Comparison of drug survival rates for tumor necrosis factor antagonists in rheumatoid arthritis.

BACKGROUND: Persistence of anti-tumor necrosis factor (TNF) therapy in rheumatoid arthritis (RA) is an overall marker of treatment success. OBJECTIVE: To assess the survival of anti-TNF treatment and to define the potential predictors of drug discontinuation in RA, in order to verify the adequacy of current practices. DESIGN: An observational, descriptive, longitudinal, retrospective study. SETTING: The Hospital Clínico Universitario de Valladolid, Valladolid, Spain. PATIENTS: RA patients treated with anti-TNF therapy between January 2011 and January 2012. MEASUREMENTS: Demographic information and therapy assessments were gathered from medical and pharmaceutical records. Data is expressed as means (standard deviations) for quantitative variables and frequency distribution for qualitative variables. Kaplan-Meier survival analysis was used to assess persistence, and Cox multivariate regression models were used to assess potential predictors of treatment discontinuation. RESULTS: In total, 126 treatment series with infliximab (n = 53), etanercept (n = 51) or adalimumab (n = 22) were administered to 91 patients. Infliximab has mostly been used as a first-line treatment, but it was the drug with the shortest time until a change of treatment. Significant predictors of drug survival were: age; the anti-TNF agent; and the previous response to an anti-TNF drug. LIMITATION: The small sample size. CONCLUSION: The overall efficacy of anti-TNF drugs diminishes with time, with infliximab having the shortest time until a change of treatment. The management of biologic therapy in patients with RA should be reconsidered in order to achieve disease control with a reduction in costs.

Adecuación de los ingresos y de la asistencia facilitada a los pacientes con neumonía adquirida en la comunidad / Adequacy of the admissions and care provided to the patients with community-acquired pneumonia

Objetivo. El objetivo de este estudio es conocer la adecuación de los ingresos hospitalarios por neumonía adquirida en la comunidad (NAC) aplicando la Regla de Clasificación Pronóstica de Fine Modificada y si la atención del paciente se realiza según los indicadores de calidad que la Infection Diseases Society of America (IDSA) recomienda. Pacientes y métodos. Estudio retrospectivo y transversal que analiza la adecuación de ingresos hospitalarios de todos los pacientes atendidos con NAC en el Hospital Clínico Universitario de Valladolid durante el año 2006. A todos los pacientes se les aplicó la Regla de Clasificación Pronóstica de Fine Modificada para evaluar la adecuación de ingresos hospitalarios analizando la comorbilidad asociada, los parámetros de gravedad y los indicadores de calidad. Resultados. Se detectaron 23 casos (6,07%) de NAC que ingresaron de manera inadecuada de los cuales 5 eran clase I (21,7%), 10 clase II (43,4%) y 8 clase III (34,7%). La EPOC (32,5%) y la hipoxemia (36%) fueron la comorbilidad y el factor de riesgo más implicados a la hora de justificar el ingreso de las NAC de bajo riesgo. Se evidenciaron 25 (32,89%) altas inadecuadas desde Urgencias y con respecto a su PSI se encontró: clase I: 2 (8%); clase II: 10 (40%); clase III: 7 (28%); clase IV: 4 (16%); clase V: 0; Fine desconocido: 2. La comorbilidad más implicada en las altas inadecuadas fue la EPOC (10 [40%]). Se realizaron: hemocultivos en 160 casos (42,2%), radiografía de tórax en 379 (100%), gasometría y/o oximetría de pulso en 379 (100%), y determinación de Ag de Streptococcus pneumoniae y Legionella en orina en 14 (87,5%) de los 16 casos de NAC que precisaron ingreso en UCI. Conclusión. La Regla de Clasificación Pronóstica de Fine Modificada puede ser muy útil a la hora de evaluar la adecuación de ingresos y para decidir la necesidad de ingresos hospitalarios por NAC. Destaca la adecuada atención de los pacientes con NAC según los indicadores de calidad establecidos por la IDSA(AU)

