Confiabilidad de un monitor automatizado para la medición de la presión arterial / Reliability of an automatic monitor for blood pressure measurement

Background A correct blood pressure (BP) measurement is essential for the diagnosis and control of high BP. Aim: To evaluate the agreement and repeatability of BP measurements with the OMRON HEM-7320-LA device compared to a mercury sphygmomanometer. Material and Methods: A cross-sectional study comparing BP measurements made by two randomly selected trained nurses and an automatic oscillometric device. The mercurial sphygmomanometer was connected to the automated device via a "T" type connector and a dual-head stethoscope was used, allowing simultaneous measurements. The results were analyzed with one-factor analysis of variance, Bland-Altman's test, repeatability coefficient (RC), and intra-class correlation coefficient (ICC). Results: Forty-nine participants aged 56 ± 19 years were included. Nineteen had hypertension (38%). We did not observe a significant difference in either systolic (SBP) or diastolic blood pressure (DBP) pressure measurements between the observers and the device. The mean difference was −0.09 mmHg (95% confidence intervals (CI)-0.9 to 0.7) for SBP and −0.9 mmHg (95% CI −1.7 to −0.13) for DBP. The RC for SBP (6.2, 5.2 and 5.8 mmHg) and DBP (4.7, 4.2 y 5.2 mmHg) was similar between the observers and the device. The ICC for SBP was 0.990 (95% CI 0.983 to 0.995, p < 0.01) and 0.986 (95% CI 0.977 to 0.991, p < 0.01) for DBP. Conclusions: There was a high level of agreement and similar measurement repeatability in the measurements performed by the automatic device and the mercurial sphygmomanometer. No differences in BP measurements were observed.

Triada mortal en pacientes politraumatizados, relación conmortalidad y severidad / Prognostic value of the lethal triad among patients with multiple trauma

Background: Patients who have suffered multiple traumatic injuries, have a serious risk for death. Hypothermia, acidosis and coagulopathy are three complications in these patients, whose presence is known as lethal triad and indicates bad prognosis.Aim: To determine if the lethal triad in multiple trauma patients is associated withhigher mortality and Injury Score Severity (ISS). Material and Methods: Onehundred multiple trauma patients aged 26 to 56 years (90 males), admitted toan emergency room, were studied. Body temperature, prothrombin time, partialthromboplastin time, platelet count and blood gases were determined on admission.Results: Twenty six patients had the lethal triad and 15% died in the emergencyroom within the first 6 hours. No death was recorded among the 74 patients withoutthe lethal triad. The mean ISS among patients with and without the lethal triad was31.7 and 25.6, respectively (p < 0.05). Conclusions: The presence of the lethal triadamong patients with multiple trauma is associated with a higher mortality and ISS.

Relación entre hiperinsulinemia, disfunción diastólica e hipertrofia del ventrículo izquierdo en pacientes con hipertensión arterial sistémica / Association of hyperinsulinemia with left ventricular hypertrophy and diastolic dysfunction in patients with hypertension

Background: Hypertension is the main independent cardiovascular risk factor. However, there are additional factors that induce organic damage. Aim: To assess the association between hyperinsulinemia, ventricular hypertrophy and left ventricular diastolic function. Patients and Methods: Seventy-four patients aged 30 to 65 years, with mild or moderate systemic hypertension, with overweight or mild obesity and normal glucose tolerance curve (GTC), were studied. Serum insulin was measured during GTC. The maximum levels of insulin and glucose were observed 60 minutes after the oral glucose load and they were expressed as rG/1. Patients were stratified in three groups according to their glucose and insulin fasting levels (I0) and post-glucose challenge levels (rG/I): Group 1 (normoinsulinemic patients) I0 <17 mU/mL and rG/I >2 (2.45+0.4). Group 2 (post-prandial hyperinsulinemic patients) I0 <17 mU/mL and rG/I <2> 1 (1.34+0.3). Group 3 (persistently hyperinsulinemic patients) I0 >17 mU/mL and <1 (0.7+0.3). Left ventricular mass and its diastolic function were measured by Doppler echocardiography. Results: No differences in blood pressure or age were observed between groups. There was a negative correlation between ventricular mass and rG/1 (r =-0.282, p =0.015). Left ventricular diastolic dysfunction was significantly more deteriorated in group 3, as compared with group 1 (p <0.001 ANOVA). There was a significant correlation between g/GI and diastolic dysfunction (r =0.232 p =0.047). Conclusions: Fasting, post challenge hyperinsulinemia and a rG/I <1 are associated with higher ventricular mass and left ventricular diastolic dysfunction, independent of blood pressure and age.

Frecuencia de abortos en familias con un caso de síndrome de Down / Frequency of abortuses in families with an affected of Down syndrome

La ocurrencia de trisomía 21 sólo se ha asociado en forma consistente con la edad materna avanzada. La evidencia de factores genéticos proviene de estudios familiares, consanguinidad y moleculares. Dada la alta ocurrencia de trisomías en abortos de primer trimestre y que la mayoría de las trisomías 21 terminan en abortos, el estudio de la falla reproductiva en familias con un caso de síndrome Down (SD), podría ser un indicador de predisposición a no disminución. Se estudió la ocurrencia de abortos en 48 familias con un caso de trisomía 21 regular y en un grupo control pareado por edad de los padres y orden de gesta, estimando el riesgo de ocurrencia de trisomía 21 ocurrido un primer evento. Se encontró una frecuencia de abortos espontáneos de 9.17 por ciento en el grupo SD y de 2.62 por ciento en el grupo control. La diferencia se mantuvo aún considerando el riesgo de recurrencia de trisomía 21 y fue más marcada en madres de 20-24 años y mayores a 35 años. Nuestros resultados sugieren la existencia de factores intrínsecos, probablemente genético que influyen en la ocurrencia de no disyunción