Medición, control y conocimiento de la presión arterial: Iniciativa Mayo Mes de la Medición Colombia 2017 / Measurement, monitoring and knowledge of blood pressure: May Measurement Month, Colombia 2017

Objetivo: Describir los hallazgos de la implementación de la iniciativa Mayo Mes de la Medición 2017 aplicada a población colombiana adulta con el objetivo de crear conciencia sobre la importancia de la medición, conocimiento y control de la presión arterial. Materiales y métodos: Mayo Mes de la Medición es una encuesta transversal que sigue las directrices de la Sociedad Internacional de Hipertensión y la Liga Mundial de Hipertensión, que recoge información de factores de riesgo cardiovascular y mediciones de presión arterial. En Colombia su implementación fue liderada por la Fundación Oftalmológica de Santander (FOSCAL) y la Sociedad Latinoamericana de Hipertensión (LASH) con el apoyo de la Red Colombiana para la Prevención de las Enfermedades Cardiovasculares y Diabetes (RECARDI). Resultados: Se recolectaron datos en 11 departamentos de 21.797 personas, siendo el 58,7% mujeres, la edad promedio fue de 40,5±17,7 años. La prevalencia global de hipertensión arterial (HTA) fue del 20,8% (autorreporte de tratamiento antihipertensivo o toma de presión arterial sistólica [≥140mmHg]). El 46,5% del total de hipertensos tuvieron cifras de presión arterial sistólica que les clasifica como no controlados (presión arterial sistólica<140mmHg) y el 26,4% no conocían su condición de hipertensos, los cuales en el presente reporte son considerados como los casos nuevos de HTA. Conclusión: La prevalencia de presión arterial es alta en esta población adulta joven, en la cual el desconocimiento de la condición de HTA es también alta, y en aquellos que conocen su condición existe un porcentaje bajo de control de la HTA, resultados que demuestran la necesidad de implementar programas eficaces de detección de pacientes hipertensos y de establecer tratamientos estandarizados para mejorar el control de la HTA como una estrategia para la reducción de eventos cardiovasculares

Aim: To describe the findings of implementing May Measurement Month 2017 in the adult Colombian population to raise awareness of the importance of blood pressure measuring, monitoring, and awareness. Materials and methods: May Measurement Month is a cross-sectional survey that follows the directives of the International Society of Hypertension and the World Hypertension League, which gathers information on cardiovascular risk factors and blood pressure readings. Its implementation in Colombia was lead by the Santander Ophthalmological Foundation (FOSCAL) and the Latin American Society of Hypertension (LASH) with the support of the Colombian Network for the Prevention of Cardiovascular Diseases and Diabetes (RECARDI). Results: Data was collected from 11 departments on 21,797 people, 58.7% of whom were female, with an average age of 40.5±17.7 years. The overall prevalence of high blood pressure (HBP) was 20.8% (self-reported antihypertensive treatment or systolic blood pressure reading [systolic blood pressure≥140mmHg]). Of the total number of hypertensives, 46.5% had systolic blood pressure readings classified as uncontrolled (systolic blood pressure<140mmHg), and 26.4% were unaware that they were hypertensive who, in this report, we consider to be new cases of HBP. Conclusion: The prevalence of (elevated) blood pressure is high in this young adult population, whose lack of awareness of HBP is also high, and HBP in those aware of their condition is poorly controlled. These results highlight the need to implement effective detection programmes for hypertensive patients and to establish standardised treatments to improve HBP control as a strategy to reduce cardiovascular events

[Measurement, monitoring and knowledge of blood pressure: May Measurement Month, Colombia 2017]. / Medición, control y conocimiento de la presión arterial: Iniciativa Mayo Mes de la Medición Colombia 2017.

