Prevalence of orthostatic hypotension in non-institutionalised elderly aged 80 and over. A diagnostic study using an oscillometric device.

BACKGROUND: Orthostatic hypotension (OH) is a common disorder, and possibly underdiagnosed. In the elderly, OH has been considered a common cause of falls, fractures, and fear of falling. Its prevalence increases with age, probably related to the number of drug treatments, decreased fluid intake, and the progressive dysfunction of the autonomic nervous system. OBJECTIVES: To evaluate the prevalence of OH in a non-institutionalised population ≥80 years, according to different criteria based on sequential measurements taken at minute 0, 1, 3 and 5 of standing. METHODS DESIGN: A diagnostic accuracy study using an oscillometric device. SETTING AND PARTICIPANTS: Convenience sampling of 176 people ≥80 years attended in an urban Primary Health Care Centre. MEASUREMENTS: Supine and standing blood pressure (BP) measurements, at minutes 0, 1, 3 and 5 using the OMRON 705-CP blood pressure device. OH definition: decrease ≥20mmHg in systolic BP (SBP) and/or ≥10mmHg in diastolic BP (DBP). RESULTS: Mean age (Standard Deviation) was 85.2 (3.7) years, and 60.2% were women. Prevalence of OH: 30.7% at minute 0; 19.3% at minute 1; 18.2% at minute 3; and 20.5% at minute 5. Age, sedentary life, smoking, diabetes and SBP values were significantly associated with a greater BP decrease at minute 0. CONCLUSION: A third of the sample had OH, with a maximum prevalence at minute 0. From a clinical point of view, it is suggested that the definition of OH is prioritized according to the BP at minute 0.

Prevalence of atrial fibrillation and its associated factors in Spain: An analysis of 6 population-based studies. DARIOS Study. / Prevalencia de fibrilación auricular y factores asociados en España, análisis de seis estudios de base poblacional. Estudio DARIOS.

BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) is the most common type of arrhythmia. The purpose of this study was to determine the prevalence of atrial fibrillation and its relationship with cardiovascular risk factors in Spain. METHODOLOGY: Cross-sectional study based on a grouped analysis of 17,291 randomized individuals recruited in 6 population studies. RESULTS: The prevalence of atrial fibrillation was 1.5% (95% CI:1.3-1.7%). Men had a greater prevalence of the disease than women (1.9 vs. 1.1%, respectively). The prevalence of atrial fibrillation progressively increased with age: 0.05% for patients younger than 45 years, 0.5% for those between 45-59 years of age, 2.3% for those between 60-74 years of age and 6.3% for those older than 75 years. The percentage of individuals who were underwent anticoagulant treatment was 74.3%. The risk factors significantly associated with arrhythmia were an age older than 60 years (odds ratio [OR]: 7.6; 95% CI: 5.1-11.2), the male sex (OR:1.8; 95% CI: 1.4-2.4), arterial hypertension (OR:1.6; 95% CI: 1.2-2.1), obesity (OR:1.5; 95% CI:1.2-2.1) and a history of coronary artery disease (OR:1.9; 95% CI: 1.3-3.0). CONCLUSION: Atrial fibrillation is a common disease in elderly individuals, while its prevalence is low in individuals younger than 60 years. Most individuals with atrial fibrillation were on anticoagulant treatment. The risk factors for this type of arrhythmia are age, the male sex, hypertension, obesity and a history of coronary artery disease.

