ABSTRACT
UNLABELLED: Psoriasis is a chronic inflammatory disease of the skin which affects 1-3% of the population. A higher association of metabolic syndrome (MS) has been described amongst sufferers. The objective of this study was to assess the association of MS and its components amongst subjects suffering psoriasis and compare it with that found for the control group. The secondary objective was to study the relationship between the duration and severity of the psoriasis and the MS. This was a case-control study: 102 subjects with psoriasis and 102 control subjects paired by sex, age and body mass index. Anamnesis: history of diabetes mellitus, arterial hypertension, dyslipidaemia and psoriasis. Lifestyle. PHYSICAL EXAMINATION: weight, height, blood pressure, waist circumference. TESTS: lipid profile, oral glucose tolerance test and insulinemia (HOMA calculation). MS classified according to the 2009 consensus. The prevalence of MS amongst psoriasis patients was 52.9%, as compared to 34.31% in the control group. MS independent factors: age (OR 1.085), body mass index (OR 1.346), sex (OR 2.69 for men) and psoriasis (OR 3.634). A comparative study of patients with psoriasis with or without MS, revealed no relationship to the severity, age at time of diagnosis or time of evolution of the psoriasis. In conclusion, the association of MS amongst psoriasis sufferers is very high and the disease is considered as an independent risk factor for MS. Our results show no relationship between the different characteristics of psoriasis and the presence of MS. The main limitation of this study is that it does not enable to conclude whether psoriasis is a risk factor for MS or the opposite.
ABSTRACT
Objetivo: El ecocardiograma (ECC) no se encuentra al alcance de todos los médicos de familia de España, a pesar de su utilidad demostrada en enfermedades tan prevalentes como la hipertensión arterial (HTA) y la insuficiencia cardíaca. Objetivo: Analizar el grado de adecuación clínica de la solicitud, rendimiento y decisiones diagnóstico-terapéuticas posteriores a la realización de ECC indicados por médicos de familia. Diseño: Estudio descriptivo, transversal, retrospectivo y multicéntrico. Emplazamiento: Atención primaria. Cuatro centros de salud. Participantes: Se incluyeron 684 pacientes, mayores de 18 años a los que se había solicitado un ECC durante 2006-2007. Mediciones principales: Revisión de la historia clínica e informe del ECC. Variables sociodemográficas, clínicas y de rendimiento diagnóstico. Resultados: El 62,3% fueron ≥ 65 años. Mujeres: 61,8%. Los motivos de solicitud más frecuentes (no excluyentes) fueron: insuficiencia cardiaca, 30%; sospecha de valvulopatía, 26%; sospecha de miocardiopatía, 24,3%. Grado de adecuación del ECC: 84% (IC del 95%: 81,09-86,7%) con diferencias por edad (p=0,02), centro de salud docente (p<0,001), comorbilidad (p<0,001) y según resultado del ECC (p<0,001). El 80% de ECC fueron patológicos, con diferencias según edad (p<0,001), comorbilidad (p=0,02), factores de riesgo cardiovascular (p<0,001) y grado de adecuación del ECC (p=0,001). Los hallazgos más frecuentes (no excluyentes) fueron: valvulopatías (61,6%); hipertrofia ventricular izquierda (43%), y disfunción diastólica (28,2%). El resultado del ECC motivó decisiones en el 35,2%: en el 17,1% derivación a cardiología, en el 10,5% cambios en el tratamiento y en el 9,6% otras pruebas complementarias. Conclusiones: Se observa una gran adecuación en la solicitud del ECC. Los resultados del ECC motivan decisiones clínicas en un porcentaje elevado de casos. El ECC debería ser accesible a todos los médicos de familia(AU)
Objective: The echocardiogram (ECC) is not available to all Spanish General Practitioners (GP) despite its proven benefits in prevalent diseases, such as hypertension and heart failure. Study objective: To analyse the clinical adequacy of the application, performance, and diagnostic and therapeutic decisions of ECC indicated by the GP. Design: Descriptive, cross-sectional, retrospective, multicentre study. Setting: Primary care. Four health centres (HC). Participants: A total of 684 patients over 18 years who had an ECC performed in 2006-2007.Main measurements A review of medical records and the ECC report. The socio-demographic variables, clinical and diagnostic performance were also evaluated. Results: The majority of patients (62.3%) were ≥ 65 years, of which 61.8% were female The most frequent reasons for performing ECC were (but not limited to): heart failure: 30%, suspected valvular disease: 26%; suspected cardiomyopathy: 24.3%. Adequacy of the ECC: 84% (95% CI: 