Background. The purpose of this study has been to know the adequacy of the hospital admissions of patients with community-acquired pneumonia (CAP), applying the Fine Modified Forecast Classification Rule and if patient care is performed in accordance with the indicators for quality by the Infectious Diseases Society of America (IDSA) recommendations. Patients and methods. A cross-sectional and retrospective study analyzing the appropriateness of hospital admissions of all patients treated for CAP at the Hospital Clínico Universitario de Valladolid during 2006. All patients were interviewed with the classification rules for Fine Modified Forecasting to evaluate the adequacy of hospital admissions through the analysis of associated comorbidity, severity parameters and quality indicators. Results. We detected 23 cases (6.07%) of CAP inadequately admitted, 5 of whom were Class I (21.7%), 10 Class II (43.4%) and 8 Class III (34.7%). COPD (32.5%) and hypoxemia (36%) were the comorbidities and risk factors most involved in the admission of low-risk CAP. A total of 25 (32.89%) inadequate discharges were observed from the Emergency Service and the following was found in regard to their Pneumonia Severity Index (PSI): Class I: 2 (8%), Class II: 10 (40%) Class III: 7 (28%), Class IV: 4 (16%), Class V: 0; Fine Unknown: 2. The most important comorbidity in inadequate discharges was 10 for COPD (40%). The following were performed: blood cultures in 160 cases (42.2%), chest x-ray in 379 (100%), gas and/or pulse measurement in 379 (100%), and measurement of Ag S. pneumoniae and Legionella in urine in 14 (87.5%) of the 16 cases of CAP that required admission to the ICU. Conclusion. The Fine Modified Forecasting Classification Rule can be very useful in assessing adequacy of admissions and to decide the need for hospital admission due to CAP. Adequate care for patients with CAP according to the quality indications established by the IDSA stands out(AU)

[Adequacy of the admissions and care provided to the patients with community-acquired pneumonia]. / Adecuación de los ingresos y de la asistencia facilitada a los pacientes con neumonía adquirida en la comunidad.

BACKGROUND: The purpose of this study has been to know the adequacy of the hospital admissions of patients with community-acquired pneumonia (CAP), applying the Fine Modified Forecast Classification Rule and if patient care is performed in accordance with the indicators for quality by the Infectious Diseases Society of America (IDSA) recommendations. PATIENTS AND METHODS: A cross-sectional and retrospective study analyzing the appropriateness of hospital admissions of all patients treated for CAP at the Hospital Clínico Universitario de Valladolid during 2006. All patients were interviewed with the classification rules for Fine Modified Forecasting to evaluate the adequacy of hospital admissions through the analysis of associated comorbidity, severity parameters and quality indicators. RESULTS: We detected 23 cases (6.07%) of CAP inadequately admitted, 5 of whom were Class I (21.7%), 10 Class II (43.4%) and 8 Class III (34.7%). COPD (32.5%) and hypoxemia (36%) were the comorbidities and risk factors most involved in the admission of low-risk CAP. A total of 25 (32.89%) inadequate discharges were observed from the Emergency Service and the following was found in regard to their Pneumonia Severity Index (PSI): Class I: 2 (8%), Class II: 10 (40%) Class III: 7 (28%), Class IV: 4 (16%), Class V: 0; Fine Unknown: 2. The most important comorbidity in inadequate discharges was 10 for COPD (40%). The following were performed: blood cultures in 160 cases (42.2%), chest x-ray in 379 (100%), gas and/or pulse measurement in 379 (100%), and measurement of Ag S. pneumoniae and Legionella in urine in 14 (87.5%) of the 16 cases of CAP that required admission to the ICU. CONCLUSION: The Fine Modified Forecasting Classification Rule can be very useful in assessing adequacy of admissions and to decide the need for hospital admission due to CAP. Adequate care for patients with CAP according to the quality indications established by the IDSA stands out.

Estudio de las características antropométricas y nutricionales de los adolescentes del núcleo urbano de Valladolid / Study of the anthropometric and nutritional characteristics of adolescents in the city of Valladolid

Objetivos: Descripción de las características antropométricas de una muestra de adolescentes de Valladolid junto al análisis de ingesta dietética del grupo de población. Material y métodos: Estudio de campo observacional descriptivo transversal, de una muestra de 557 adolescentes (14 - 18 años), seleccionada por muestreo probabilística de entre 6 institutos públicos y privados, de distintos barrios de Valladolid. Se realizó un cuestionario de frecuencia de consumo junto a la medición antropométrica. La clasificación de los individuos se realizó mediante el cálculo del Z-score del Índice de Masa Corporal (IMC),los puntos de corte para el IMC de Cole y criterios de la International Diabetes Federation (IDF). El análisis nutricional se realizó mediante un enfoque probabilístico y el índice de adecuación nutricional. Resultados: El exceso de peso es similar en ambos sexos(17%), sin emabargo existe un 15,2% de prevalencia de bajo peso entre las mujeres estudiadas, frente al 4,5% en varones(p<0,005). El 1,3% presentan riesgo de padecer síndrome metabólico. El consumo energético se distribuye: 30-32% lípidos, 45% hidratos de carbono y 16-17% proteínas. La valoración nutricional refleja probable déficit de consumo en yodo, zinc, vitaminas A y E. Conclusiones: La prevalencia de obesos está próxima ala de otras series, pero la prevalencia de sobrepeso es inferior. Es muy importante el porcentaje de mujeres con IMC por debajo de lo normal para su edad y sexo. Existe un exceso de aporte proteico, de grasas saturadas y de colesterol, con un déficit en el consumo de hidratos de carbono, yodo, zinc y vitaminas A y E (AU)

