&#44; con la calidad de vida&#46; Ni la ansiedad ni la depresi&#243;n se relacionaron con la extensi&#243;n de las BQ en el TCAR&#44; la funci&#243;n pulmonar&#44; PaO<span class="elsevierStyleInf">2</span>&#44; ni el sexo&#46; La depresi&#243;n se relacion&#243; con la disnea&#44; la fatiga f&#237;sica y mental y la tolerancia al ejercicio&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Un estudio coreano realizado en enfermos ambulatorios &#8212;84 con EPOC&#44; 33 con BQ y 7 con asma&#8212; evaluados con los mismos cuestionarios empleados en nuestro trabajo &#40;BDI-<span class="elsevierStyleSmallCaps">II</span> y STAI&#41;&#44; describi&#243; en los pacientes con BQ un 55&#37; de depresi&#243;n &#40;similar a los EPOC&#41; y un 39&#37; de ansiedad &#40;mayor que en los EPOC y asm&#225;ticos&#41;&#46; Se concluy&#243; que los enfermos con BQ m&#225;s afectados por los s&#237;ntomas psicol&#243;gicos eran los de mayor obstrucci&#243;n bronquial y con historia de tabaquismo<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">En el presente trabajo se observa que m&#225;s de la mitad de los enfermos presentaban puntuaciones por encima del percentil 50 en ansiedad&#44; estado y rasgo&#44; y un tercio depresi&#243;n&#46; En nuestro trabajo&#44; a diferencia de los otros&#44; solo se hall&#243; que la cantidad de expectoraci&#243;n y la colonizaci&#243;n bacteriana&#44; espec&#237;ficamente por <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#44; se relacionaba con ansiedad&#46; La mujeres tuvieron puntuaciones m&#225;s altas de depresi&#243;n&#44; hallazgo no coincidente con los estudios mencionados&#44; aunque s&#237; con los datos referidos en la poblaci&#243;n general que describen una prevalencia 2 o 3<span class="elsevierStyleHsp" style=""></span>veces mayor de depresi&#243;n en mujeres<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46; No encontramos relaci&#243;n entre la calidad de vida y la morbilidad psicol&#243;gica&#44; aunque lo enfermos con depresi&#243;n tuvieron las puntuaciones m&#225;s altas&#44; pero en ninguna escala fue significativa&#46; Ello pudo ser debido a que los pacientes no tuvieron puntuaciones muy elevadas en SGRQ y que pudieron ser otros factores &#8212;como la edad&#44; la obligaci&#243;n de realizar un tratamiento diario&#44; as&#237; como algunos aspectos no contemplados&#44; como el estado civil o factores sociales&#8212; los que pudieran haber motivado la alta prevalencia de s&#237;ntomas de ansiedad y depresi&#243;n&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Es relevante destacar la proporci&#243;n de pacientes con s&#237;ntomas de depresi&#243;n y ansiedad existentes en nuestro trabajo&#46; Estas diferencias pudieron ser debidas en una parte&#44; a la mayor edad de los enfermos incluidos&#44; pero principalmente&#44; a las diferencias de sensibilidad de los cuestionarios&#44; ya que en los trabajos precedentes se emple&#243; la HADS&#44; y en este&#44; la STAI y BDI-<span class="elsevierStyleSmallCaps">II</span>&#46; De esta manera&#44; en el estudio coreano los porcentajes se aproximaron m&#225;s a los nuestros&#46; BDI-<span class="elsevierStyleSmallCaps">II</span> es m&#225;s sensible que HADS&#44; ya que eval&#250;a un amplio espectro de s&#237;ntomas depresivos&#44; aunque al incluir s&#237;ntomas no solo de la esfera cognitiva &#40;&#237;tems 1-14&#41;&#44; sino tambi&#233;n de la esfera som&#225;tica &#40;&#237;tems 15-21&#41;&#44; estos podr&#237;an solaparse con los de la propia enfermedad&#44; sobreestimando la prevalencia de depresi&#243;n&#46; Para evitar esto incrementamos el punto de corte&#44; seg&#250;n lo recomendado en la literatura para pacientes cr&#243;nicos&#46; As&#237; mismo&#44; el cuestionario STAI facilita m&#225;s informaci&#243;n que la HADS&#44; ya que con sus 2<span class="elsevierStyleHsp" style=""></span>subescalas permite diferenciar entre ansiedad transitoria &#40;estado&#41; y personalidad ansiosa &#40;rasgo&#41;&#46; Por otro lado&#44; las caracter&#237;sticas de los enfermos o las variables analizadas fueron distintas&#44; y ello pudo influir igualmente en la divergencia de los resultados&#46; Por ello es necesario realizar trabajos con un mayor n&#250;mero de pacientes empleando unos mismos cuestionarios para perfilar estas diferencias&#46; Est&#225; claro que cualquier trastorno psicol&#243;gico puede traer consecuencias en el cumplimiento terap&#233;utico&#44; y de esta manera en la evoluci&#243;n de la enfermedad&#44; y por ello su diagn&#243;stico es de gran relevancia&#46; Los cuestionarios validados de cribado psicol&#243;gico nos pueden ayudar&#44; en la pr&#225;ctica cl&#237;nica habitual&#44; a seleccionar a los pacientes que debemos derivar a los especialistas de salud mental&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Los estudios de prevalencia de psicomorbilidad en los