Un método de detección de gammapatías monoclonales de IgM en un analizador / A method for detect Ig M monoclonal gammopathies in an autoanalyzer

Introducción. Frecuentemente el mieloma múltiple es precedido de una gammapatía monoclonal de significado incierto. Este estudio analiza la utilidad de una lipidemia falsamente positiva como un método rutinario y barato de detección de gammapatías monoclonales de IgM. Material y métodos. Se examinaron los sueros de 244 pacientes consecutivos con un índice lipidémico falso positivo (n=34) o negativo (n=210) y triglicéridos < 1,7mmol/L. Las concentraciones de inmunoglobulinas se estudiaron mediante un autoanalizador AU-5430. Los test de lipidemia fueron realizados con una concentración salina de 0,038M y los proteinogramas mediante una electroforesis capilar de la zona. Resultados. Con el diagnóstico de banda monoclonal la lipidemia falsa positiva tuvo una sensibilidad del 97% (95% CI: 91-100) y especificidad del 94% (95% CI: 91-97). El valor predictivo positivo y negativo fue de 72% (95% CI: 59-85) y 99% (95% CI: 99-100), respectivamente. Para el diagnóstico de IgM elevada la sensibilidad fue del 71% (95% CI: 55-86), la especificidad del 99% (95% CI: 98-100) y el valor predictivo positivo y negativo del 92% (95% CI: 82-103) y 95% (95% CI: 93-98), respectivamente. El OR ajustado por edad y sexo de la lipidemia falso positivo fue de 768,0 (95% CI: 75,8-7.799,3) para la IgM elevada y de 219,4 (95% CI: 42,9-1.120,5) para la banda monoclonal. Conclusiones. La lipidemia falsamente positiva se asoció a la IgM elevada y particularmente a la gammapatía monoclonal. Es una herramienta barata, sensible y específica para detectar una gammapatía monoclonal de IgM en los índices de interferencia rutinarios en analizadores (AU)

Introduction. Most patients with multiple myeloma have a previous monoclonal gammopathy of undetermined significance. This study analyzes the possible clinical usefulness of a false positive lipemia as a routine, inexpensive screening tool for IgM monoclonal gammopathies. Material and methods. Serum samples from 244 consecutive patients with a false positive (n=34) or negative lipemia test (n=210), with triglycerides <1.7mmol/L were studied. Immunoglobulin levels were quantified in an AU-5430 autoanalyzer. Lipemia tests were performed in a final saline concentration of 0,038M, and proteins by capillary-zone electrophoresis. Results. Sensitivity for monoclonal band detection was 97% (95% CI 91-100) for false lipemia, with 94% (95% CI: 91-97) specificity. The positive and negative predictive values were 72% (95% CI: 59-85) and 99% (95% CI: 99-100), respectively. Its sensitivity for elevated IgM detection was 71% (95% CI: 55-86) and 99% (95% CI: 98-100) specificity, positive and negative predictive values of 92% (95% CI: 82-100) and 95% (95% CI: 93-98), respectively. Age and sex-adjusted odds ratio of elevated IgM for false lipemic serum patients was 768.0 (95% CI: 75.8-7799.3), and 219.4 (95% CI: 42.9-1120.5) for the monoclonal band. Conclusions. A false positive lipemic test was associated with elevated IgM, and particularly with monoclonal gammopathy. This finding offers an inexpensive, sensitive and specific screening tool to detect IgM monoclonal gammopathy processes in routine autoanalyzer interference tests (AU)

Validity of a short diet-quality index to predict changes in anthropometric and cardiovascular risk factors: a simulation study.

Coronary heart disease prevention in the primary care setting, where time is extremely limited, requires valid instruments that efficiently screen for unhealthy lifestyle habits. Identification of the individuals who would most benefit from dietary intervention is particularly important in this context. We used dietary intake data derived from a full-length food frequency questionnaire to simulate responses to our previously validated short dietary quality screener. We determined the prospective association of the resulting diet-quality index (DQI) with changes in anthropometric and cardiometabolic risk variables in 2181 men and women in a 10-year follow-up. Multiple linear regression analyses revealed that a higher DQI score at baseline related directly (P=0.002) to high-density lipoprotein cholesterol (HDL-C) and inversely (P<0.016) to waist circumference (WC), triacylglycerides (TG), the TG to HDL-C ratio and the total cholesterol to HDL-C ratio at follow-up. A low DQI score is predictive for an increase in WC and the development of an unfavourable cardiometabolic profile.