AIM: To describe the findings of implementing May Measurement Month 2017 in the adult Colombian population to raise awareness of the importance of blood pressure measuring, monitoring, and awareness. MATERIALS AND METHODS: May Measurement Month is a cross-sectional survey that follows the directives of the International Society of Hypertension and the World Hypertension League, which gathers information on cardiovascular risk factors and blood pressure readings. Its implementation in Colombia was lead by the Santander Ophthalmological Foundation (FOSCAL) and the Latin American Society of Hypertension (LASH) with the support of the Colombian Network for the Prevention of Cardiovascular Diseases and Diabetes (RECARDI). RESULTS: Data was collected from 11 departments on 21,797 people, 58.7% of whom were female, with an average age of 40.5±17.7 years. The overall prevalence of high blood pressure (HBP) was 20.8% (self-reported antihypertensive treatment or systolic blood pressure reading [systolic blood pressure≥140mmHg]). Of the total number of hypertensives, 46.5% had systolic blood pressure readings classified as uncontrolled (systolic blood pressure<140mmHg), and 26.4% were unaware that they were hypertensive who, in this report, we consider to be new cases of HBP. CONCLUSION: The prevalence of (elevated) blood pressure is high in this young adult population, whose lack of awareness of HBP is also high, and HBP in those aware of their condition is poorly controlled. These results highlight the need to implement effective detection programmes for hypertensive patients and to establish standardised treatments to improve HBP control as a strategy to reduce cardiovascular events.

Survival Benefit From Kidney Transplantation Using Kidneys From Deceased Donors Aged ≥75 Years: A Time-Dependent Analysis.

Patients with end-stage renal disease have longer survival after kidney transplantation than they would by remaining on dialysis; however, outcome with kidneys from donors aged ≥75 years and the survival of recipients of these organs compared with their dialysis counterparts with the same probability of obtaining an organ is unknown. In a longitudinal mortality study, 2040 patients on dialysis were placed on a waiting list, and 389 of them received a first transplant from a deceased donor aged ≥75 years. The adjusted risk of death and survival were calculated by non-proportional hazards analysis with being transplanted as a time-dependent effect. Projected years of life since placement on the waiting list was almost twofold higher for transplanted patients. Nonproportional adjusted risk of death after transplantation was 0.44 (95% confidence interval [CI] 0.61-0.32; p < 0.001) in comparison with those that remained on dialysis. Stratifying by age, adjusted hazard ratios for death were 0.17 (95% CI 0.47-0.06; p = 0.001) for those aged <65 years, 0.56 (95% CI 0.92-0.34; p = 0.022) for those aged 65-69 years and 0.82 (95% CI 1.28-0.52; p = 0.389) for those aged ≥70 years. Although kidney transplantation from elderly deceased donors is associated with reduced graft survival, transplanted patients have lower mortality than those remaining on dialysis.

Age may explain the association of an early dialysis initiation with poor survival.

BACKGROUND: Some studies postulate that early dialysis initiation may increase mortality. AIM: The aim of the present study was to assess to what extent this was due to confounding by age. DESIGN: Observational retrospective cohort study. METHODS: We studied all patients starting dialysis therapy between 1 January 1995 and 31 December 2009 in our center. The following variables at dialysis initiation in end-stage renal disease (ESRD) patients were analysed: estimated glomerular filtration rate (eGFR), age, gender, diabetes mellitus, serum albumin, hemoglobin, period of dialysis initiation, history of ischemic heart disease and stroke. Multivariate Cox model was used to calculate adjusted patient survival. RESULTS: Over the last 15 years, 428 patients initiated dialysis therapy in our reference area. Median eGFR at dialysis initiation was 8.16 ml/min. In the univariate analysis, increased eGFR, age, dialysis initiation 1995-1999/2000-2004, diabetes and history of ischemic heart disease were associated (P < 0.05) with increased mortality in ESRD. Patients that started dialysis program with eGFR > 8.16 were older than those who did it with eGFR < 8.16 (66 vs. 61 years, P < 0.001). The association between mortality and eGFR in the crude multivarite Cox model was lost when the model was adjusted by age. In the multivariate Cox model, dialysis initiation period, serum albumin and history of ischemic heart disease were associated with mortality. CONCLUSION: History of ischemic heart disease, serum albumin and dialysis start before 2005 were risk factors for mortality in ESRD patients. Older age is usually associated with early dialysis initiation, so age adjustment is needed to perform studies aimed to calculate the effect of eGFR at dialysis initiation on survival.