enfermos con BQ con FQ son algo m&#225;s numerosos y muestran&#44; tambi&#233;n&#44; una prevalencia elevada&#44; aunque al analizar la relaci&#243;n con las variables cl&#237;nicas no todos coinciden en sus resultados&#44; como sucedi&#243; en nuestro caso&#46; Mientras algunos encuentran concordancia entre las exacerbaciones y la ansiedad&#44; no todos demuestran una relaci&#243;n entre la funci&#243;n pulmonar o extensi&#243;n de las lesiones en TCAR con los s&#237;ntomas de ansiedad o depresi&#243;n<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23-25</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">El actual trabajo tiene algunas limitaciones&#58; la primera&#44; el n&#250;mero de pacientes incluidos&#59; la segunda&#44; no haber empleado&#44; adem&#225;s de los cuestionarios referidos&#44; la HADS&#44; con la que existe experiencia previa en los pacientes con BQ&#44; y la tercera&#44; no haber remitido a todos los pacientes para entrevistas regladas psicol&#243;gicas y haber podido establecer la sensibilidad y la especificidad de los cuestionarios&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Podemos concluir que existe una elevada prevalencia de s&#237;ntomas de depresi&#243;n y ansiedad en los pacientes con BQ no FQ&#44; por lo que es necesario valorarla para realizar un manejo adecuado y evitar las consecuencias de la psicomorbilidad&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0145" class="elsevierStylePara elsevierViewall">Los autores declaran no tener conflictos de intereses&#46;</p></span></span>"
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          "identificador" => "xres277899"
          "titulo" => array:5 [
            0 => "Resumen"
            1 => "Introducci&#243;n"
            2 => "Pacientes y m&#233;todos"
            3 => "Resultados"
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          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Introduction"
            2 => "Patients and methods"
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          "titulo" => "Pacientes y m&#233;todos"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "An&#225;lisis estad&#237;stico"
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          "titulo" => "Resultados"
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            0 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Caracter&#237;sticas de los pacientes con bronquiectasias"
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            1 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Inventario de Depresi&#243;n de Beck"
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            2 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Cuestionario de Ansiedad Estado-Rasgo"
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            3 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Depresi&#243;n y ansiedad estado-rasgo y variables cl&#237;nicas"
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              "identificador" => "sec0045"
              "titulo" => "Depresi&#243;n y ansiedad estado-rasgo y calidad de vida"
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          "titulo" => "Discusi&#243;n"
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          "titulo" => "Conflicto de intereses"
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          "titulo" => "Bibliograf&#237;a"
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    "fechaRecibido" => "2012-11-04"
    "fechaAceptado" => "2013-01-26"
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          "clase" => "keyword"
          "titulo" => "Palabras clave"
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          "palabras" => array:7 [
            0 => "Fibrosis qu&#237;stica"
            1 => "Ansiedad"
            2 => "Depresi&#243;n"
            3 => "Calidad de vida"
            4 => "<span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>"
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            0 => "Cystic fibrosis"
            1 => "Anxiety"
            2 => "Depression"
            3 => "Health-related quality of life"
            4 => "<span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>"
            5 => "Beck Depression Inventory"