La glucemia basal alterada es un factor de riesgo para el infarto cerebralaterotrombótico o lacunar. Estudio de casos y controles / Impaired fasting glucose as a risk factor for atherothrombotic or lacunar cerebral infarction. A case-control study

Introducción. Los factores de riesgo vasculares modificables(FRVM) para los infartos cerebrales aterotrombóticos y lacunares sonbien conocidos, pero hay pocos estudios poblacionales y desconocemosel riesgo de estados glucémicos previos a la diabetes mellitus(DM). El objetivo del trabajo es estudiar la relación entre la glucemiabasal alterada (GBA) y otros FRVM con los infartos cerebrales aterotrombóticosy lacunares.Métodos. Estudio de casos y controles de base poblacional realizadoen dos centros de salud urbanos. Casos: 236 pacientes con infartoscerebrales aterotrombótico o lacunar diagnosticados mediante tomografíacomputarizada o resonancia magnética. Se excluyeron los infartoscerebrales cardioembólicos de causa infrecuente o indeterminada ylas hemorragias intracerebrales. Controles: 441 pacientes sin infartocerebral, apareados por edad y sexo, seleccionados por muestreo aleatoriosimple. Mediante regresión logística se estudiaron las odds ratio(OR) de los factores de riesgo GBA, DM, tabaquismo, hipertensión arterial(HTA), hipercolesterolemia, hipertrigliceridemia y obesidad.Resultados. La edad media fue de 71,1 años, con un 62% devarones. La prevalencia en los casos de los FRVM fue: GBA, 32,9%;DM, 49,6%; tabaquismo, 26,3%; HTA, 78,8%; hipercolesterolemia,29,3%; hipertrigliceridemia, 18,2 %, y obesidad, 63,5%. Todos losFRVM se asociaron en el análisis crudo con un aumento del riesgo deinfarto cerebral. En el análisis multivariante se asociaron de manerasignificativa la GBA (OR: 3,2; intervalo de confianza [IC] del 95%:1,1-7,9), la DM (OR: 4,5; IC 95%: 1,4-14,9), la HTA (OR: 2,6; IC 95%:1,5-4,5), la hipercolesterolemia (OR: 2,3; IC 95%: 1,4-3,9) y la obesidad(OR: 1,7; IC 95%: 1,0-2,9).Conclusiones. Las alteraciones del metabolismo de la glucosaGBA y DM son un importante FRVM para el IC aterotrombótico ylacunar por la elevada magnitud de la OR y elevada prevalencia en lapoblación con infarto cerebral (AU)

Introduction. Modifiable vascular risk factors (MVRF) foratherotrombotic or lacunar cerebral infarction have been clearlyestablished, even though only a few population studies havebeen conducted and we do not know the risk of glycemic statusprior to the diabetes mellitus (DM). This study has aimed todetermine the relationship between impaired fasting glucose(IFG) and others MVRF with atherothrombotic or lacunar cerebralinfarctions.Methods. A population based case-control study was conductedin two urban health care centers. Cases: 236 patientswith atherothrombotic or lacunar CI, diagnosed by computedtomography scan magnetic resonance imaging. Unusual, indeterminateand cardioembolic cerebral infarction and cerebralhemorrhage were excluded. Controls: 441 patients withoutcerebral infarction, matched by age and gender, selected bymeans of simple random sampling. The odds ratios (OR) of IFG,DM, smoking, high blood pressure, hypercholesterolemia,hypertriglyceridemia, and obesity were measured with logisticregression.Results. Mean age was 71.1 years old, 62 % being male.Prevalence in cases of MVRF was: IFG, 32.9%; DM, 49.6 %;smoking, 26.3%; high blood pressure, 78.8%; hypercholesterolemia,29.3%; hypertriglyceridemia, 18.2%, and obesity, 63.5%.All MVRFs were associated in the crude analysis with increasedrisk of cerebral infarction. In the multivariate analysis, significantassociations were found for IFG (OR: 3.2; 95 % confidenceinterval [CI]:1.1-7.9), DM (OR: 4.5; 95 % CI: 1.4-14.9),high blood pressure (OR: 2.6; 95 % CI: 1.5-4.5), hypercholesterolemia(OR: 2.3; 95 % CI: 1.4-3.9), and obesity (OR: 1.7; 95%CI: 1.0-2.9).Conclusions. Alterations of the glucose metabolism IFG andDM are important MVRF for atherothrombotic or lacunar cerebralinfarction as seen by the high rate of OR and high prevalence inthe population with cerebral infarction (AU)

