Tasas de prevalencia de enfermedad renal crónica y su asociación con factores cardiometabólicos y enfermedades cardiovasculares. Estudio SIMETAP-ERC / Prevalence rates of chronic kidney disease and its association with cardiometabolic factors and cardiovascular diseases. SIMETAP-CKD study

Introducción: La enfermedad renal crónica (ERC) constituye un importante problema de salud que contribuye al desarrollo de alteraciones cardiovasculares como la insuficiencia cardíaca y la enfermedad cardiovascular arteriosclerótica (ECVA). Los objetivos de este estudio fueron determinar la prevalencia de ERC y evaluar su asociación con factores de riesgo cardiometabólicos y la ECVA. Métodos: Estudio observacional transversal realizado en el ámbito de atención primaria. Muestra aleatoria de base poblacional: 6.588 personas entre 18 y 102 años (tasa de respuesta: 66%). Se determinaron las tasas de prevalencia brutas y ajustadas por sexo y edad de ERC según KDIGO valorando albuminuria y filtrado glomerular estimado según CKD-EPI, y sus asociaciones con factores cardiometabólicos y ECVA. Resultados: La prevalencia cruda de ERC fue 11,48% (IC95%: 10,72–12,27%), sin diferencia significativa entre hombres (11,64% [IC95%: 10,49–12,86%]) y mujeres (11,35% [IC95%: 10,34–12,41%]). La tasa de prevalencia ajustada por edad y sexo de ERC fue 9,16% (hombres: 8,61%; mujeres: 9,69%). La prevalencia del filtrado glomerular estimado reducido (<60mL/min/1,73m2) y de albuminuria (≥30mg/g) fueron 7,95% (IC95%: 7,30–8,61) y 5,98% (IC95%: 5,41–6,55), respectivamente. Hipertensión, diabetes, prediabetes, índice cintura-talla aumentado, insuficiencia cardíaca, fibrilación auricular y ECVA se asociaban independientemente con ERC (p<0,001). El 77,51% (IC95%: 74,54–80,49) de la población con ERC tenía un riesgo cardiovascular muy alto según SCORE. Conclusiones: La prevalencia ajustada de ERC era del 9,2% (filtrado glomerular estimado reducido: 8%; albuminuria: 6%). La mayoría de los pacientes con ERC tenía riesgo cardiovascular muy alto. Hipertensión, diabetes, prediabetes, índice cintura-talla aumentado y ECVA se asociaban independientemente con la ERC.(AU)

Introduction: Chronic kidney disease (CKD) is a major health problem that contributes to the development of cardiovascular disorders such as heart failure and arteriosclerotic cardiovascular disease (ACVD). The aims of this study were to determine the prevalence of CKD and to assess its association with ACVD and cardiometabolic risk factors. Methods: Cross-sectional observational study conducted in primary care setting. Population-based random sample: 6,588 people between 18 and 102 years old (response rate: 66%). Crude and sex- and age-adjusted prevalence rates of CKD according to KDIGO were determined by assessing albuminuria and estimated glomerular filtration rate according to CKD-EPI, and their associations with cardiometabolic factors and ACVD were determined. Results: The crude prevalence of CKD was 11.48% (95%CI: 10.72–12.27%), without significant difference between men (11.64% [95%CI: 10.49–12.86%]) and women (11.35% [95%CI: 10.34–12.41%]). The age- and sex-adjusted prevalence rate of CKD was 9.16% (men: 8.61%; women: 9.69%). The prevalence of low estimated glomerular filtration rate (<60mL/min/1.73m2) and albuminuria (≥30mg/g) were 7.95% (95%CI: 7.30–8.61) and 5.98% (95%CI: 5.41–6.55), respectively. Hypertension, diabetes, prediabetes, increased waist-to-height ratio, heart failure, atrial fibrillation, and ACVD were independently associated with CKD (P<.001). Very high cardiovascular risk according to SCORE was found in 77.51% (95%CI: 74.54–80.49) of the population with CKD. Conclusions: The adjusted prevalence of CKD was 9.2% (low estimated glomerular filtration rate: 8.0%; albuminuria: 6.0%). Most of the patients with CKD had very high cardiovascular risk. Hypertension, diabetes, prediabetes, increased waist-to-height ratio and ACVD were independently associated with CKD.(AU)

Development of a multi-layer quality assurance program to evaluate the uncertainty of deformable dose accumulation in adaptive radiotherapy.

PURPOSE: Deformable dose accumulation (DDA) has uncertainties which impede the implementation of DDA-based adaptive radiotherapy (ART) in clinic. The purpose of this study is to develop a multi-layer quality assurance (MLQA) program to evaluate uncertainties in DDA. METHODS: A computer program is developed to generate a pseudo-inverse displacement vector field (DVF) for each deformable image registration (DIR) performed in Accuray's PreciseART. The pseudo-inverse DVF is first used to calculate a pseudo-inverse consistency error (PICE) and then implemented in an energy and mass congruent mapping (EMCM) method to reconstruct a deformed dose. The PICE is taken as a metric to estimate DIR uncertainties. A pseudo-inverse dose agreement rate (PIDAR) is used to evaluate the consequence of the DIR uncertainties in DDA and the principle of energy conservation is used to validate the integrity of dose mappings. The developed MLQA program was tested using the data collected from five representative cancer patients treated with tomotherapy. RESULTS: DIRs were performed in PreciseART to generate primary DVFs for the five patients. The fidelity index and PICE of these DVFs on average are equal to 0.028 mm and 0.169 mm, respectively. With the criteria of 3 mm/3% and 5 mm/5%, the PIDARs of the PreciseART-reconstructed doses are 73.9 ± 4.4% and 87.2 ± 3.3%, respectively. The PreciseART and EMCM-based dose reconstructions have their deposited energy changed by 5.6 ± 3.9% and 2.6 ± 1.5% in five GTVs, and by 9.2 ± 7.8% and 4.7 ± 3.6% in 30 OARs, respectively. CONCLUSIONS: A pseudo-inverse map-based EMCM program has been developed to evaluate DIR and dose mapping uncertainties. This program could also be used as a sanity check tool for DDA-based ART.

Prevalence rates of chronic kidney disease and its association with cardiometabolic factors and cardiovascular diseases. SIMETAP-CKD study. / Tasas de prevalencia de enfermedad renal crónica y su asociación con factores cardiometabólicos y enfermedades cardiovasculares. Estudio SIMETAP-ERC.