Ganoderma lucidum reduces kainic acid-induced hippocampal neuronal damage via inflammatory cytokines and glial fibrillary acid protein expression.

Ganoderma lucidum, a traditional Chinese medicine, has been shown to target the Central Nervous System. In this work we analyze whether G. lucidum, collected in Mexico, has a protective effect in the hippocampus of rats treated with kainic acid, a neurotoxin that causes seizures and neuronal loss. The aqueous extract of G. lucidum (10 mg/Kg, i.p.) was administered to rats 30 min before kainic acid injection (5 mg/Kg, i.p.). Animals that had received prior treatment with G. lucidum showed no tonic-clonic seizure activity. Histopathological analysis showed a significant decrease in neuronal loss and cellular alterations in the hippocampal CA3 region. Immunohistochemical analysis shows that when using G. lucidum in rats, there is less immunoreactivity for GFAP as well as TNF-alpha and IL-1beta in the CA3 region when compared with rats treated with kainic acid. Our results demonstrate that G. lucidum protects against kainic acid-induced alterations of hippocampal cells and expression of immunological markers in this model of excitotoxicity.

[Study of vascular risk in Navarre: objectives and design. Prevalence of metabolic syndrome and of vascular risk factors]. / Estudio de riesgo vascular en Navarra: objetivos y diseño. Prevalencia del síndrome metabólico y de los factores mayores de riesgo vascular.

BACKGROUND: To determine in a representative sample of the population the prevalence of risk factors and metabolic syndrome; their association with sub-clinical atherosclerotic lesions and their impact on cardiocerebrovascular disease 10 years after. MATERIAL AND METHODS: (Phase 1) Cross sectional survey of a random sample stratified by age and sex of the population of Navarre aged between 35 and 84. Antecedents, risk factors, physical and analytical exploration. (Phase II) Ten year follow-up cohort study, in 500 exposed to MS and 500 not exposed persons, aged between 45 and 74 years; with an 82.25% power to detect a risk ratio of 2; with analytical and image markers of sub-clinical atherosclerosis. (Phase III) Follow up of vascular events at ten years. RESULTS: The subjects recruited were 6,553; excluded or not found 871; the final sample was 5,682 (2,644 men and 3,038 women); 4,168 (73,4%) took part in the study. The prevalence of MS was 22.1% (95%CI 20.5 - 23.7) for men and 17,2% (95%CI 15.8 - 18.5) for women. The main cardiovascular RF were high compared to other geographical areas except for HDL cholesterol. The rate was 8.5% (95%CI 7.4 - 9.6) for men and 1.7% (95%CI 1.3 - 2.2) CONCLUSIONS: There are important differences in risk between sex, being worst for men. The high figures for HDL cholesterol and the low prevalence of MS might mean a lower risk of vascular events in Navarra.

Estudio de riesgo vascular en Navarra: objetivos y diseño. Prevalencia del síndrome metabólico y de los factores mayores de riesgo vascular / Study of vascular risk in Navarre: objectives and design. Prevalence of metabolic syndrome and of vascular risk factors