[Impaired fasting glucose as a risk factor for atherothrombotic or lacunar cerebral infarction. A case-control study]. / La glucemia basal alterada es un factor de riesgo para el infarto cerebral aterotrombótico o lacunar. Estudio de casos y controles.

INTRODUCTION: Modifiable vascular risk factors (MVRF) for atherotrombotic or lacunar cerebral infarction have been clearly established, even though only a few population studies have been conducted and we do not know the risk of glycemic status prior to the diabetes mellitus (DM). This study has aimed to determine the relationship between impaired fasting glucose (IFG) and others MVRF with atherothrombotic or lacunar cerebral infarctions. METHODS: A population based case-control study was conducted in two urban health care centers. CASES: 236 patients with atherothrombotic or lacunar CI, diagnosed by computed tomography scan magnetic resonance imaging. Unusual, indeterminate and cardioembolic cerebral infarction and cerebral hemorrhage were excluded. CONTROLS: 441 patients without cerebral infarction, matched by age and gender, selected by means of simple random sampling. The odds ratios (OR) of IFG, DM, smoking, high blood pressure, hypercholesterolemia, hypertriglyceridemia, and obesity were measured with logistic regression. RESULTS: Mean age was 71.1 years old, 62 % being male. Prevalence in cases of MVRF was: IFG, 32.9%; DM, 49.6 %; smoking, 26.3%; high blood pressure, 78.8%; hypercholesterolemia, 29.3%; hypertriglyceridemia, 18.2%, and obesity, 63.5%. All MVRFs were associated in the crude analysis with increased risk of cerebral infarction. In the multivariate analysis, significant associations were found for IFG (OR: 3.2; 95 % confidence interval [CI]:1.1-7.9), DM (OR: 4.5; 95 % CI: 1.4-14.9), high blood pressure (OR: 2.6; 95 % CI: 1.5-4.5), hypercholesterolemia (OR: 2.3; 95 % CI: 1.4-3.9), and obesity (OR: 1.7; 95% CI: 1.0-2.9). CONCLUSIONS: Alterations of the glucose metabolism IFG and DM are important MVRF for atherothrombotic or lacunar cerebral infarction as seen by the high rate of OR and high prevalence in the population with cerebral infarction.

[Analysis of the new active principles sold in Spain (1992-2002)]. / Análisis de los nuevos principios activos comercializados en España (1992-2002).

OBJECTIVES: To describe the active principles (AP) marketed in Spain from 1992 to 2002, to determine their characteristics, and to find whether they supposed genuine therapeutic advances (TA). DESIGN: Transversal, descriptive study. MAIN MEASUREMENTS: The degree of TA in the AP analysed was studied with the classification used by the FDA (A*: exceptional therapeutic novelty; A: important therapeutic novelty; B: modest therapeutic improvement; C: null or very little therapeutic improvement, corresponding to "me-too" drugs; and D: not classified), the context of use and the price. RESULTS: 369 new AP were marketed. 3.5% were in group A*, 11.9% in A, 30.1% in B, 49.3% in C, and 5.1% in D. 42.3% corresponded to AP used in hospitals for therapy or diagnosis. Significant differences were found (P<.05) on comparing the degree of TA and the context of use, such that more AP in the A/A* (32.6%) and B (44.0%) groups were found in AP used in hospital therapy and diagnosis than in AP used in primary care and generally (5.3% in the A/A* groups and 23.4% in group B). Only 11 AP of the A/A* groups were used in primary care. The cost per defined daily dose was 17.6 euros; and the new AP in group C were dearer than already existing alternatives in 93.4% of cases. CONCLUSIONS: Real TA are few in number and preferentially used in hospitals. Almost all the new AP are "me-too" drugs and are dearer than already existing alternatives.