INTRODUCTION: Chronic kidney disease (CKD) is a major health problem that contributes to the development of cardiovascular disorders such as heart failure and arteriosclerotic cardiovascular disease (ACVD). The aims of this study were to determine the prevalence of CKD and to assess its association with ACVD and cardiometabolic risk factors. METHODS: Cross-sectional observational study conducted in primary care setting. Population-based random sample: 6,588 people between 18 and 102 years old (response rate: 66%). Crude and sex- and age-adjusted prevalence rates of CKD according to KDIGO were determined by assessing albuminuria and estimated glomerular filtration rate according to CKD-EPI, and their associations with cardiometabolic factors and ACVD were determined. RESULTS: The crude prevalence of CKD was 11.48% (95%CI: 10.72-12.27%), without significant difference between men (11.64% [95%CI: 10.49-12.86%]) and women (11.35% [95%CI: 10.34-12.41%]). The age- and sex-adjusted prevalence rate of CKD was 9.16% (men: 8.61%; women: 9.69%). The prevalence of low estimated glomerular filtration rate (<60mL/min/1.73m2) and albuminuria (≥30mg/g) were 7.95% (95%CI: 7.30-8.61) and 5.98% (95%CI: 5.41-6.55), respectively. Hypertension, diabetes, prediabetes, increased waist-to-height ratio, heart failure, atrial fibrillation, and ACVD were independently associated with CKD (P<.001). Very high cardiovascular risk according to SCORE was found in 77.51% (95%CI: 74.54-80.49) of the population with CKD. CONCLUSIONS: The adjusted prevalence of CKD was 9.2% (low estimated glomerular filtration rate: 8.0%; albuminuria: 6.0%). Most of the patients with CKD had very high cardiovascular risk. Hypertension, diabetes, prediabetes, increased waist-to-height ratio and ACVD were independently associated with CKD.

Incorporating uncertainty bounds in daily deformable dose accumulation for adaptive radiation therapy of head-and-neck cancer.

BACKGROUND: The widespread use of deformable dose accumulation (DDA) in adaptive radiotherapy (ART) has been limited due to the lack of clinically compatible methods to consider its related uncertainties. PURPOSE: We estimate dose reconstruction uncertainties in daily DDA during CT-guided radiotherapy of head-and-neck cancer (HNC). We project confidence intervals of cumulative dose-volume parameters to the parotids and determine threshold values to guide clinical decision-making in ART. METHODS: Doses from daily images (megavoltage CTs [MVCTs]) of 20 HNC patients treated with tomotherapy were reconstructed and accumulated in the planning CT (PCT) utilizing a commercial DDA algorithm (PreciseART, Accuray, Inc.). For each mapped fraction, we warped the planning contours to the MVCT. Dose-volume histograms (DVHs) calculated in the MVCT (with warped contour and native dose) and the PCT (with native contour and mapped dose) were compared; the observed inconsistencies were associated with dose reconstruction errors. We derived uncertainty bounds for the transferred dose to voxels within the structure of interest in the PCT. The confidence intervals of cumulative dose-volume parameters were mid-treatment projected and evaluated as predictors of the end of treatment cumulative metrics. The need for plan adaptation was tested by comparing the projected uncertainty bounds with the treatment constraint points. RESULTS: Among all cases, the uncertainty in mean values of daily dose distributions mapped to the reference parotid's contours averaged between 2.8% and 3.8% of typical single fraction planning values and less than 1% for the planning target volume (PTV) D95%. These daily inconsistencies were higher in the ipsilateral compared to the contralateral parotid and increased toward the end of treatment. The magnitude of the uncertainty bounds for the cumulative treatment mean dose, D50%, and V20 Gy to the parotids, and PTV D95% were on average 3.5%, 6.6%, 4.6%, and 0.4% of the planned or prescribed values, with confidence intervals of 97.1%-107.0%, 98.2%-110.4%, 95.6%-111.1%, and 98.2%-100.2% respectively. The uncertainty intervals projected at mid-treatment intersected with the end of treatment bounds in 82% of the parotid's metrics; half of them presented an overlapping percentage greater than 60%. In five patients, the cumulative mean doses were projected at mid-treatment to exceed the total treatment constraint point by at least 3%; this threshold was exceeded at the end of treatment in the five cases. Underdosing was projected in only one case; the cumulative PTV D95% at the end of treatment was below the clinical threshold. CONCLUSION: Uncertainty bounds were incorporated into the results of a commercial DDA tool. The cohort's statistics showed that the parotids' cumulative DVH metrics frequently exceeded the planning values if confidence intervals were included. Most of the uncertainty bounds of the PTV metrics were kept within the clinical thresholds. We verified that mid-treatment violation projections led to exceeding the constraint point at the end of the treatment. Based on a 3% threshold, approximately one fourth of the patients are expected to be replanned at mid-treatment for parotids sparing during HNC radiotherapy.

Tasas de prevalencia de sobrepeso y obesidad y sus asociaciones con factores cardiometabólicos y renales. Estudio SIMETAP-OB / Prevalence rates of overweight and obesity and their associations with cardiometabolic and renal factors. SIMETAP-OB study

Introducción: El exceso de peso constituye un importante problema de salud. Los objetivos del estudio fueron determinar las tasas de prevalencia de sobrepeso y obesidad, y comparar sus asociaciones con factores de riesgo cardiometabólicos y renales entre las poblaciones con y sin obesidad, y entre las poblaciones con y sin sobrepeso. Métodos: Estudio observacional transversal realizado en Atención Primaria. Muestra aleatoria de base poblacional: 6.588 sujetos de estudio entre 18 y 102 años (tasa de respuesta: 66%). Se calcularon las prevalencias brutas y ajustadas por edad y sexo de sobrepeso y obesidad, y se evaluaron sus asociaciones con variables cardiometabólicas y renales mediante análisis bivariado y multivariado. Resultados: Las prevalencias ajustadas por edad y sexo de sobrepeso y obesidad fueron 36,0% (42,1% en hombres; 33,1% en mujeres) y 25,0% (26,2% en hombres; 24,5% en mujeres), respectivamente. Estas prevalencias se incrementaban con la edad, y eran más elevadas en hombres que en mujeres. El 52,0% (IC95%: 50,0-53,9) de la población con sobrepeso y el 62,3% (IC95%: 60,1-64,5) de la población con obesidad tenían un riesgo cardiovascular alto o muy alto. La obesidad abdominal, la inactividad física, la prediabetes, la hipertensión, la hipertrigliceridemia y el c-HDL bajo se asociaban independientemente con ambas entidades. Además, la diabetes se asociaba independientemente con el sobrepeso y la hipercolesterolemia con la obesidad. Conclusiones: La prevalencia de sobrepeso y obesidad era del 61,0% (68,4% en hombres y 59,0% en mujeres). Más de la mitad de la población con sobrepeso y casi dos tercios de la población con obesidad tenían un riesgo cardiovascular elevado. La hiperglucemia, el sedentarismo, la hipertensión, la hipercolesterolemia, el c-HDL bajo y la hipertrigliceridemia se asociaban independientemente con el sobrepeso y la obesidad.(AU)