Objectives: A description of the anthropometric characteristics of a sample of adolescents from Valladolid and the analysis of dietary intake of the population. Materials and methods: Observational study of descriptive cross-field of a sample of 557 adolescents (14 - 18years) by probabilistic sampling from 6 public and private, in different districts of Valladolid. We carried out a food frequency questionnaire with anthropometric measurements. The classification of individuals was by calculating the Z-score of body mass index (BMI), the Cole`s cut off points for BMI and criteria of the International Diabetes Federation (IDF). Nutritional analysis: probabilistic approach and the nutrient adequacyratio. Results: Excess weight is similar in both sexes (17%),but there is a 15.2% prevalence of underweight among the women studied, compared to 4.5% in males (p<0.005). 1.3% risk of having metabolic syndrome. Energy consumption is distributed: 30-32% fat, 45% carbohydrates and 16-17% protein. The nutritional deficiency likely reflects consumption in iodine, zinc, vitamins A and E. Conclusions: The prevalence of obesity is close to that of other series, but the prevalence of overweight is lower. It is very important percentage of women with a BMI below normal for their age and sex. There is an excess of protein intake of saturated fat and cholesterol, with a deficit in the consumption of carbohydrates, iodine, zinc and vitamins A and E (AU)

[Study of the anthropometric and nutritional characteristics of adolescents in the city of Valladolid]. / Estudio de las características antropométricas y nutricionales de los adolescentes del núcleo urbano de Valladolid.

OBJECTIVES: A description of the anthropometric characteristics of a sample of adolescents from Valladolid and the analysis of dietary intake of the population. MATERIALS AND METHODS: Observational study of descriptive cross-field of a sample of 557 adolescents (14-18 years) by probabilistic sampling from 6 public and private, in different districts of Valladolid. We carried out a food frequency questionnaire with anthropometric measurements. The classification of individuals was by calculating the Z-score of body mass index (BMI), the Cole´s cutoff points for BMI and criteria of the International Diabetes Federation (IDF). Nutritional analysis: probabilistic approach and the nutrient adequacy ratio. RESULTS: Excess weight is similar in both sexes (17%), but there is a 15.2% prevalence of underweight among the women studied, compared to 4.5% in males (p<0.005). 1.3% risk of having metabolic syndrome. Energy consumption is distributed: 30-32% fat, 45% carbohydrates and 16-17% protein. The nutritional deficiency likely reflects consumption in iodine, zinc, vitamins A and E. CONCLUSIONS: The prevalence of obesity is close to that of other series, but the prevalence of overweight is lower. It is very important percentage of women with a BMI below normal for their age and sex. There is an excess of protein intake of saturated fat and cholesterol, with a deficit in the consumption of carbohydrates, iodine, zinc and vitamins A and E.

Resistencia a la insulina, síndrome metabólico y metabolismo de la glucosa en pacientes con hipertensión arterial esencial / Insulin resistance, metabolic syndrome and glucose metabolism in patients with essential arterial hypertension

Objetivo: La hipertensión arterial esencial es un trastorno asociado a la resistencia a la insulina (RI), al síndrome metabólico (SM) y a las alteraciones del metabolismo glucídico. Se evalúa su prevalencia en una población de pacientes hipertensos esenciales. Material y métodos: Estudio transversal sobre 204 pacientes hipertensos no diabéticos conocidos que acudieron a la Unidad de Hipertensión o de Medicina Interna, en el Hospital Clínico Universitario de Valladolid. Se determinaron datos antropométricos, concentraciones plasmáticas de lípidos, glucemia e insulina basal y a los 120 minutos tras la sobrecarga oral de glucosa con 75 g de glucosa. Se consideró RI cuando el índice de HOMA (homeostasis model assessment) fue ≥ 3,8. Se utilizaron los criterios de la Federación Internacional de Diabetes para el diagnóstico del SM y los de la Asociación Americana de Diabetes para el de las alteraciones de la glucosa. Resultados: La edad fue de 58,28 ± 9,86 años, siendo el 43,6% hombres. Presentaron un índice de masa corporal de 29,79 ± 3,55 kg/m2 y una circunferencia de cintura de 92,76 ± 11,92 cm. El 15,2% fue diagnosticado de RI, el 6,4% de alteración de la glucosa en ayunas, el 29,4% de intolerancia a la glucosa y el 14,7% de diabetes mellitus. El 34,3% tenían un metabolismo de la glucosa normal. El 19,1% fueron diagnosticados de SM. El 10,3% presentaron hipertrofia ventricular izquierda. No hubo diferencias significativas en cuanto al sexo salvo en los niveles de lipoproteínas de alta densidad y en el perímetro de la circunferencia, más elevados en la mujer (p < 0,001). Conclusiones: La RI, el SM y las alteraciones de la glucosa son muy frecuentes en la hipertensión arterial, lo que aumenta el riego para las enfermedades cardiovasculares(AU)