[Good morning, Mr. Representative. Anything new to tell us about? Analysis of the pharmacological products introduced by the drugs industry into a health district]. / Buenos días, señor Visitador. ¿Algo nuevo que contar? Análisis de las especialidades farmacológicas presentadas por la industria farmacéutica en un área básica de salud.

OBJECTIVE: To study whether the visits of technical health representatives (ITS) mean that new drugs are introduced. Design. Prospective, descriptive study. SETTING: Urban health centre. PARTICIPANTS: The products presented by 137 ITS from 83 drug laboratories in weekly sessions for a year were studied. MAIN MEASUREMENTS: The products presented, the year they were first marketed, intrinsic value (IV), newness and use potential, cost per package and defined daily dose and material handed over were studied. RESULTS: 472 drug products were introduced. The most common ones belonged to the cardiovascular group (27.3%), digestion and metabolism (14.8%) and anti-infection drugs (13.3%). 65.5% had been on the market for <5 years. 84.3% had a high IV. Only 31 products (6.6%) were new (95% CI, 4.5-9.2). 71% of these supposed no or very slight therapeutic improvement, 25.8% a modest improvement and 3.2% a major improvement. Mean cost was 19.3 euros per package and 2 euros per DDD, with significant differences found (P<.006) on stratifying by date of marketing (more recently marketed products cost more). 61% of the products were presented with additional material (leaflets, monographs, journals), 21.6% with gifts of symbolic value, and 19.9% with samples of the product. There were significant differences (P<.03) between the new drugs and the normal prescriptions issued at the centre. In the new drugs, there were fewer products with high IV and cost per package and per DDD was higher. CONCLUSIONS: The products introduced by the reps do not include any important new drugs. They are presented with abundant back-up and are more expensive than those normally prescribed.

Buenos días, señor visitador. ¿Algo nuevo que contar? Análisis de las especialidades famacológicas presentadas por la industria farmacéutica en un área básica de salud / Good morning Mr. Drug Industry Representative, what´s new? Analysis of drugs presented by the pharmaceutical industry in a basic health area

Objetivo. Estudiar si las visitas de los informadores técnicos sanitarios (ITS) suponen la presentación de novedades farmacológicas. Diseño. Estudio descriptivo, prospectivo. Emplazamiento. Centro de salud urbano. Participantes. Se estudiaron los productos presentados por 137 ITS de 83 laboratorios mediante sesiones semanales durante un año. Mediciones principales. Se estudiaron los productos presentados, el año de comercialización, el valor intrínseco (VI), la novedad y el potencial de uso, el coste por envase y dosis diaria definida (DDD) y el material entregado. Dichos productos se compararon con una muestra aleatoria de la prescripción anual del centro. Resultados. Se presentaron 472 productos farmacéuticos. Los más frecuentes fueron de los grupos siguientes: cardiovascular (27,3 por ciento), digestivo y metabolismo (14,8 por ciento) y antiinfecciosos (13,3 por ciento). El 65,5 por ciento llevaba comercializado menos de 5 años. El 84,3 por ciento tenía un VI elevado. Solamente 31 productos (6,6 por ciento) eran novedades (intervalo de confianza [IC] del 95 por ciento, 4,5-9,2). De ellos, el 71 por ciento supuso una nula o muy pequeña mejora terapéutica, el 25,8 por ciento una modesta mejora y el 3,2 por ciento una importante mejora. El coste medio fue de 19,3 euros por envase y de 2,0 euros por DDD, con diferencias significativas (p < 0,006) al estratificar por la fecha de comercialización (coste superior en los productos más recientemente comercializados). El 61 por ciento de los productos se presentó con material adicional (folletos, monografías, revistas, libros), el 21,6 por ciento, con regalos de valor simbólico, y el 19,9 por ciento, con muestras del producto. Se observaron diferencias significativas (p < 0,03) respecto a la prescripción habitual del centro: proporción inferior de productos con VI elevado y coste superior por envase y por DDD. Conclusiones. Los productos presentados por los ITS no suponen novedades importantes, se presentan con abundante soporte y son más caros que los prescritos habitualmente (AU)

