Thoracoabdominal manifestations of immunoglobulin G4-related disease.

Immunoglobulin G4-related disease (IgG4-RD) comprises a group of immune-mediated diseases that, until recently, were considered separate entities. These entities have a similar clinical presentation, serological findings, and pathogenesis, so they are currently considered a single multisystemic disease. The common characteristic is the infiltration of involved tissues by plasma cells and lymphocytes that are positive for IgG4. Three major criteria have been proposed for the diagnosis of IgG4-RD: clinical, laboratory, and histological. The pancreas is the organ that is most affected by IgG4-RD, which can simulate a tumor. In this respect, a series of signs could help us suspect that the pancreatic findings do not reflect a tumor (halo sign, duct-penetrating sign, absence of vascular invasion, etc.). The differential diagnosis is important to avoid unnecessary surgical interventions.

Manifestaciones toracoabdominales de las enfermedades relacionadas con la inmunoglobulina G4 / Thoracoabdominal manifestations of immunoglobulin G4-related disease

Las enfermedades relacionadas con la IgG4 (ER-IgG4) son un conjunto de enfermedades inmunomediadas que, hasta no hace mucho tiempo, se consideraban como entidades individuales. Se ha demostrado la existencia de una clínica, una serología y una patogenia similares, por lo que, actualmente, se considera como una única enfermedad multisistémica. Su característica común es la infiltración de los tejidos afectados por células plasmáticas y linfocitos IgG4 positivos. Se han propuesto 3 criterios mayores para su diagnóstico, que son el clínico, el analítico y el anatomopatológico. El páncreas es el órgano que más se afecta en esta enfermedad, pudiendo simular un proceso tumoral. De ahí que se haya descrito una serie de signos que podrían hacernos sospechar que no se trata de una neoplasia (signo del halo, del conducto penetrante, ausencia de invasión vascular, etc.). El diagnóstico diferencial es importante de cara a evitar cirugías innecesarias (AU)

Immunoglobulin G4-related disease (IgG4-RD) comprises a group of immune-mediated diseases that, until recently, were considered separate entities. These entities have a similar clinical presentation, serological findings, and pathogenesis, so they are currently considered a single multisystemic disease. The common characteristic is the infiltration of involved tissues by plasma cells and lymphocytes that are positive for IgG4. Three major criteria have been proposed for the diagnosis of IgG4-RD: clinical, laboratory, and histological. The pancreas is the organ that is most affected by IgG4-RD, which can simulate a tumor. In this respect, a series of signs could help us suspect that the pancreatic findings do not reflect a tumor (halo sign, duct-penetrating sign, absence of vascular invasion, etc.). The differential diagnosis is important to avoid unnecessary surgical interventions (AU)

[Submandibular fold. An alternative for the assessment of subcutaneous fat]. / El pliegue submandibular. Una opción para la valoración de la grasa subcutánea.

BACKGROUND: Folds are a useful method of measuring subcutaneous fat. This study reports the feasibility of the use of the submandibular fold to evaluate the subcutaneous fat. METHODS: A transversal descriptive study was designed by a poly-staged stratified randomized sample (n = 572). A series of anthropometric measurements (weight, height, different folds and surrounding areas) were performed in addition to the measurement of the submandibular fold. In addition blood pressure was determined as well as oral glucose tolerance test. RESULTS: After correction of the effect of age, the submandibular fold was found to be related with both the Quetelet's index (BMI) (males r = 0.50; females r = 0.61, both p < 0.0001) and the Benn's index (males r = 0.53; females r = 0.60, both p < 0.0001). Their correlations with those of other folds and with the measurements of centralization place the submandibular fold in a median position with respect to central and peripheral fat deposits. Furthermore, the percentage of fat which the increase in BMI carries is practically constant. Likewise, it was associated with the presence of high blood pressure in both sexes (males F = 9.7, p < 0.025; females F = 6.1, p < 0.025), diabetes mellitus (F = 6.1, p < 0.005) and inguinal hernias (F = 10.8, p < 0.0025) in males and in females, as well as to the presence of abdominal striae in females (F = 12.2, p < 0.001). CONCLUSIONS: The submandibular fold may be used by investigators who wish to evaluate subcutaneous fat through one sole fold, which is accessible and easy to measure. This measure is intermediate between the central and peripheral zones. In addition, it may reflect the fat deposit which is produced with both an increase in the body mass index and age.

Self-reported height and weight and prevalence of obesity. Study in a Spanish population.