Fundamento. Determinar en una muestra poblacional la prevalencia de los factores de riesgo y del síndrome metabólico, su asociación con las lesiones arterioscleróticas subclínicas y su impacto sobre la enfermedad cardiovascular y cerebrovascular a los 10 años. Material y métodos. (Fase I) Estudio transversal en una muestra aleatoria estratificada por edad y sexo de la población de Navarra entre 35 y 84 años, por encuesta sobre antecedentes vasculares, factores de riesgo, exploración física y analítica. (Fase II) Estudio de cohortes de 10 años de seguimiento, en 500 expuestos y 500 no expuestos al SM, entre 45 y 74 años seleccionados para una razón de riesgo de 2, y una potencia del 82,25%, con exploración de marcadores de arteriosclerosis subclínica por imagen y analíticos. (Fase III) Seguimiento de eventos de enfermedad vascular a los 10 años de la muestra poblacional y de la cohorte prospectiva. Resultados. (Fase 1) Los sujetos requeridos fueron 6.553; excluidos y no localizados 871; la muestra efectiva 5.682 (2.644 hombres y 3.038 mujeres) y completaron el estudio 4.168 sujetos, (73,4%). La prevalencia del síndrome metabólico entre 35 y 84 años fue de 22,1 por 100 (IC95% 20,5-23,7) en hombres y de 17,2% (IC95% 15,8-18,5) en mujeres. Los factores mayores de riesgo vascular presentan prevalencias altas esperadas respecto a otras áreas geográficas excepto la del HDL colesterol bajo que lo fue de 8,5 por 100 (IC95% 7,4-9,6) en hombres y de 1,7% (IC95% 1,3-2,2). Conclusiones. Existen diferencias importantes de riesgo entre sexos en detrimento de los hombres. Las altas cifras promedio de HDL colesterol y la baja prevalencia de síndrome metabólico pueden justificar el menor riesgo de eventos vasculares en Navarra

Background. To determine in a representative sample of the population the prevalence of risk factors and metabolic syndrome; their association with sub-clinical atherosclerotic lesions and their impact on cardiocerebrovascular disease 10 years after. Material and Methods. (Phase 1) Cross sectional survey of a random sample stratified by age and sex of the population of Navarre aged between 35 and 84. Antecedents, risk factors, physical and analytical exploration. (Phase II) Ten year follow-up cohort study, in 500 exposed to MS and 500 not exposed persons, aged between 45 and 74 years; with an 82.25% power to detect a risk ratio of 2; with analytical and image markers of subclinical atherosclerosis. (Phase III) Follow up of vascular events at ten years. Results. The subjects recruited were 6,553; excluded or not found 871; the final sample was 5,682 (2,644 men and 3,038 women); 4,168 (73,4%) took part in the study. The prevalence of MS was 22.1% (95%CI 20.5 - 23.7) for men and 17,2% (95%CI 15.8 - 18.5) for women. The main cardiovascular RF were high compared to other geographical areas except for HDL cholesterol. The rate was 8.5% (95%CI 7.4 - 9.6) for men and 1.7% (95%CI 1.3 - 2.2) Conclusions. There are important differences in risk between sex, being worst for men. The high figures for HDL cholesterol and the low prevalence of MS might mean a lower risk of vascular events in Navarra

[Intramyocardial dissecting haematoma: an unusual form of cardiac rupture]. / Hematoma disecante intramiocárdico: una forma poco frecuente de rotura cardíaca.

The intramyocardial dissecting haematoma is an unusual rupture of the left ventricular wall, complicating acute myocardial infarction. The mechanism is an hemorrhagic dissection among the spiral myocardial fibres creating a neocavitation limited by the myocardium. It appears in 9% of left ventricular wall ruptures, complicating acute myocardial infarction. Diagnosis is often difficult and in most of the cases it is post-mortem. We present the case report of a 69 year old patient who suffered a posterolateral acute myocardial infarction treated with primary PTCA/Stent plus AAS, clopidogrel, unfractioned heparin bolus and GP IIb- IIIa inhibitors. In the following few hours he suffered this unusual form of cardiac rupture that took him into cardiogenic shock and finally led to his death. The pathophysiology, diagnosis and management of this lethal complication of acute myocardial infarction (90% mortality in the medically treated group) which is only effectively treated by surgery are also reviewed.

[Sudden death in a normal heart. Idiopathic ventricular fibrillation. Review of the literature concerning one case]. / Muerte súbita en un corazón normal. Fibrilación ventricular idiopática. Revisión de la literatura a propósito de un caso.