[Modifiable risk factors for non-cardioembolic transient ischemic attacks. Case control studies in the general population]. / Factores de riesgo modificables para el accidente isquémico transitorio no cardioembólico. Estudio de casos y controles en población general.

INTRODUCTION: Transient ischemic attacks (TIA) often precede a stroke. AIMS: The purpose of this study is to examine the modifiable cardiovascular risk factors for non-cardioembolic TIA. PATIENTS AND METHODS: A population based case control study was conducted in a district within the city of Barcelona. The cases were 103 patients with non-cardioembolic TIA, who had been diagnosed by a neurologist, and with normal CAT or MRI scans. Subjects were paired by age and sex with 193 controls without TIA or stroke, who were selected by simple random sampling from the clinical records file at the centre. The risk factors were studied using a standardized questionnaire that included the following factors which were codified in a dichotomous manner: smoking, arterial hypertension (AHT), hypercholesterolemia, hypertriglyceridemia, obesity, impaired fasting glucose and diabetes mellitus (DM). RESULTS: The average age was 74.6 years and 52.3% of the subjects were females. All the modifiable cardiovascular risk factors were associated to a higher risk of TIA, although only AHT (OR: 1.9; CI 95%: 1.1-3.3) and obesity (OR: 2.1; CI 95%: 1.2-3.6) were associated in a significant way in the univariate analysis. In the multivariate analysis by logistic regression, the modifiable cardiovascular risk factors that were associated in a significant manner were AHT (OR: 1.9; CI 95%: 1.0-3.6), obesity (OR: 2.8; CI 95%: 1.4-12.3) and DM (OR: 1.7; CI 95%: 1.0-2.9). CONCLUSIONS: In the present study, AHT, obesity and DM were seen to be modifiable risk factors for non-cardioembolic TIA.

[Prevalence of Helicobacter pylori infection in primary care: sero-epidemiological study]. / Prevalencia de la infección por Helicobacter pylori en atención primaria: estudio seroepidemiológico.

OBJECTIVES: To find the prevalence of Helicobacter pylori (HP) infection in primary care in our area and to study factors associated with this infection. DESIGN: Descriptive and prospective study.Setting. Urban health district with 30 765 people registered. PARTICIPANTS: 267 patients, selected by quota sampling from the census of age and sex groups, as a function of an alpha of 0.05, 0.06 accuracy, and expected prevalence of 50%. MAIN MEASUREMENTS: HP infection was studied through validated IgG serology (ELISA Wampole(R)). The following were studied as associated factors: age, sex, education, profession, alcohol and tobacco consumption, and non-steroidal anti-inflammatory drugs taken. RESULTS: Mean age was 38.4, and 51.3% were women. Prevalence of HP infection was 52.4% (95% CI, 46.4-58.4). This proportion increased steadily with age, with a minimum of 11.5% in the 0-9 years-old range and a maximum of 87.5% in the 60-69 years-old group. There was more HP in men (56.9%) than in women (48.2%). In univariate analysis a linear tendency was found between HP infection and increased age (P<.0001) and the consumption of alcohol (P=.003), with no relationship to other variables studied. In the multivariate analysis, only age maintained statistical significance (P=.001). CONCLUSIONS: In our area the prevalence of HP infection is similar to that in other studies: it increases steadily with age and shows en epidemiological pattern that is half-way between countries of high and low prevalence.

[Cardiovascular events linked to the new diagnostic categories of diabetes mellitus]. / Episodios cardiovasculares asociados a las nuevas categorías diagnósticas de la diabetes mellitus propuestas por la Asociación Americana de Diabetes.