The objective of this investigation was to evaluate the usefulness of self-reported measures of height and weight under the hypothesis that they under-estimate the prevalence of obesity. A cross-sectional study was carried out on a random sample of the adult population of the province of León, Spain. The study involved 572 participants (262 men and 310 women). All participants were interviewed and questioned about socio-cultural characteristics plus their weight and height. All respondents were later weighted and measured for height using standard methods. A Quetelet or body mass index (BMI) > or = 30 kg/m2 was used as the index for obesity. Many people were unaware of their weight and/or height. Self-reported BMI could not be calculated in 40 men (15%) and 107 women participants (35%). This occurrence was more frequent in women than in men (chi 2 = 3.98; P < 0.05). The prevalence of obesity, based on measured weight and height, was 1.8 times that from self-reported values in men and 2.5 times that from self-reported values in women. If we consider only the measured values for those individuals who supplied self-reported heights and weights, these prevalences fall to 1.7 and 1.6 times those from self-reported values respectively. In addition, the difference between measured and self-reported height increase with age. All these differences are statistically significant. We believe that the use of self-reported values of weight and height in epidemiological studies should be avoided in an elderly population. These measurements could, however, be used on a younger population.

Is there a relationship between non-insulin diabetes mellitus and birth order?

Our objective was to determine the prevalence of non-insulin dependent diabetes mellitus Type 2 Diabetes, in the province of Leon, Spain, and to investigate the relationship between birth order and the presence of diabetes. A cross-sectional study was therefore carried out on a stratified sample of the adult population (n = 569). The participants completed a socio-demographic questionnaire and an analysis of their basal capillary glycaemia and an oral glucose tolerance test (OGTT) after a 75 g load according to WHO recommendations. Type 2 diabetes prevalence was 5.62%. It was higher in subjects with a birth order above 4 than among those with a birth order below or equal to 4. (16.81% vs 2.85%, p < 0.001). This remained after adjusting for age. It was not proved that either sex, obesity or a family history of diabetes could amount to confusion factors. Greater values of fasting glycaemia (5.12 vs 4.73 mmol/l, p < 0.001) and less satisfactory post-OGTT glycaemic curves were also shown is subjects with a birth order > 4. Although it was not-possible to definitely conclude, from our study, that children born after the fourth birth have a greater risk of presenting alterations in their carbohydrate metabolism, there are indicators arguing for a more detailed study of such a possibility.

[Obesity in the province of León. Differing criteria, different prevalences]. / La obesidad en la provincia de León. Distintos criterios, diferentes prevalencias.

OBJECTIVE: To assess the prevalence of obesity among the adult population of our province. DESIGN: Cross-sectional. SITE. León Province. PATIENTS OR OTHERS PARTICIPANTS: This was a random sample with 572 individuals over 17. They were picked from the electoral register. The confidence level was 95%, with a 3.5% length of interval. They were selected by means of proportional, multi-stage stratified sampling. The Hansen method was used for a subsequent survey of the cases missed. MAIN MEASUREMENTS AND RESULTS: Socio-demographic data were collected, and weight and size measured, using standard procedures. Those who had a Quetelet index > or = 30 kg/m2 or with a relative weight > or = 120%, in line with different weight tables, were considered to be obese. Under the first criterion there was a 23.25% prevalence of obesity (CI: 19.79-26.71). The second showed long variations, running from 59.92% (CI: 55.64-64.20) to 16.17% (CI: 13.06-19.28). CONCLUSIONS: The prevalence of obesity among adults in our province is above that in other zones of Spain and other countries. The calculation of relative weight is not possible in an important number of cases because age or size are not properly included in the reference table. The criteria for defining someone as obese need to be unified in order to be able to make comparisons between different surveys.

[What is the normal threshold of glycemia in our elderly?]. / Cuál es el límite de normalidad de la glucemia de nuestros ancianos?

The aim of this paper is to study the evolution of basal glucemia and TTOG with age, as well as the prevalence of diabetes in different age groups. A cross-sectional descriptive study was designed, with a polystratified random sampling method among the whole adult population of Leon. In addition to fill in a questionnaire, basal glucemia was measured with a capillary reflectometer and a TTOG with 75 g. The effect of age on the average values of basal glucemia and on TTOG glucemia was no demonstrated. A significant correlation between the prevalence of the disease and the age of subjects was also observed, being maximum in the age group 60-69 (14.50%). After discussing the results, we conclude that only prospective studies will be able to establish the threshold of glucose tolerance-intolerance, beyond which the risk increases.

[Epidemiology of diabetes mellitus in the province of Leon]. / Epidemiología de la diabetes mellitus en la provincia de León.