Idiopathic ventricular fibrillation is that which is produced in the absence of structural cardiac disease and of other identifiable causes of ventricular fibrillation such as cardiotoxicity, electrolytical alterations or hereditary predisposition. The case of a healthy male, aged 37, who was asymptomatic until the day he was admitted to hospital where he showed numerous episodes of ventricular fibrillation without any previous triggering, is discussed. In the examination no cause was found to explain this, and an automatic defibrillator was implanted. The requirements for its diagnosis, risk stratification and the usefulness of the tests employed, as well as the treatments proposed are discussed.

Efecto del tratamiento con eprosartán sobre la presión de pulso. Factores predictores de la respuesta / Effect of eprosartan treatment on pulse pressure. Predictive factors of response

Fundamento. La presión de pulso (PP) o diferencial viene siendo reconocida como uno de los principales factores de riesgo cardiovascular, especialmente en individuos de avanzada edad o con hipertensión arterial (HTA) sistólica aislada. El objetivo del presente trabajo ha sido el de evaluar el efecto del tratamiento antihipertensivo con eprosartán sobre la PP, así como los factores que influyen en dicho efecto. Métodos. Estudio observacional efectuado con 4.067 pacientes afectos de HTA esencial (55 por ciento mujeres) con una edad media de 67 años. Completaron 12 semanas de tratamiento con eprosartán 3.133 pacientes (87 por ciento en monoterapia) prescrito a criterio de los médicos investigadores por nuevo fármaco o falta de eficacia de la terapia previa. El ámbito de actuación fue la Atención Primaria y la medida de presión se llevó a cabo con un aparato oscilométrico validado OMRON 705CP, provisto de impresora. Resultados. Eprosartán produjo un descenso significativo (p < 0,001) de la PP (13,5 mmHg) a las 12 semanas de tratamiento. Los descensos de presión arterial sistólica (PAS) (26,0 mmHg), presión arterial diastólica (PAD) (12,6 mmHg) y presión arterial media (PAM) (17,1 mmHg) fueron igualmente significativos. Tras corregir la PP por la intensidad de la HTA (cociente PP/PAM) se observó un efecto del fármaco en la reducción de dicho cociente, que pasó del 62 por ciento al 58 por ciento, hecho que indica una reducción del 4 por ciento del componente pulsátil independiente del componente estático. Esta reducción fue más marcada en los pacientes mayores de 60 años, con un cociente basal más elevado y con complicaciones cardiovasculares. La tasa de reacciones adversas al fármaco fue del 1,5 por ciento. Conclusión. Eprosartán es un fármaco efectivo y bien tolerado capaz de reducir la presión de pulso, en parte de forma independiente a la reducción de otros componentes tensionales. Este hecho puede ser importante en términos de seguridad y protección de órganos diana (AU)

Muerte súbita en un corazón normal. Fibrilación ventricular idiopática. Revisión de la literatura a propósito de un caso / Sudden death in a normal heart. Idiopathic ventricular fibrillation. Review of the literature concerning one case

La fibrilación ventricular idiopática es aquella que se produce en ausencia de enfermedad cardíaca estructural y de otras causas identificables de fibrilación ventricular como cardiotoxicidad, alteraciones electrolíticas o predisposición hereditaria. Comentamos el caso de un varón sano de 37 años de edad asintomático hasta el día de su ingreso en el cual presentó múltiples episodios de fibrilación ventricular sin ningún desencadenante previo, no encontrándose en el estudio ninguna causa que lo justificase, implantándose finalmente un desfibrilador automático implantable. Comentamos los requisitos para su diagnóstico, la estratificación de riesgo y la utilidad de las pruebas utilizadas, así como los tratamientos propuestos (AU)