Introduction: Excess weight is a major health problem. Aims of this study were to determine the prevalence rates of overweight and obesity, and to compare their associations with cardiometabolic and renal risk factors between obese and non-obese populations, and between overweight and non-overweight populations. Methods: Cross-sectional observational study conducted in Primary Care. Population-based random sample: 6,588 study subjects between 18 and 102 years of age (response rate: 66%). Crude and sex- and age-adjusted prevalence rates of overweight and obesity were calculated, and their associations with cardiometabolic and renal variables were assessed by bivariate and multivariate analysis. Results: The age- and sex-adjusted prevalence rates of overweight and obesity were 36.0% (42.1% in men; 33.1% in women) and 25.0% (26.2% in men; 24.5% in women), respectively. These prevalences increased with age, and were higher in men than in women. Fifty-two percent (95%CI: 50.0-53.9) of the overweight population and 62.3% (95%CI: 60.1-64.5) of the obese population had a high or very high cardiovascular risk. Abdominal obesity, physical inactivity, prediabetes, hypertension, hypertriglyceridemia, and low HDL-C were independently associated with both entities. Furthermore, diabetes was independently associated with overweight and hypercholesterolemia with obesity. Conclusions: The prevalence of overweight and obesity was 61.0% (68.4% in men and 59.0% in women). More than half of the overweight population and nearly two-thirds of the obese population had a high cardiovascular risk. Hyperglycemia, physical inactivity, hypertension, hypercholesterolemia, low HDL-C, and hypertriglyceridemia were independently associated with overweight and obesity.(AU)

Prevalencia de prediabetes y asociación con factores cardiometabólicos y renales. Estudio SIMETAP-PRED / Prevalence of prediabetes and association with cardiometabolic and renal factors. SIMETAP-PRED study

Introducción: La prediabetes constituye un importante problema de salud pública. Los objetivos del estudio fueron determinar la prevalencia de prediabetes según dos criterios diagnósticos, y comparar la asociación de factores de riesgo cardiometabólicos y renales entre las poblaciones con y sin prediabetes. Métodos: Estudio observacional transversal realizado en el ámbito de Atención Primaria. Muestra aleatoria de base poblacional: 6.588 sujetos de estudio (tasa de respuesta: 66%). Se utilizaron dos criterios diagnósticos: 1) prediabetes según la Sociedad Española de Diabetes (PRED-SED): glucosa plasmática en ayunas 110–125mg/dL o HbA1c 6,0%–6,4%; 2) prediabetes según la Asociación Americana de Diabetes (PRED-ADA): glucosa plasmática en ayunas 100–125mg/dL o HbA1c 5,7%–6,4%. Se evaluaron las prevalencias crudas y ajustadas por edad y sexo, y las variables cardiometabólicas y renales asociadas con prediabetes. Resultados: Las prevalencias crudas de PRED-SED y PRED-ADA fueron 7,9% (IC95% 7,3–8,6%), y 22,0% (IC95% 21,0–23,0%) respectivamente, y sus prevalencias ajustadas fueron 6,6% y 19,1% respectivamente. El riesgo cardiovascular alto o muy alto de las poblaciones PRED-SED y PRED-ADA fueron 68,6% (IC95% 64,5–72,6%) y 61,7% (IC95% 59,1–64,1%) respectivamente. La hipertensión, hipertrigliceridemia, sobrepeso, obesidad y el índice cintura-talla aumentado se asociaban independientemente con PRED-SED. Además de estos factores, el filtrado glomerular bajo y la hipercolesterolemia también se asociaban independientemente con PRED-ADA. Conclusiones: La prevalencia de PRED-ADA triplica a la PRED-SED. Dos tercios de la población con prediabetes tenían un riesgo cardiovascular elevado. Varios factores de riesgo cardiometabólicos y renales se asociaban con la prediabetes. En comparación con los criterios de la SED, los criterios de la ADA facilitan más el diagnóstico de la prediabetes. (AU)

Introduction: Prediabetes is a major public health problem. The aims of the SIMETAP-PRED study were to determine the prevalence rates of prediabetes according to two diagnostic criteria, and to compare the association of cardiometabolic and renal risk factors between populations with and without prediabetes. Methods: Cross-sectional observational study conducted in Primary Care. Based random sample: 6,588 study subjects (response rate: 66%). Two diagnostic criteria for prediabetes were used: 1) prediabetes according to the Spanish Diabetes Society (PRED-SDS): Fasting plasma glucose (FPG) 110–125mg/dL or HbA1c 6.0% –6.4%; 2) prediabetes according to the American Diabetes Association (PRED-ADA): FPG 100–125mg/dL or HbA1c 5.7%–6.4%. The crude and sex- and age-adjusted prevalence rates, and cardiometabolic and renal variables associated with prediabetes were assessed. Results: The crude prevalence rates of PRED-SDS and PRED-ADA were 7.9% (95% CI 7.3–8.6%), and 22.0% (95% CI 21.0–23.0%) respectively, their age-adjusted prevalence rates were 6.6% and 19.1 respectively. The high or very high cardiovascular risk of the PRED-SDS or PRED-ADA populations were 68.6% (95%CI 64.5–72.6%) and 61.7% (95%CI 59.1–64.1%) respectively. Hypertension, hypertriglyceridemia, overweight, obesity, and increased waist-to-height ratio were independently associated with PRED-SDS. In addition to these factors, low glomerular filtration rate and hypercholesterolemia were also independently associated with PRED-ADA. Conclusions: The prevalence of PRED-ADA triples that of PRED-SDS. Two thirds of the population with prediabetes had a high cardiovascular risk. Several cardiometabolic and renal risk factors were associated with prediabetes. Compared to the SDS criteria, the ADA criteria make the diagnosis of prediabetes easier. (AU)

Prevalence rates of overweight and obesity and their associations with cardiometabolic and renal factors. SIMETAP-OB study. / Tasas de prevalencia de sobrepeso y obesidad y sus asociaciones con factores cardiometabólicos y renales. Estudio SIMETAP-OB.