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    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con bronquiectasias &#40;BQ&#41;&#44; como enfermos cr&#243;nicos&#44; pueden verse afectados por trastornos psicol&#243;gicos&#46; El objetivo del trabajo fue valorar la presencia de s&#237;ntomas de ansiedad y depresi&#243;n&#44; mediante cuestionarios validados&#44; en pacientes con BQ controlados en una unidad monogr&#225;fica&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">De forma consecutiva se incluyeron en el estudio pacientes diagnosticados de BQ&#44; no relacionadas con fibrosis qu&#237;stica&#44; mediante una tomograf&#237;a axial computarizada de alta resoluci&#243;n&#46; Los enfermos estaban en fase estable en las &#250;ltimas 3<span class="elsevierStyleHsp" style=""></span>semanas y cumplimentaron los cuestionarios Inventario de Depresi&#243;n de Beck&#44; Escala de Ansiedad Estado-Rasgo y Cuestionario Respiratorio St&#46; George&#44; despu&#233;s de firmar el consentimiento informado&#46; Los pacientes fueron clasificados seg&#250;n las puntuaciones obtenidas en los cuestionarios de cribado psicol&#243;gico y sus resultados se compararon con las variables cl&#237;nicas&#44; radiol&#243;gicas y funcionales y con las puntuaciones de calidad de vida&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Setenta enfermos&#44; 48 de ellos mujeres y 22 hombres&#44; con una edad media de 64&#44;19<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; respondieron de forma voluntaria a los cuestionarios&#46; El 34&#37; de los pacientes mostraron s&#237;ntomas de depresi&#243;n&#44; y alrededor del 55&#37; puntuaciones por encima del percentil 50 en ansiedad &#40;rasgo y estado&#41;&#46; La cantidad de expectoraci&#243;n se relacion&#243; con la ansiedad rasgo&#46; La colonizaci&#243;n bacteriana se relacion&#243; con la ansiedad &#40;rasgo y estado&#41;&#44; especialmente la colonizaci&#243;n por <span class="elsevierStyleItalic">Pseudomonas aeruginosa&#46;</span> El sexo femenino mostr&#243; mayor riego de depresi&#243;n&#46; No existi&#243; relaci&#243;n entre las clasificaciones establecidas de ansiedad y depresi&#243;n y las puntuaciones de calidad de vida&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con BQ muestran en un alto porcentaje presencia de s&#237;ntomas de ansiedad&#44; rasgo y estado&#44; as&#237; como de depresi&#243;n&#46; Los m&#225;s afectados por ansiedad son los m&#225;s expectoradores y los colonizados por bacterias&#44; y por depresi&#243;n&#44; las mujeres&#46; Creemos que es necesario valorar la presencia de psicomorbilidad asociada&#44; especialmente en este perfil de enfermos&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Patients with chronic bronchiectasis &#40;BQ&#41; may suffer from psychological disorders&#46; The objective of this study was to assess the presence of anxiety and depression in patients from a specialised BQ Unit&#44; using validated questionnaires&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We included patients consecutively diagnosed with BQ &#40;unrelated to cystic fibrosis&#41; by high resolution computed tomography in the study&#46; Patients were clinically stable in the previous three weeks and voluntarily completed the Beck Depression Inventory&#44; State-Trait Anxiety Inventory and St&#46; George&#39;s Respiratory Questionnaire&#44; after signing the informed consent&#46; They were classified according to their scores on the psychological screening questionnaires&#44; and their results were compared with the clinical&#44; radiological and functional parameters and Quality of Life&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Seventy patients were included&#44; 48 women and 22 men&#44; with a mean age of 64&#46;19<span class="elsevierStyleHsp" style=""></span>years&#46; Thirty-four percent &#40;34&#37;&#41; of patients showed symptoms of depression&#44; and around 55&#37; had scores above the 50th percentile in trait and state anxiety&#46; The amount of sputum was associated with trait anxiety&#46; Bacterial colonization was related to anxiety &#40;trait and state&#41;&#44; especially <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> colonization&#46; Female patients showed a higher risk of depression&#46; There was no relationship between the Quality of Life scores and the established classifications of anxiety and depression&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A high percentage of patients with BQ presented anxiety &#40;trait and state&#41; and depression&#46; The daily sputum production and bacterial colonization &#40;especially with <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&#41; were the variables most related to anxiety&#59; depression was more common in women&#46; We believe that the presence of psychological disorders should be evaluated&#44; especially in patients with this profile&#46;</p>"