Idiopathic ventricular fibrillation is that which is produced in the absence of structural cardiac disease and of other identifiable causes of ventricular fibrillation such as cardiotoxicity, electrolytical alterations or hereditary predisposition. The case of a healthy male, aged 37, who was asymptomatic until the day he was admitted to hospital where he showed numerous episodes of ventricular fibrillation without any previous triggering, is discussed. In the examination no cause was found to explain this, and an automatic defibrillator was implanted. The requirements for its diagnosis, risk stratification and the usefulness of the tests employed, as well as the treatments proposed are discussed (AU)

El infarto de miocardio en la población de 25-74 años de Navarra. Incidencia, letalidad y tratamiento en el periodo 1997-98. Estudio IBERICA / Myocardial infarction in the population aged 25-74 in navarra. Incidence, lethality and treatment in the period 1997-98. IBERICA study

El objetivo principal de este trabajo fue determinar la incidencia de infarto de miocardio en la población de 25-74 años de Navarra, la letalidad a los 28 días y las características del tratamiento aplicado en los hospitales durante los años 1997-1998. Se realizó una búsqueda de los posibles casos de infarto de miocardio en los servicios hospitalarios que los atienden, mediante la revisión de las historias clínicas. Los casos letales que no llegaron a los hospitales se investigaron a través de los boletines estadísticos de defunción, completándose la información sobre los mismos a través de los médicos de familia. Se registraron 1.059 eventos coronarios, que correpondían a una tasa cruda de ataque de 238 casos por 100.000 entre las mujeres. Entre los pacientes varones que llegaron vivos a los hospitales, el 50 por ciento fumaban, el 41 por ciento presentaban hipercolesterolemia, el 35,9 por ciento eran hipertensos y el 16 por ciento diabéticos. Entre las mujeres, que presentaban una edad media más alta, la hipertensión arterial fue el factor de riesgo más frecuente, el 66 por ciento. Durante la hospitalización se realizó trombolisis en el 39,2 por ciento de los pacientes, angioplastia primaria o deresacte en el 4,6 por ciento; se administraron aspirina u otros antiagregantes al 94,2 por ciento de los pacientes, ß-bloqueantes, al 60,6 por ciento y el IECA al 37,4 por ciento. Este trabajo ha mostrado que la frecuencia de infarto de miocardio en Navarra es inferior a la registrada en muchos países europeos y norteamericanos y concordante con las bajas tasas de mortalidad por esta causa. En los años 1997 y 1998 se observo una alta implementación de las recomendaciones de las guías de atención de esta enfermedad en lo relativo al uso de terapias eficaces cuando se analizan los datos globalmente. Se han observado, sin embargo, y con la excepción del uso de antiagregantes, variabilidad hospitalaria en el uso de la terapia trombolítica y de terapias adjuvantes como los betabloqueantes o IECA, y en el uso de técnicas diagnósticas como la arteriografía (AU)

[Myocardial Infarction in the population aged 25-74 in Navarra. Incidence, lethality and treatment in the period 1997-98. IBERICA study]. / El infarto de miocardio en la población de 25-74 años de Navarra. Incidencia, letalidad y tratamiento en el periodo 1997-98. Estudio IBERICA.

The principal aim of this study was to determine the incidence of Myocardial Infarction in the population aged 25-74 in Navarra, lethality after 28 days, and the characteristics of the treatment applied in the hospitals during the years 1997-1998. A search was conducted for possible cases of heart attack in the hospital services responsible for attending to them, by means of a review of clinical histories. The lethal cases that did not reach the hospitals were researched through the statistical bulletins of deaths, with the information on these deaths completed through the family doctors. 1,059 coronary events were registered, which corresponded to a crude rate of attack of 238 cases per 100,000 amongst men and 59 cases per 100,000 amongst women. Amongst the male patients who reached hospital alive, 50% were smokers, 41% showed hypercholesterolaemia, 35.9% were hypertense and 16% were diabetic. Amongst the women, who showed a higher average age, arterial hypertension was the most frequent risk factor, with 66%. During hospitalisation thrombolysis was carried out on 39.2% of the patients, primary or rescue angioplasty on 4.6%; aspirin or other anticoagulants were administered to 94.2%, beta-blockers to 60.6% and IECA to 37.4%. This study has shown that the frequency of Myocardial Infarction in Navarra is lower than that registered in many European and North American countries, and is concordant with the low rates of mortality due to this cause. Global analysis of the data shows that a high implementation of the care guidelines for this disease with respect to the use of efficient therapies could be observed in the years 1997 and 1998. Nonetheless, with the exception of the use of anticoagulants, hospital variability has been observed in the use of thrombolytic therapy and adjuvant therapies such as the beta-blockers or ACE Inhibitor, and in the use of diagnostic techniques such as arteriography.