INTRODUCTION: Excess weight is a major health problem. Aims of this study were to determine the prevalence rates of overweight and obesity, and to compare their associations with cardiometabolic and renal risk factors between obese and non-obese populations, and between overweight and non-overweight populations. METHODS: Cross-sectional observational study conducted in Primary Care. Population-based random sample: 6,588 study subjects between 18 and 102 years of age (response rate: 66%). Crude and sex- and age-adjusted prevalence rates of overweight and obesity were calculated, and their associations with cardiometabolic and renal variables were assessed by bivariate and multivariate analysis. RESULTS: The age- and sex-adjusted prevalence rates of overweight and obesity were 36.0% (42.1% in men; 33.1% in women) and 25.0% (26.2% in men; 24.5% in women), respectively. These prevalences increased with age, and were higher in men than in women. Fifty-two percent (95%CI: 50.0-53.9) of the overweight population and 62.3% (95%CI: 60.1-64.5) of the obese population had a high or very high cardiovascular risk. Abdominal obesity, physical inactivity, prediabetes, hypertension, hypertriglyceridemia, and low HDL-C were independently associated with both entities. Furthermore, diabetes was independently associated with overweight and hypercholesterolemia with obesity. CONCLUSIONS: The prevalence of overweight and obesity was 61.0% (68.4% in men and 59.0% in women). More than half of the overweight population and nearly two-thirds of the obese population had a high cardiovascular risk. Hyperglycemia, physical inactivity, hypertension, hypercholesterolemia, low HDL-C, and hypertriglyceridemia were independently associated with overweight and obesity.

Prevalence of prediabetes and association with cardiometabolic and renal factors. SIMETAP-PRED study. / Prevalencia de prediabetes y asociación con factores cardiometabólicos y renales. Estudio SIMETAP-PRED.

INTRODUCTION: Prediabetes is a major public health problem. The aims of the SIMETAP-PRED study were to determine the prevalence rates of prediabetes according to two diagnostic criteria, and to compare the association of cardiometabolic and renal risk factors between populations with and without prediabetes. METHODS: Cross-sectional observational study conducted in Primary Care. Based random sample: 6,588 study subjects (response rate: 66%). Two diagnostic criteria for prediabetes were used: 1) prediabetes according to the Spanish Diabetes Society (PRED-SDS): Fasting plasma glucose (FPG) 110-125mg/dL or HbA1c 6.0% -6.4%; 2) prediabetes according to the American Diabetes Association (PRED-ADA): FPG 100-125mg/dL or HbA1c 5.7%-6.4%. The crude and sex- and age-adjusted prevalence rates, and cardiometabolic and renal variables associated with prediabetes were assessed. RESULTS: The crude prevalence rates of PRED-SDS and PRED-ADA were 7.9% (95% CI 7.3-8.6%), and 22.0% (95% CI 21.0-23.0%) respectively, their age-adjusted prevalence rates were 6.6% and 19.1 respectively. The high or very high cardiovascular risk of the PRED-SDS or PRED-ADA populations were 68.6% (95%CI 64.5-72.6%) and 61.7% (95%CI 59.1-64.1%) respectively. Hypertension, hypertriglyceridemia, overweight, obesity, and increased waist-to-height ratio were independently associated with PRED-SDS. In addition to these factors, low glomerular filtration rate and hypercholesterolemia were also independently associated with PRED-ADA. CONCLUSIONS: The prevalence of PRED-ADA triples that of PRED-SDS. Two thirds of the population with prediabetes had a high cardiovascular risk. Several cardiometabolic and renal risk factors were associated with prediabetes. Compared to the SDS criteria, the ADA criteria make the diagnosis of prediabetes easier.

Use of a DVH overlay technique for quality assurance of deformable image registration-based dose accumulation.

PURPOSE: We present a DVH overlay technique as a quality assurance (QA) metric for deformable image registration-based dose accumulation (DIR-DA). We use the technique to estimate the uncertainty in a DIR-DA for a revised treatment plan, and to compare two different DIR algorithms. MATERIALS AND METHODS: The required inputs to the DVH overlay workflow are deformably registered primary and secondary images, primary regions-of-interest (ROIs), and secondary dose distribution. The primary ROIs were forward warped to the secondary image, the secondary dose was inversely warped to the primary image, and the DVHs for each image were compiled. Congruent DVHs imply minimal inverse consistency error (ICE) within an ROI. For a pancreas case re-planned after 21 fractions of a 29-fraction course, the workflow was used to quantify dose accumulation error attributable to ICE, based on a hybrid contour-and-intensity-based DIR. The usefulness of the workflow was further demonstrated by assessing the performance of two DIR algorithms (one free-form intensity-based, FFIB, the other using normalized correlation coefficients, NCC, over small neighborhood patches) as applied toward kilovoltage computed tomography (kVCT)-to-megavoltage computed tomography (MVCT) registration and five-fraction dose accumulation of ten male pelvis cases. RESULTS: For the re-planned pancreas case, when applying the DVH-overlay-based uncertainties the resulting accumulated dose remained compliant with all but two of the original plan objectives. Among the male pelvis cases, FFIB and NCC DIR showed good invertibility within the planning target volume (PTV), according to the DVH overlay QA results. NCC DIR exhibited better invertibility for the bladder and rectum compared with FFIB. However, compared with FFIB, NCC DIR exhibited less regional deformation for the bladder and a tendency for increased local contraction of the rectum ROI. For the five-fraction summations, ICE for the PTV V100%Rx is comparable for both algorithms (FFIB 0.8 ± 0.7%, NCC 0.7 ± 0.3%). For the bladder and rectum V70%Rx , ICE is greater for FFIB (1.8 ± 0.7% for bladder, 1.7 ± 0.6% for rectum) than for NCC (1.0 ± 0.3% for bladder, 1.0 ± 0.4% for rectum). CONCLUSIONS: The DVH overlay technique identified instances in which a DIR exhibits favorable invertibility, implying low ICE in a DIR-based dose accumulation. Differences in the overlaid DVHs can also estimate dose accumulation errors attributable to ICE for given ROIs.