OBJECTIVE: To study the cardiovascular events linked to the new diagnostic categories of diabetes mellitus proposed by the American Diabetes Association. DESIGN: Descriptive cross-sectional study.Setting. Urban health district.Participants. 2248 patients > 14, selected by simple random sampling from the medical records archive. MAIN MEASUREMENTS: Through the medical records review, patients were classified into those with normal glucaemia, those intolerant to glucose when fasting (IGF) and those with type-2 diabetes mellitus (DM2). Patients were studied for cardiovascular events, ischaemic cardiopathy, cerebrovascular disease and peripheral arteriopathy. The likelihood of such events in patients with IGF and DM2 was compared with normal-glucose patients through logistical regression, adjustment for age, gender, hypertension, hypercholesterolaemia, hypertriglyceridaemia and tobacco dependency. RESULTS: 1677 patients were classified: 1237 with normal glucaemia, 175 with IGF and 265 with DM2. The DM2 patients were more likely to have at least one cardiovascular event (OR, 2.7; 95% CI, 1.7-4.4), ischaemic cardiopathy (OR, 2.0; 95% CI, 1.1-3.6), cerebrovascular disease (OR, 3.0; 95% CI, 1.4-6.6) or peripheral arteriopathy (OR, 2.9; 95% CI, 1.2-7.7). Results reached no statistical significance in patients with IGF, though these were more likely to suffer a cardiovascular event (OR, 1.1; 95% CI, 0.6-2.1), ischaemic cardiopathy (OR, 1.1; 95% CI, 0.3-4.4), cerebrovascular disease (OR, 1.5; 95% CI, 0.5-4.1) or peripheral arteriopathy (OR, 1.2; 95% CI, 0.3-4.6). CONCLUSIONS: Patients with DM2 are more likely to present cardiovascular events, a phenomenon not seen in the case of IGF.

Episodios cardiovasculares asociados a las nuevas categorías diagnósticas de la diabetes mellitus propuestas por la Asociación Americana de Diabetes / Cardiovascular events linked to the new diagnostic categories of diabetes mellitus proposed by the American Diabetes Association

Objetivo. Estudiar los episodios cardiovasculares asociados a las categorías diagnósticas de la diabetes propuestas por la Asociación Americana de Diabetes. Diseño. Estudio descriptivo, transversal. Emplazamiento. Área básica de salud urbana. Participantes. Un total de 2.248 pacientes > 14 años, seleccionados por muestreo aleatorio simple del archivo de historias clínicas (HC). Mediciones principales. Mediante revisión de la HC se clasificó a los pacientes en normoglucemia, intolerancia a la glucosa en ayuno (IGA) y diabetes mellitus tipo 2 (DM2). Se estudió si los pacientes presentaban los episodios cardiovasculares cardiopatía isquémica, enfermedad cerebrovascular y arteriopatía periférica. La probabilidad de presentar dichos episodios en los pacientes con IGA y DM2 respecto a los pacientes normoglucémicos se analizó mediante regresión logística, ajustando por edad, sexo, hipertensión arterial, hipercolesteremia, hipertrigliceridemia y tabaquismo. Resultados. Se clasificó a 1.677 pacientes, de los que 1.237 fueron normoglucémicos, 175 pacientes presentaron IGA y 265 tenían DM2. Los pacientes con DM2 presentaron una probabilidad superior de tener al menos un episodio cardiovascular (OR, 2,7; IC del 95 por ciento, 1,7-4,4), cardiopatía isquémica (OR, 2,0; IC del 95 por ciento, 1,1-3,6), enfermedad cerebrovascular (OR, 3,0; IC del 95 por ciento, 1,46,6) y arteriopatía periférica (OR, 2,9; IC del 95 por ciento, 1,2-7,7). Los resultados no alcanzaron significación estadística en los pacientes con IGA, aunque tuvieron una mayor probabilidad de presentar algún episodio cardiovascular (OR, 1,1; IC del 95 por ciento, 0,6-2,1), cardiopatía isquémica (OR, 1,1; IC del 95 por ciento, 0,3-4,4), enfermedad cerebrovascular (OR, 1,5; IC del 95 por ciento, 0,54,1) y arteriopatía periférica (OR, 1,2; IC del 95 por ciento, 0,3-4,6). Conclusiones. Los pacientes con DM2 tienen una probabilidad superior de presentar episodios cardiovasculares, fenómeno que no se evidencia en la IGA (AU)