[Risk factor prevalence and drug treatment in coronary patients at hospital discharge. Results of a national multicenter registry (3C Program)]. / Prevalencia de los factores de riesgo y tratamiento farmacológico al alta hospitalaria en el paciente coronario. Resultados de un registro multicéntrico nacional (Programa 3C).

INTRODUCTION AND OBJECTIVES: Based on the results of clinical trials the guidelines of international societies recommend secondary prevention in patients. Several surveys have shown that the application of these guidelines in clinical practice is not adequate. The aim of this study was to determine the practical application of the recommendations of these guidelines and drug prescription in patients with coronary heart disease on hospital discharge. METHODS: We included 3,215 coronary patients (myocardial infarction, angina and post-revascularization) discharged from 25 Spanish hospitals. We studied the prevalence of risk factors and the medical treatment on discharge in relation to gender, age, and clinical diagnosis. RESULTS: We found a significantly higher prevalence of risk factors, except for smoking, in women. With regards to age and diagnosis neither was, the prevalence uniform, with an increase in hypertension and diabetes being predominantly seen in the elderly as well as angina patients. Fifty-six point three percent of the patients showed a total cholesterol greater than 200 mg/dl and 88% demonstrated a LDL-cholesterol greater than 100 mg/dl. The prevalence of hypercholesterolemia and low HDL was higher among women. The prescription of betablockers and lipid-lowering drugs is low, especially in women and in patients over the age of 64 years. CONCLUSIONS: The registry of data concerning some risk factors in patient clinical files is poor. The prevalence of risk factors is higher in women. The prescription of betablockers and lipid-lowering drugs was lower than recommended, mainly among women and patients older than 64 years. There is a need for improvement in secondary prevention in coronary patients on hospital discharge.

[Impact of domestic violence on reproductive and neonatal health]. / Impacto de la violencia doméstica sobre la salud reproductiva y neonatal.

BACKGROUND: Domestic violence can have an important influence on mother and child health. AIM: To assess the consequences of remote and actual, emotional or physical, domestic violence on the reproductive and newborn health in pregnant women. MATERIAL AND METHODS: A longitudinal epidemiological observation from an Urban Primary Health Care Center from Valdivia, Chile, in 1998. Two cohorts were studied: Pregnant women that experienced domestic violence (index group) and pregnant women not exposed to domestic violence (control group). Women were followed during pregnancy and at labor. The newborn was also assessed. RESULTS: The index group had a higher relative risk (RR) for impending abortion (RR 1.44, 95% confidence interval (CI): 1.07-1.93), hypertensive syndrome of pregnancy (RR 1.5, 95% CI: 1.18-1.96), intrahepatic cholestasis (RR 1.5, 95% CI: 1.1-1.94). Women that experienced violence during pregnancy had a higher risk of urinary tract infection (RR 2.88, 95% CI: 1.28-6.43), intrauterine growth retardation (RR 3.7, 95% CI: 1.77-7.93) and intrahepatic cholestasis. Newborns from the index group had lower weight, size and gestational age. CONCLUSIONS: Domestic violence is associated with hypertension during pregnancy and intrauterine growth retardation. The incorporation of bio-psychological evaluation and monitoring systems could attenuate the consequences of domestic violence.

Achalasia presenting as acute airway obstruction.