Prevalencia de diabetes mellitus en el ámbito de la atención primaria española y su asociación con factores de riesgo cardiovascular y enfermedades cardiovasculares. Estudio SIMETAP-DM / Prevalence of diabetes mellitus in Spanish primary care setting and its association with cardiovascular risk factors and cardiovascular diseases. SIMETAP-DM study

Introducción: Los objetivos del estudio fueron determinar las tasas de prevalencia brutas y ajustadas por edad y sexo de diabetes mellitus (DM), DM tipo 1 (DM1) y DM tipo 2 (DM2), y comparar la asociación de factores de riesgo cardiovascular, enfermedades cardiovasculares, enfermedad renal crónica y enfermedades metabólicas entre las poblaciones con y sin DM. Métodos: SIMETAP-DM es un estudio observacional transversal realizado en atención primaria, con una muestra aleatoria de base poblacional de 10.579 adultos. Tasa de respuesta: 66%. Los diagnósticos de DM, DM1 y DM2 se basaron en criterios clínicos y bioquímicos y/o en la comprobación de estos diagnósticos en las historias clínicas. Se determinaron las prevalencias brutas y ajustadas por edad y sexo (estandarizadas con la población española). Resultados: Las prevalencias brutas de DM1, DM2 y DM fueron del 0,87% (intervalo de confianza al 95% [IC 95%]: 0,67-1,13), el 14,7% (IC 95%: 13,9-15,6) y el 15,6% (IC 95%: 14,7-16,5), respectivamente. Las prevalencias ajustadas por edad y sexo de DM1, DM2 y DM fueron del 1,0% (1,3% para hombres y 0,7% para mujeres), el 11,5% (13,6% para hombres y 9,7% para mujeres) y el 12,5% (14,9% para hombres y 10,5% para mujeres), respectivamente. La prevalencia de DM en la población ≥ 70 años era el doble (30,3% [IC 95%: 28,0-32,7]) que en la población entre 40 y 69 años (15,3% [IC 95%: 14,1-16,5%]). La hipertensión arterial, la enfermedad arterial periférica, el índice cintura-talla aumentado, la albuminuria, la enfermedad coronaria, la dislipidemia aterogénica y la hipercolesterolemia se asociaban con la DM. Conclusiones: En el ámbito de la atención primaria española, las prevalencias ajustadas por edad de DM1, DM2 y DM en la población adulta fueron del 1,0, el 11,5 y el 12,5%, respectivamente. Un tercio de la población mayor de 70 años padecía DM

Introduction: The aims of this study were to determine the age- and sex-adjusted prevalence rates of DM, type-1 DM (T1DM), and type-2 DM (T2DM), and to compare the relationship with cardiovascular risk factors, cardiovascular diseases, chronic kidney disease, and metabolic diseases between populations with and without DM. Methods: SIMETAP-DM is a cross-sectional observational study conducted in a Primary Care setting with a random population-based sample of 10,579 adults. Response rate: 66%. The diagnoses of DM, T1DM and T2DM were based on clinical and biochemical criteria and/or the checking of these diagnoses in the medical records. The crude and age- and sex-adjusted (standardised for Spanish population) prevalence rates were calculated. Results: The crude prevalence rates of T1DM, T2DM, and DM were 0.87% (95% confidence interval [95% CI]: 0.67-1.13), 14.7% (95% CI: 13.9-15.6), and 15.6% (95% CI: 14.7-16.5), respectively. The age- and sex-adjusted prevalence rates of T1DM, T2DM, and DM were 1.0% (1.3% for men and 0.7% for women), 11.5% (13.6% for men and 9.7% for women), and 12.5% (14.9% for men and 10.5% for women), respectively. The prevalence of DM in the population ≥ 70 years was double (30.3% [95% CI: 28.0-32.7]) that of the population between 40 and 69 years (15.3% [95% CI: 14.1-16.5]). Hypertension, peripheral arterial disease, increased waist-to-height ratio, albuminuria, coronary heart disease, atherogenic dyslipidaemia and hypercholesterolaemia were associated with DM. Conclusions: In a Spanish primary care setting, the age-adjusted prevalences of T1DM, T2DM and DM in the adult population were 1.0, 11.5, and 12.5%, respectively. One-third (33%) of the population over 70 years had DM

Clinical evolution of patients treated with aripiprazole long-acting injectable: a preliminary, prospective, observational study.

Objective: To evaluate the effectiveness of 6-month treatment with aripiprazole long-acting injectable (LAI) in improving psychotic symptoms, social functioning and side effects and reducing co-administered antipsychotic drugs.Methods: Multicentre, observational, prospective study that enrolled 53 patients with diagnosis of schizophrenia spectrum disorders who initiated or switched to aripiprazole LAI. The effectiveness of aripiprazole LAI was assessed through the Positive and Negative Syndrome Scale (PANSS), the Udvalg for Kliniske Undersogelser scale for side effects, the Global Assessment of Functioning and the Clinical Global Impression-Schizophrenia (CGI-SCH).Results: Upon treatment with aripiprazole LAI, patients significantly improved all the domains of PANSS (p < .05). Adverse event severity significantly improved after a 6-month aripiprazole LAI treatment (p < .05). Differences from baseline to month 6 in Global Assessment of Functioning score were significant (p = .0002). The proportion of severely ill patients decreased upon treatment with aripiprazole LAI (CGI-SCH scale). Prolactin levels were normalised after a 6-month treatment (from 43.0 to 14.7 ng/mL). Co-administered antipsychotic drugs significantly decreased after a 6-month treatment with aripiprazole LAI.Conclusion: A 6-month treatment with aripiprazole LAI improved the clinical status of our patients without modifying their metabolic profile, and allowed the reduction of co-administered antipsychotic drugs.Practice implicationsLong-acting injectable antipsychotics are effective treatment options for the maintenance of patients with schizophrenia and related disorders, and to ensure treatment adherence. This study describes the evolution of patients over six months of treatment with aripiprazole long-acting injectable. The results from this study support previous data on the efficacy and safety of this atypical antipsychotic. This study may be of wide interest to the community of psychiatrists and may help clinicians optimise treatment adherence in patients with schizophrenia spectrum disorders.Key pointsAripiprazole long-acting injectable is an atypical antipsychotic intended to improve treatment adherence and prevent relapses.This multicentre prospective study evaluated the effectiveness of aripiprazole long-acting injectable over six months of treatment on the control of a comprehensive set of clinical variables.Clinical rating scales showed that treatment with aripiprazole long-acting injectable improved clinical symptoms and social functioning, and reduced the severity of adverse events.Aripiprazole long-acting injectable contributed to the maintenance of adequate metabolic profiles and the normalisation of prolactin levels.Patients significantly decreased co-administered antipsychotic drugs after 6-month treatment with aripiprazole.