Riesgo cardiovascular asociado a las nuevas categorías diagnósticas de la diabetes mellitus propuestas por la asociación americana de diabetes / Cardiovascular risk and the new diagnostic categories for diabetes mellitus proposed by the american diabetes association

Objetivo. Estudiar el riesgo cardiovascular (RCV) asociado a las categorías diagnósticas de la diabetes propuestas por la Asociación Americana de Diabetes. Diseño. Estudio descriptivo, transversal. Emplazamiento. Área básica de salud (ABS) urbana. Pacientes. Se estudiaron 1.840 pacientes 15 años, seleccionados por muestreo aleatorio simple del archivo de historias clínicas (HC). Método. Mediante revisión de la HC se clasificó a los pacientes en normoglucemia, glucemia basal alterada (GBA) y diabetes mellitus tipo 2 (DM2). Se estudió el RCV mediante el método de Framingham simplificado y los factores de RCV obesidad, tabaquismo, hipertensión arterial, hipercolesterolemia y hipertrigliceridemia. La probabilidad de tener un RCV elevado o muy elevado y los factores de RCV descritos en los pacientes con GBA y DM2 respecto a los normoglucémicos se estudiaron mediante regresión logística, ajustando la odds ratio (OR) por edad y sexo. Resultados. Se clasificó a 1.351 pacientes: 995 normoglucémicos, 146 pacientes GBA y 210 pacientes DM2. Los pacientes con GBA y DM2 tuvieron una probabilidad superior de presentar un RCV elevado o muy elevado, con unas OR de 2,26 (IC del 95 por ciento, 1,39-3,69) y 2,74 (IC del 95 por ciento, 1,81-4,15), respectivamente. También presentaron diferencias (p 0,05) respecto al tabaquismo y la hipercolesterolemia. No se detectaron diferencias (p > 0,05) entre GBA y DM2 respecto al RVC y los factores de RCV estudiados. Conclusiones. Los pacientes con GBA y DM2 tienen un elevado RCV (AU)

[Efficacy of a multistep strategy for Helicobacter pylori eradication: quadruple therapy with omeprazole, metronidazole, tetracycline and bismuth after failure of a combination of omeprazole, clarithromycin and amoxycillin]. / Eficacia de una terapia secuencial en la erradicación de Helicobacter pylori: cuádruple terapia con omeprazol, metronidazol, tetraciclina y bismuto tras el fracaso de la combinación de omeprazol, claritromicina y amoxicilina.

BACKGROUND: To evaluate the efficacy of a multistep strategy for Helicobacter pylori (HP) eradication. PATIENTS AND METHOD: 151 patients, with peptic ulcer or chronic gastritis, infected by HP, treated (first-step) with omeprazole (20 mg/12 h), clarithromycin (500 mg/12 h) and amoxycillin (1 g/12 h) for a week (OCA) and second-step (first-step failures) with omeprazole (20 mg/12 h), metronidazole (500 mg/12 h), tetracyclin (500 mg/6 h) and bismuth (120 mg/6 h) for two weeks. RESULTS: Intention-to-treat analysis, eradication was achieved with OCA in 78.1% (CI 95%: 71.6-84.7) and OMTB in 90.3% (CI 95%: 74.2-98), with an cumulative eradication rate of 96.7% (CI 95%: 92.4-98.9). CONCLUSIONS: The efficacy of multistep strategy is high. Therapy with OMTB its a good option after failure with OCA.