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Mujeres adultas</td><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Ansiedad estado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Ansiedad rasgo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Ansiedad estado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Ansiedad rasgo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">P 50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">P 75&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">P 85&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">P 99&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t">51&#47;23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">IMC &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41; &#40;<span class="elsevierStyleSmallCaps">X</span></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24&#44;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;81&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">H&#225;bito tab&#225;quico &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No fumadores&#47;Exfumadores&#47;Fumadores activos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">&#205;ndice de Charlson&#40;<span class="elsevierStyleSmallCaps">X</span></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Grado 1&#47;Grado 2 de disnea MRC &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">47&#44;3&#47;27&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>ml&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5-30<span class="elsevierStyleHsp" style=""></span>ml&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mucosa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mucopurulenta&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Purulenta&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Marron&#225;cea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hemoptisis &#8805;100</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ml&#47;d&#237;a&#47;sinusitis &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">&#37;FVC</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#44;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Bronquiectasias qu&#237;sticas&#47;difusas &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#47;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#47;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Exacerbaciones respiratorias &#40;<span class="elsevierStyleSmallCaps">X</span></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;46&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hospitalizaciones &#40;<span class="elsevierStyleSmallCaps">X</span></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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Article information
ISSN: 03002896
Original language: Spanish
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2023 January 120 49 169
2022 December 78 76 154
2022 November 121 48 169
2022 October 122 55 177
2022 September 104 72 176
2022 August 126 76 202
2022 July 129 81 210
2022 June 117 114 231
2022 May 159 110 269
2022 April 172 58 230
2022 March 167 95 262
2022 February 143 63 206
2022 January 147 55 202
2021 December 146 89 235
2021 November 165 82 247
2021 October 159 90 249
2021 September 142 86 228
2021 August 171 93 264
2021 July 174 89 263
2021 June 207 120 327
2021 May 205 108 313
2021 April 506 132 638
2021 March 372 73 445
2021 February 226 61 287
2021 January 197 49 246
2020 December 232 85 317
2020 November 208 31 239
2020 October 201 46 247
2020 September 194 30 224
2020 August 183 36 219
2020 July 260 37 297
2020 June 214 21 235
2020 May 176 27 203
2020 April 213 30 243
2020 March 243 30 273
2020 February 268 44 312
2020 January 266 52 318
2019 December 234 35 269
2019 November 253 45 298
2019 October 281 50 331
2019 September 345 52 397
2019 August 226 48 274
2019 July 235 46 281
2019 June 227 56 283
2019 May 228 67 295
2019 April 301 100 401
2019 March 241 79 320
2019 February 174 58 232
2019 January 162 44 206
2018 December 166 42 208
2018 November 219 50 269
2018 October 246 40 286
2018 September 198 56 254
2018 July 1 0 1
2018 May 77 1 78
2018 April 136 48 184
2018 March 111 28 139
2018 February 97 34 131
2018 January 100 43 143
2017 December 87 28 115
2017 November 108 28 136
2017 October 89 30 119
2017 September 101 24 125
2017 August 103 42 145
2017 July 117 53 170
2017 June 114 39 153
2017 May 122 49 171
2017 April 112 41 153
2017 March 125 62 187
2017 February 136 70 206
2017 January 113 24 137
2016 December 149 24 173
2016 November 229 53 282
2016 October 229 46 275
2016 September 247 49 296
2016 August 174 28 202
2016 July 149 29 178
2016 June 178 49 227
2016 May 187 70 257
2016 April 121 2 123
2016 March 173 3 176
2016 February 169 6 175
2016 January 209 76 285
2015 December 205 69 274
2015 November 254 95 349
2015 October 256 8 264
2015 September 237 0 237
2015 August 176 0 176
2015 July 212 0 212
2015 June 188 0 188
2015 May 215 0 215
2015 April 175 0 175
2015 March 140 0 140
2015 February 94 0 94
2015 January 131 0 131
2014 December 104 0 104
2014 November 176 0 176
2014 October 148 0 148
2014 September 126 0 126
2014 August 128 0 128
2014 July 126 0 126
2014 June 165 0 165
2014 May 161 0 161
2014 April 146 0 146
2014 March 163 0 163
2014 February 129 0 129
2014 January 104 0 104
2013 December 4 0 4
2013 November 4 0 4
2013 October 39 0 39
2013 September 2 0 2
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