Prevalence of diabetes mellitus in Spanish primary care setting and its association with cardiovascular risk factors and cardiovascular diseases. SIMETAP-DM study. / Prevalencia de diabetes mellitus en el ámbito de la atención primaria española y su asociación con factores de riesgo cardiovascular y enfermedades cardiovasculares. Estudio SIMETAP-DM.

INTRODUCTION: The aims of this study were to determine the age- and sex-adjusted prevalence rates of DM, type-1 DM (T1DM), and type-2 DM (T2DM), and to compare the relationship with cardiovascular risk factors, cardiovascular diseases, chronic kidney disease, and metabolic diseases between populations with and without DM. METHODS: SIMETAP-DM is a cross-sectional observational study conducted in a Primary Care setting with a random population-based sample of 10,579 adults. Response rate: 66%. The diagnoses of DM, T1DM and T2DM were based on clinical and biochemical criteria and/or the checking of these diagnoses in the medical records. The crude and age- and sex-adjusted (standardised for Spanish population) prevalence rates were calculated. RESULTS: The crude prevalence rates of T1DM, T2DM, and DM were 0.87% (95% confidence interval [95% CI]: 0.67-1.13), 14.7% (95% CI: 13.9-15.6), and 15.6% (95% CI: 14.7-16.5), respectively. The age- and sex-adjusted prevalence rates of T1DM, T2DM, and DM were 1.0% (1.3% for men and 0.7% for women), 11.5% (13.6% for men and 9.7% for women), and 12.5% (14.9% for men and 10.5% for women), respectively. The prevalence of DM in the population≥70 years was double (30.3% [95% CI: 28.0-32.7]) that of the population between 40 and 69 years (15.3% [95% CI: 14.1-16.5]). Hypertension, peripheral arterial disease, increased waist-to-height ratio, albuminuria, coronary heart disease, atherogenic dyslipidaemia and hypercholesterolaemia were associated with DM. CONCLUSIONS: In a Spanish primary care setting, the age-adjusted prevalences of T1DM, T2DM and DM in the adult population were 1.0, 11.5, and 12.5%, respectively. One-third (33%) of the population over 70 years had DM.

Prevalence of erectile dysfunction in Spanish primary care setting and its association with cardiovascular risk factors and cardiovascular diseases. SIMETAP-ED study / Prevalencia de la disfunción eréctil en el ámbito de la atención primaria española y su asociación con factores de riesgo cardiovasculares y enfermedades cardiovasculares. Estudio SIMETAP-ED

Introduction: Few studies conducted in primary care setting report about age-adjusted prevalence rates of erectile dysfunction (ED). Aims of SIMETAP-ED study were to determine crude and age-adjusted prevalence rates of ED diagnosis, to compare these rates with other similar studies, and to compare prevalence rates of cardiovascular risk factors (CVRF), cardiovascular diseases (CVD), metabolic diseases and chronic kidney disease (CKD) between populations with and without ED. Methods: Cross-sectional observational study conducted in primary care setting. Population-based random sample: 2934 adult men. Response rate: 66%. A clinical interview was conducted to diagnose ED using a question derived from ED definition. The medical records of patients were reviewed to identify their CVRF and diseases associated with ED. The age-adjustments were standardized to Spanish population. Results: The prevalence rates of metabolic diseases, CVD, CVRF, and CKD in population with ED were higher than population without ED, highlighting the CVD. The crude prevalence of ED was 17.2% (95% confidence interval: 15.8-18.6). The age-adjusted prevalence rates of ED were 0.71% in men under 40 years, 12.4% in men over 18 years, 10.8% in men aged 40-69 years, 18.9% in men over 40 years, and 48.6% in men over 70 years. Conclusions: SIMETAP-ED study showed association of ED with metabolic diseases, CKD, CVRF, and highlighting CVD. The age-adjusted prevalence of ED was 12.4% in adult men, 19% in men over 40 years, and almost 50% in men over 70 years

Introducción: Existen pocos estudios realizados en atención primaria sobre prevalencias ajustadas por edad de la disfunción eréctil (ED, por sus siglas en inglés). Los objetivos del estudio SIMETAP-ED fueron determinar las prevalencias crudas y ajustadas por edad del diagnóstico de la ED, comparar estas tasas con otros estudios similares, y comparar las prevalencias de factores de riesgo cardiovasculares (FRCV), enfermedades cardiovasculares (ECV), enfermedades metabólicas y enfermedad renal crónica (ERC) entre las poblaciones con y sin ED. Métodos: Estudio observacional transversal realizado en atención primaria. Muestra aleatoria base poblacional: 2.934 varones adultos. Tasa de respuesta: 66%. Se realizó una entrevista clínica para diagnosticar ED mediante una pregunta derivada de la definición de ED. Se revisaron las historias clínicas de los pacientes para identificar sus FRCV y enfermedades asociadas con la ED. Los ajustes de tasas se estandarizaron con respecto a la población española. Resultados: Las prevalencias de enfermedades metabólicas, ECV, FRCV y ERC en la población con ED fueron más altas que en la población sin ED, destacando las ECV. La prevalencia cruda de la ED fue del 17,21% (intervalo de confianza del 95%: 15,86-18,63). Las tasas de prevalencia ajustadas por edad de la ED fueron del 0,71% en menores de 40 años, del 12,4% en mayores de 18 años, del 10,8% en varones entre 40 y 69 años, del 18,9% en mayores de 40 años y del 48,6% en mayores de 70 años. Conclusiones: El estudio SIMETAP-ED mostró asociación de la ED con las enfermedades metabólicas, ERC, FRCV y, sobre todo, con ECV. La prevalencia ajustada por edad de la ED fue del 12,4% en varones adultos, del 19% en mayores de 40 años y casi del 50% en mayores de 70 años

Prevalence of erectile dysfunction in Spanish primary care setting and its association with cardiovascular risk factors and cardiovascular diseases. SIMETAP-ED study.