Achalasia presenting as acute airway obstruction is an uncommon complication. We report the case of an elderly woman with previously undiagnosed achalasia who presented with acute respiratory distress due to megaesophagus. Emergency endotracheal intubation and insertion of a catheter into the esophagus, with continuous aspiration was required. Upon introduction of the esophageal catheter an abruptand audible air decompression occurred, with marked improvement of the clinical picture. Endoscopic injection of botulinum toxin was chosen as the definitive treatment with good clinical result. The pathophysiology of the phenomenon of esophageal blowing in achalasia is unclear, but different hypothetical mechanisms have been suggested. One postulated mechanism is an increase in upper esophageal sphincter (UES) residual pressure or abnormal UES relaxation with swallowing in achalasia patients. We reviewed the UES manometric findings in 50 achalasia patients and compared it with measurement performed in 45 healthy controls. We did not find any abnormalities in UES function in any of our achalasia patients group, or in the case under study. An alternative hypothesis postulates that airway compromise in patients with achalasia results from the loss UES belch reflex (abnormal UES relaxation during esophageal air distension), and in fact, an abnormal UES belch reflex was evidenced in our case.

[Domestic violence and sexuality]. / Violencia doméstica y sexualidad.

BACKGROUND: Women's reproductive health is closely related to the conditions in which intercourse is carried out with the sexual partner. Physical and emotional abuse is expressed as loss of bonds, reduction in self esteem and deterioration in interpersonal relationships. AIM: To assess the effects of domestic violence on pregnant women attitudes towards sexual relations with their partners, and to critically analyze the dependence of these variables on biosociodemographic factors, socioeconomic status and family functioning. MATERIAL AND METHODS: Sixty three pregnant women with a domestic violence background (index group) and 43 women without such background (control group) were subjected to a structured survey including questions about biosociodemographic variables, socioeconomic status, family relations, couple interactions and questions about attitudes towards sexual relations. RESULTS: Domestic violence was caused by the woman's partner or ex partner in 73% of cases. A greater family dysfunction and disturbance in the couple's relation was observed in the index group (p < 0.05). Association tests and multiple correspondence analysis did not show a clear correspondence between variables related to a woman's attitude towards sex relations and the risk of domestic violence. CONCLUSIONS: This quantitative methodology was unable to identify the reasons, interpretations and meanings that women with a background of violence, give to features associated with their sexuality.

[Retrospective analysis of a large number of patients over 70 years old, subject to percutaneous coronary angioplasty or to surgery]. / Análisis retrospectivo de una cohorte de pacientes mayores de 70 años sometidos a angioplastia coronaria percutánea o a cirugía.

INTRODUCTION: The number of patients of advanced age with symptomatic coronary illness that need surgical or percutaneous revascularisation is increasing. The aim of the present paper is to gain knowledge of the evolution of patients over 70 years of age subjected to myocardial revascularisation. MATERIAL AND METHODS: We compare two groups of patients, in a non-aleatory manner, subjected to angioplasty (N=65) and to surgery (N=75). The average age was 74.12 +/- 3.5 (70-85) and 71.97 +/- 1.9 (70-79) years respectively. The number of unhealthy vessels was greater in the surgical group (1.84 +/- 0.8 vs 2.65 +/- 0.8). RESULTS: The number revascularised vessels is greater and revascularisation more complete in the surgical group (1.14 +/- 0.4 vs 2.59 +/- 0.9) and (76% vs 49%). There is no difference in mortality in both groups. The functional degree during the evolution is worse for the angioplasty group and besides more antianginous medicines are used in treatment (1.92 +/- 1.2 vs 1.26 +/- 0.8) and they are subjected more frequently to a new revascularisation. CONCLUSIONS: Both the sick rate and the mortality of the procedure was similar in both groups. Both procedures are valid therapeutic alternatives and are acceptably safe with these patients. Surgery is more complete and is carried out on a group of patients with greater coronary distress. There are no differences in life expectancy amongst the patients treated with either of the techniques. During the follow-up period the functional degree of the surgical group is better and there are more patients treated with monotherapy.