BACKGROUND: Diabetes mellitus (DM) is a very important health problem because of its high morbidity and mortality. The aim of the present study was to investigate the prevalence of diabetes in the adult population of the León province and its possible association with the most common risk factors and markers. METHODS: A cross-sectional descriptive study was designed with a multistage stratified sampling (572 individuals). A questionnaire about several sociodemographic variables, an alimentary survey, measurements of height and weight, capillary baseline glycemia, and oral glucose tolerance test with 75 g glucose were carried out. RESULTS: The observed prevalence of diabetes mellitus was 5,6% and that of glucose intolerance 10,3%. The known/unknown DM ratio was 2,2/1. The prevalence of treated DM was 1,9%. The leading variables associated with DM were age, a positive family history of diabetes and obesity. A higher incidence of DM was found in females, in urban media, and in high social classes. BACKGROUND: Diabetes had been previously underrated in the León province. The observed prevalence values are close to those from other methodologically similar studies. In addition, an association was found between DM and some non-modifiable risk factors (age, sex or family history); by contrast, there is a very important risk factor (obesity) which may be modified by intervention.

[The diagnosis of diabetes mellitus in epidemiological studies]. / El diagnóstico de la diabetes mellitus en los estudios epidemiológicos.

The aim of the present study was to evaluate the relative usefulness of some of the diagnostic methods used to estimate the prevalence of diabetes mellitus in epidemiological studies. A cross-sectional descriptive study with multistage stratified sampling was designed. A personal interview, a capillary baseline glycemia and a OGTT were carried out. The medical records and the use of antidiabetic drugs and self-control products were also evaluated. The prevalences obtained with these methods were: Medical records = 1.31%, personal interview = 7.91%, use of drugs = 1.93%, self-control products = 1.05%, capillary baseline glycemia greater than or equal to 120 mg/dl = 4.04%, OGTT with WHO criteria = 5.62%. Using OGTT as a reference, the diagnostic test with the greatest overall value was capillary baseline glycemia equal to or higher than 120 mg/dl. We think that, as a whole, the election of one method or another will depend on both the precise aim of the study and the type of design and the cost that can be sustained.

[The usefulness of the Peak Flow Meter for assessing patients with acute respiratory disease]. / Utilidad del "Peak Flow Meter" para la valoración de enfermos respiratorios agudos.

The aim of the study was to evaluate the utility of the extrahospital use of "Peak Flow Meter" (PFM) in patients with an acute respiratory disease. 70 patients were studied. PFM, arterial gasometry, physical examination and dyspnea evaluation were performed on all of them. The PFM were posteriorly transformed into the rate related to the ideal result, following the Nunn and Gregg equation (1989). We found an association between the PFM rate and the different arterial blood gas test results, and a relation to the degree of dyspnea and the listening of sibilant rales. There was more significance with the rate of PFM than with the PFM transformed in all cases, and only association was found between arterial blood changes and PFM. We concluded that all patients with an acute respiratory disease with a rate of PFM greater than 50% should be evaluated carefully because of the probability of existing hypoxemia, and those with rate of less than 20% must be referred to hospital.

[Tuberculosis in León. An epidemiological approach]. / La tuberculosis en León. Aproximación epidemiológica.

The aim of the present study was an approach to the epidemiological status of tuberculosis in the León province. To this end, we studied the morbidity through the EDOs and we carried out two tuberculin surveys during 1988-1989 to assess RAI. The results showed infection prevalences of 1.19 and 1.09 at six years of age for the two study years, respectively, with a RAI between 0.118 and 0.079. We conclude that tuberculosis still is an important health problem. The RAI indicates that our level is that of a developed country. We also discuss the supposed increase in the frequency of tuberculosis.

[What epidemiological measures are useful in the evaluation of tuberculous disease?]. / "Qué medidas epidemiológicas son útiles en la valoración de la enfermedad tuberculosa?"

Among the epidemiological barometers useful in evaluating tuberculosis, the Annual Infection Risk is the one which has been shown to be the most useful. This rate can be calculated indirectly (by way of Tables) or directly (by testing the same group of individuals twice over a one-year period). The most ideal method for making these calculations, by consecutively having the same population of 6 year-olds at intervals over a one-year period, is presented. The results indicate a statistically significant difference (P less than 0.001) between the two methods, an indirect AIR of 0.079 to 0.118 being obtained, as related to a Case Rate of 0.44. The fact that said difference is probably due to the impact of the BCG vaccination, which leads to pressure phenomena, and finally, whilst we are not free of said vaccination, this index should be calculated indirectly, based on tuberculosis infection prevalence rates.

[Hospital emergencies in the catchment area of León. A study of the repercussions of primary care]. / Urgencias hospitalarias en el área sanitaria de León. Estudio de la repercusión de la atención primaria.

The filter role of primary health care on the attendance to hospital emergency services was evaluated in view of the saturation of the latter. It was demonstrated that those patients who had not previously attended primary care services (40.3%) had a higher rate of problems for which emergency attention was considered unjustified (51.64%), with the consequent performance deterioration. In the group of patients who were referred to the hospital by a physician, the highest rates of examination of the patient, degree of justification for care, and diagnostic agreement with our center were found among the youngest physicians. As a whole, the filter role of primary care in our area is clearly higher than that from other similar studies, although optimal levels have not yet been achieved.