81.09-86.7%) with differences by age (p=.02), HC teaching (p<.001), comorbidity (p<.001) and abnormal ECC (p<.001). A disease was found in 80% of ECC, with differences according to age (p<.001), comorbidity (p=0.02), cardiovascular risk factors (p<.001) and degree of appropriateness of ECC (p=.001). The most common findings (but not limited to) included: valvular heart disease (61.6%) left ventricular hypertrophy (43%) diastolic dysfunction (28.2%). The results of the ECC helped make decisions in 35.2%, with 17.1% referred to cardiology, 10.5% treatment change and 9.6% other tests. Conclusions: We found that the application of ECC was highly appropriate. The results of ECC drive clinical decisions in a high percentage of cases. The ECC should be accessible to all GP(AU)
Subject(s)
Humans , Male , Female , Adult , Physicians, Primary Care/ethics , Hypertrophy/diagnosis , Echocardiography/trends , Echocardiography , Family Practice/methods , Comprehensive Health Care/methods , Physicians, Primary Care/statistics & numerical data , Physicians, Primary Care/standards , Physicians, Primary Care , Hypertrophy , Spain/epidemiology , Family Practice/organization & administration , Family Practice/standards , Retrospective Studies , Cross-Sectional Studies/methods , Comorbidity/trendsABSTRACT
OBJECTIVE: The echocardiogram (ECC) is not available to all Spanish General Practitioners (GP) despite its proven benefits in prevalent diseases, such as hypertension and heart failure. STUDY OBJECTIVE: To analyse the clinical adequacy of the application, performance, and diagnostic and therapeutic decisions of ECC indicated by the GP. DESIGN: Descriptive, cross-sectional, retrospective, multicentre study. SETTING: Primary care. Four health centres (HC). PARTICIPANTS: A total of 684 patients over 18 years who had an ECC performed in 2006-2007. MAIN MEASUREMENTS: A review of medical records and the ECC report. The socio-demographic variables, clinical and diagnostic performance were also evaluated. RESULTS: The majority of patients (62.3%) were ≥ 65 years, of which 61.8% were female The most frequent reasons for performing ECC were (but not limited to): heart failure: 30%, suspected valvular disease: 26%; suspected cardiomyopathy: 24.3%. Adequacy of the ECC: 84% (95% CI: 81.09-86.7%) with differences by age (p=.02), HC teaching (p<.001), comorbidity (p<.001) and abnormal ECC (p<.001). A disease was found in 80% of ECC, with differences according to age (p<.001), comorbidity (p=0.02), cardiovascular risk factors (p<.001) and degree of appropriateness of ECC (p=.001). The most common findings (but not limited to) included: valvular heart disease (61.6%) left ventricular hypertrophy (43%) diastolic dysfunction (28.2%). The results of the ECC helped make decisions in 35.2%, with 17.1% referred to cardiology, 10.5% treatment change and 9.6% other tests. CONCLUSIONS: We found that the application of ECC was highly appropriate. The results of ECC drive clinical decisions in a high percentage of cases. The ECC should be accessible to all GP.
Subject(s)
Echocardiography , Family Practice , Primary Health Care , Aged , Cross-Sectional Studies , Echocardiography/statistics & numerical data , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
We performed structural and immunohistochemical studies on the thymus of juvenile turbot (Psetta maxima L.) in order to define its cellular composition. The thymic stroma was mainly composed of two subpopulations of reticulo-epithelial cells (RECs). RECs immunoreactive to anti-actin antibody were distributed through the organ, while RECs that were cytokeratin-immunopositive were located in the outer zone of the thymus. The parenchyma of the thymus was composed of several cell types such as lymphocytes/thymocytes, lymphoblasts, melano-macrophages and to a lesser extent of nurse-like cells, immunoglobulin positive (Ig+) cells, mucous cells, rodlet cells and neuroendocrine cells. CD3ε+ lymphocytes were mainly located in the outer zone. On the other hand, Ig+ cells were observed in the transitional region between the inner and outer zones of the thymus. The neuroendocrine cells were large and exhibited immunoreactivity to neuropeptide Y and vasoactive intestinal polypeptide. They were located in the inner zone of the thymus in close association with lymphoblasts and lymphocytes/thymocytes. This work provides useful information on the structure and cellular composition of the thymus of turbot, identifying several immunomarkers that allow the identification of different cell types, providing the basis for further studies on the immune response of turbot against diseases.