INTRODUCTION: Few studies conducted in primary care setting report about age-adjusted prevalence rates of erectile dysfunction (ED). Aims of SIMETAP-ED study were to determine crude and age-adjusted prevalence rates of ED diagnosis, to compare these rates with other similar studies, and to compare prevalence rates of cardiovascular risk factors (CVRF), cardiovascular diseases (CVD), metabolic diseases and chronic kidney disease (CKD) between populations with and without ED. METHODS: Cross-sectional observational study conducted in primary care setting. Population-based random sample: 2934 adult men. Response rate: 66%. A clinical interview was conducted to diagnose ED using a question derived from ED definition. The medical records of patients were reviewed to identify their CVRF and diseases associated with ED. The age-adjustments were standardized to Spanish population. RESULTS: The prevalence rates of metabolic diseases, CVD, CVRF, and CKD in population with ED were higher than population without ED, highlighting the CVD. The crude prevalence of ED was 17.2% (95% confidence interval: 15.8-18.6). The age-adjusted prevalence rates of ED were 0.71% in men under 40 years, 12.4% in men over 18 years, 10.8% in men aged 40-69 years, 18.9% in men over 40 years, and 48.6% in men over 70 years. CONCLUSIONS: SIMETAP-ED study showed association of ED with metabolic diseases, CKD, CVRF, and highlighting CVD. The age-adjusted prevalence of ED was 12.4% in adult men, 19% in men over 40 years, and almost 50% in men over 70 years.

Población y metodología del estudio SIMETAP: Prevalencia de factores de riesgo cardiovascular, enfermedades cardiovasculares y enfermedades metabólicas relacionadas / Population and methodology of the SIMETAP study: Prevalence of cardiovascular risk factors, cardiovascular diseases, and related metabolic diseases

La prevención de la enfermedad cardiovascular se fundamenta en la detección y control de los factores de riesgo cardiovascular (FRCV). En España existen importantes diferencias territoriales tanto en la prevalencia como en el grado de control de los FRCV. En la última década ha habido una mejora del control de la hipertensión y la dislipidemia, pero un empeoramiento de los factores de riesgo cardiometabólicos relacionados con la obesidad y la diabetes. El estudio SIMETAP es un estudio observacional descriptivo transversal realizado en 64 centros de atención primaria de la Comunidad de Madrid. El objetivo principal es determinar las tasas de prevalencia de FRCV, de las enfermedades cardiovasculares y de las enfermedades metabólicas relacionadas con el riesgo cardiovascular. El presente artículo informa sobre las características basales de la población, la metodología del estudio, y las definiciones de los parámetros y enfermedades en estudio. Se seleccionaron 6.631 sujetos de estudio mediante una muestra aleatoria base poblacional. Se determinaron variables antropométricas, estilos de vida, presión arterial, parámetros bioquímicos, y tratamientos farmacológicos. Las prevalencias crudas más elevadas se detectaron en tabaquismo, inactividad física, obesidad, prediabetes, diabetes, hipertensión, dislipidemias y síndrome metabólico. Para valorar la verdadera dimensión epidemiológica de estas enfermedades y FRCV, es necesario realizar un análisis pormenorizado de tasas de prevalencia estratificadas por grupos etarios y de las tasas de prevalencia ajustadas por edad y sexo

The prevention of cardiovascular disease is based on the detection and control of cardiovascular risk factors (CVRF). In Spain there are important geographical differences both in the prevalence and in the level of control of the CVRF. In the last decade there has been an improvement in the control of hypertension and dyslipidaemia, but a worsening of cardio-metabolic risk factors related to obesity and diabetes. The SIMETAP study is a cross-sectional descriptive, observational study being conducted in 64 Primary Care Centres located at the Community of Madrid. The main objective is to determine the prevalence rates of CVRF, cardiovascular diseases, and metabolic diseases related to cardiovascular risk. A report is presented on the baseline characteristics of the population, the study methodology, and the definitions of the parameters and diseases under study. A total of 6,631 study subjects were selected using a population-based random sample. The anthropometric variables, lifestyles, blood pressure, biochemical parameters, and pharmacological treatments were determined. The highest crude prevalences were detected in smoking, physical inactivity, obesity, prediabetes, diabetes, hypertension, dyslipidaemias, and metabolic syndrome. A detailed analysis needs to be performed on the prevalence rates, stratified by age groups, and prevalence rates adjusted for age and sex to assess the true epidemiological dimension of these CVRF and diseases

Population and methodology of the SIMETAP study: Prevalence of cardiovascular risk factors, cardiovascular diseases, and related metabolic diseases. / Población y metodología del estudio SIMETAP: Prevalencia de factores de riesgo cardiovascular, enfermedades cardiovasculares y enfermedades metabólicas relacionadas.

The prevention of cardiovascular disease is based on the detection and control of cardiovascular risk factors (CVRF). In Spain there are important geographical differences both in the prevalence and in the level of control of the CVRF. In the last decade there has been an improvement in the control of hypertension and dyslipidaemia, but a worsening of cardio-metabolic risk factors related to obesity and diabetes. The SIMETAP study is a cross-sectional descriptive, observational study being conducted in 64 Primary Care Centres located at the Community of Madrid. The main objective is to determine the prevalence rates of CVRF, cardiovascular diseases, and metabolic diseases related to cardiovascular risk. A report is presented on the baseline characteristics of the population, the study methodology, and the definitions of the parameters and diseases under study. A total of 6,631 study subjects were selected using a population-based random sample. The anthropometric variables, lifestyles, blood pressure, biochemical parameters, and pharmacological treatments were determined. The highest crude prevalences were detected in smoking, physical inactivity, obesity, prediabetes, diabetes, hypertension, dyslipidaemias, and metabolic syndrome. A detailed analysis needs to be performed on the prevalence rates, stratified by age groups, and prevalence rates adjusted for age and sex to assess the true epidemiological dimension of these CVRF and diseases.

