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.

[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.

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

Introducción. Frecuentemente, el accidente isquémico transitorio (AIT) precede al ictus. Objetivo. Estudiar factores de riesgo cardiovascular modificables para el AIT no cardioembólico. Pacientes y métodos. Se realizó un estudio de casos y controles de base poblacional, realizado en un barrio urbano de la ciudad de Barcelona. Los casos fueron 103 pacientes con AIT no cardioembólico, diagnosticados por un neurólogo y con TAC o RM normales. Se aparearon por edad y sexo con 193 controles sin AIT ni ictus, seleccionados por muestreo aleatorio simple del archivo de historias clínicas del centro. Los factores de riesgo se estudiaron mediante un cuestionario estandarizado que recogió los siguientes factores codificados de manera dicotómica: tabaquismo, hipertensión arterial (HTA), hipercolesterolemia, hipertrigliceridemia, obesidad, intolerancia a la glucosa en ayuno y diabetes mellitus (DM). Resultados. La edad media fue de 74,6 años, con un 52,3 por ciento de mujeres. Todos los factores de riesgo cardiovascular modificables se asociaron a un superior riesgo de AIT, aunque sólo la HTA (OR = 1,9; IC 95 por ciento = 1,1-3,3) y la obesidad (OR = 2,1; IC 95 por ciento = 1,2-3,6) se asociaron de manera significativa en el análisis univariado. En el análisis multivariante mediante regresión logística, los factores de riesgo cardiovascular modificables asociados de manera significativa fueron la HTA (OR = 1,9; IC 95 por ciento = 1,0-3,6), la obesidad (OR = 2,8; IC 95 por ciento = 1,4-12,3) y la DM (OR = 1,7; IC = 95 por ciento = 1,0-2,9). Conclusiones. En el presente estudio, la HTA, la obesidad y la DM han sido factores de riesgo modificables para el AIT no cardioembólico (AU)

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 (AU)

[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.

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

Objetivos. Conocer la prevalencia de la infección por Helicobacter pylori (HP) en la atención primaria de nuestra área y estudiar factores asociados a dicha infección. Diseño. Descriptivo y prospectivo. Emplazamiento. Área básica de salud urbana, con 30.765 personas censadas. Participantes. Doscientos sesenta y siete pacientes, seleccionados mediante muestreo por cuotas por grupos de edad y sexo a partir del censo, en función de un alfa de 0,05, una precisión de 0,06 y una prevalencia esperada del 50 por ciento. Mediciones principales. La infección por HP se estudió mediante serología validada IgG (ELISA Wampole®). Como factores asociados se estudiaron los siguientes: edad, sexo, estudios, profesión, consumo de alcohol, tabaco y antiinflamatorios no esteroides. Resultados. La edad media fue de 38,4 años, con un 51,3 por ciento de mujeres. La prevalencia de infección por HP fue del 52,4 por ciento (intervalo de confianza [IC] del 95 por ciento, 46,4-58,4). Esta proporción aumentó progresivamente con la edad, con un mínimo del 11,5 por ciento en el estrato 0-9 años y un máximo del 87,5 por ciento en el de 60-69 años, y un predominio en varones (56,9 por ciento) respecto a mujeres (48,2 por ciento). En el análisis univariado se objetivó una tendencia lineal entre la infección por HP y el aumento de la edad (p < 0,0001) y el consumo de alcohol (p = 0,003), sin relación con las otras variables estudiadas. En el análisis multivariado sólo la edad mantuvo la significación estadística (p = 0,001). Conclusiones. La prevalencia de infección por HP encontrada en este estudio es parecida a la de otros realizados en nuestro medio, aumentando progresivamente con la edad y presentando un patrón epidemiológico intermedio entre los de países de alta y baja prevalencias (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.