Meningoencefalitis bacteriana en niños de Guantánamo. Su comportamiento durante 2007-2013 / Bacterial meningoencephalitis in Guantanamo children. Your behavior during 2007-2013

Introducción: en la unidad de cuidados intensivos no siempre se conocen los factores que determinan el pronóstico del paciente con peritonitis. Objetivo: precisar los factores determinantes de la mortalidad por peritonitis secundaria en esta unidad en el Hospital "Dr. Agostinho Neto" durante los años 2014-2016. Método: se realizó un estudio analítico prospectivo y longitudinal de todos los pacientes ingresados en la citada UCI por peritonitis secundaria en los años 2014-2016 (n=70), los que se agruparon según fueran egresados vivos o fallecidos. Se precisaron las variables más relacionadas con la probabilidad de que el paciente falleciera y las más frecuentes en los fallecidos. Se calculó el riesgo absoluto (RA) de cada variable. Resultados: los factores más frecuentes fueron: fiebre (n=53), Síndrome respuesta inflamatoria sistémica (n=51) y la leucocitosis/desviación izquierda (n=51). Los factores con mayor probabilidad de determinar la muerte fueron: fallo multiorgánico (RA 17.8), fluido peritoneal fecaloideo (RA 7.8) y choque séptico (RA 7.3). Conclusión: Los factores que determinan la mortalidad por peritonitis secundaria son: la peritonitis difusa, presencia de fallo multiorgánico, hipoxemia ? 85 mmHg y/o Sp02 ? 90 por ciento, edad ? 60 años, presión intrabdominal poscirugía ? 21 cm H2O (15 mmHg), síntomas ? 24 h antes de cirugía, choque séptico, fluido peritoneal fecaloideo, origen colónico de la peritonitis(AU)

A retrospective longitudinal descriptive study was carried out to determine the behavior of children with bacterial meningoencephalitis at the Pediatric Hospital Pedro A Pérez in the period from 2007 to 2013. The study universe was composed of 58 patients. We studied a series of variables such as: behavior by age, age, main symptoms and signs at admission, evolution in intensive care, and prognosis. The data were collected from the medical records. The main results were: 2009 was the year of greatest morbidity, infants were the most affected, the main symptoms were: fever, headache and vomiting; electrolytic disorders and shock were the main complications and the favorable evolution prevailed. Conclusions and recommendations were issued(AU)

Meningoencefalitis bacteriana en niños de Guantánamo. Su comportamiento durante 2007-2013 / Bacterial meningoencephalitis in Guantanamo children. Your behavior during 2007-2013

Se realizó un estudio descriptivo longitudinal retrospectivo para conocer el comportamiento en niños con meningoencefalitis bacteriana en el Hospital Pediátrico Docente "General Pedro Agustín Pérez" en el período comprendido de 2007 a 2013. El universo de estudio quedó constituido por 58 pacientes. Se estudiaron las variables: comportamiento por años, edad, principales síntomas y signos al ingreso, evolución en cuidados intensivos, y pronóstico. Los datos fueron recogidos de las historias clínicas. Los principales resultados fueron: el año 2009 el de mayor morbilidad, los lactantes más afectados, los principales síntomas fueron: fiebre, cefalea y vómitos; los trastornos electrolíticos y el shock constituyeron las principales complicaciones y predominó la evolución favorable. Se emitieron conclusiones y recomendaciones(AU)

A retrospective longitudinal descriptive study was carried out to determine the behavior of children with bacterial meningoencephalitis at the Pediatric Hospital "Pedro A. Pérez" in the period from 2007 to 2013. The study universe was composed of 58 patients. We studied a series of variables such as: behavior by age, age, main symptoms and signs at admission, evolution in intensive care, and prognosis. The data were collected from the medical records. The main results were: 2009 was the year of greatest morbidity, infants were the most affected, the main symptoms were: fever, headache and vomiting; electrolytic disorders and shock were the main complications and the favorable evolution prevailed. Conclusions and recommendations were issued.

Hipertensión arterial en pediatría. estudio de tres años / Arterial hypertension in pediatrics. three year study

Se realizó un estudio descriptivo con el objetivo de analizar algunos factores relacionados con la hipertensión arterial en pacientes que fueron atendidos en el Hospital Pediátrico Pedro A Pérez, desde el mes de enero del 2014 hasta el mes de enero de 2016. El universo de estudio quedo constituido por 58 pacientes diagnosticados con hipertensión arterial. Los datos primarios se obtuvieron de la revisión de las historias clínicas. Las variables estudiadas fueron: grupos de edades, sexo, procedencia, factores de riesgo, y tipo de hipertensión. Los resultados más relevantes fueron: predominio de los adolescentes, el sexo masculino, la procedencia urbana, el factor de riesgo obesidad. Y la hipertensión esencial. Se emitieron conclusiones y recomendaciones(AU)

A descriptive study was carried out with the objective of analyzing some factors related to arterial hypertension in patients who were treated at the Pedro A Perez Pediatric Hospital from January 2014 to January 2016. The study universe consisted of 58 patients diagnosed with hypertension. Primary data were obtained from review of medical records. The variables were studied: age, sex, origin, risk factors, and type of hypertension. The most relevant results were: predominance of adolescents, male sex, urban origin, obesity risk factor. Essential hypertension. Conclusions and recommendations were issued.

Meningoencefalitis bacteriana, estudio de algunos factores / Bacterial meningoencephalitis, study of some factors

La meningoencefalitis bacteriana constituye una de las causas de ingreso en las unidades de cuidados intensivos con una morbilidad en todas las edades pediátricas. Se realizó un estudio descriptivo longitudinal retrospectivo para conocer el comportamiento de algunos factores en niños con meningoencefalitis bacteriana en el Hospital Pediátrico Pedro A. Pérez en el período comprendido de 2007 a 2013. El universo de estudio quedo constituido por 58 pacientes. Se tomaron los datos de las historias clínicas, las variables estudiadas fueron: edad, sexo, procedencia, factores de riesgo sociales (hacinamiento, contactos con personas enfermas, la falta de inmunización) y factores de riesgos biológicos (antecedente de infección respiratoria aguda siete días antes, pretérmino, desnutrido, inmunodeprimido, tratamiento antibiótico menos de 48 horas, egreso menos de 72 horas). Los principales resultados fueron: hubo predominio de lactantes, del sexo masculino y procedencia urbana; como factores de riesgo biológico lo constituyeron las infecciones respiratorias agudas siete días antes, y la desnutrición, y como riesgos sociales el hacinamiento y el contacto con enfermos. Se emitieron conclusiones y recomendaciones(AU)

Bacterial meningoencephalitis is one of the causes of admission to intensive care units with morbidity in all pediatric ages. A retrospective longitudinal descriptive study was carried out to determine the behavior of some factors in children with bacterial meningoencephalitis at the Pediatric Hospital Pedro A. Pérez in the period from 2007 to 2013. The universe of study was made up of 58 patients. Data were taken from the medical records, age, gender, origin, social risk factors (overcrowding, contacts with sick people, lack of immunization) and biological risk factors (history of acute respiratory infection seven days Before, preterm, malnourished, immunosuppressed, antibiotic treatment less than 48 hours, egress less than 72 hours), the main results were: predominance of infants, males and urban origin; As biological risk factors consisted of acute respiratory infections seven days before, and malnutrition, and as social risks overcrowding and contact with patients. Conclusions and recommendations were issued