Objectives: Essential hypertension is a disorder associated to insulin resistance (IR), metabolic syndrome (MS), and glucose metabolism disorders. Its prevalence in a population of essential hypertensive patients is evaluated. Material and methods: This is a cross-sectional study on 204 hypertensive patients, with no known diabetes, who came to the hypertension unit or internal medicine service in the University Clinic Hospital of Valladolid (Spain). Anthropometrics parameters, fasting lipid profile, glycemia and basal insulin were measured at enrolment and at 120 minutes after a standard oral glucose tolerance test. IR was considered to exist when the HOMA index (homeostasis model assessment) ≥ 3.8. International Diabetes Federation criteria were used to diagnose MS and American Diabetes Association criteria to diagnose glucose disorders. Results: Patients were aged 58.28 ± 9.86 years old, with 43.6% men. Body masss index was 29.79 ± 3.55 kg/m2 and abdominal perimeter was 92.76 ± 11.92 cm. IR was observed in 15.2% of the patients, glucose disorders in 6.4%, glucose intolerance in 29.4% and 14.7% patients suffered from silent diabetes. Only 34.3% had normal glucose metabolism. 19.1% were diagnosed of MS and 10.3% had ventricular hypertrophy. There were no differences between genders and the rest of variables studied, except high density lipoproteins levels and abdominal perimeter, were higher in women (p < 0.001). Conclusions: IR, MS and glucose metabolism disorders are very frequent in essential hypertension, which increases the risk of cardiovascular diseases(AU)

Anemia ferropénica crónica en paciente joven / No disponible

No disponible

Radiografía de tórax con patrón alveolointersticial en paciente con diabetes mellitus tipo 1 y fiebre / No disponible

No disponible

[Clinical and therapeutic characteristics in patients with heart failure cared for in an internal medicine department]. / Características clínicas y terapeúticas de los pacientes ingresados en un Servicio de Medicina Interna por insuficiencia cardiaca.

INTRODUCTION: The Heart Failure (HF) is a very common clinic syndrome in the clinical practise, and a great sanitary social problem. In Spain, it is the main cause of hospitalization in Internal Medicine Services in patients over 65 years old, due to its high comorbidity, in many cases. OBJECTIVE: To determine the profile of admitted patients with HF to an Internal Medicine Service. MATERIAL AND METHODS: It is a retrospective and descriptive study. The following variables were analysed: sex, age, cause of admission, aetiology, risk factors, Framingham diagnostic criteria, type of HF, treatment-on-released, average stay, number of readmissions and the type of ventricular dysfunction (echocardiography). Chi-square test of Pearson or Fisher test were used as statistical methods. P < 0.05 was considered to be statistically relevant. RESULTS: 104 patients were analysed. The percentage of HF was 13.76%. 52.88% were men with an average age of 72.16 +/- 17.78 year. Average age for women was 82.92 +/- 7.24 year. The main cause of admission was dysnea (74%). Hypertension was the principal risk factor (70.13%). When it comes to aetiology, HTA (68.57%) was the main one. Global and left HF (33.65% either) were the most common type of HF. 5.17% of women and 20.69% of men suffered from systolic dysfunction (p < 0.023). 32.76% of women and 41.38% of men had diastolic dysfunction. The base treatment-on-release for the majority of patients consisted of diuretics and digoxin. Patients stayed 15.49 days on average, and the number of readmitted ones came up to 26.67%. CONCLUSIONS: The diagnosis and treatment of HF in an Internal Medicine Service is acceptable. It will be very important to promote the use of beta blockers and angiotensina-converting enzyme inhibitors.

Características clínicas y terapeúticas de los pacientes ingresados en un Servicio de Medicina Interna por insuficiencia cardiaca / Clinical and therapeutic characteristics in patients with heart failure cared in an Internal Medicine department

Introducción: La insuficiencia cardiaca (IC) es un síndrome muy frecuente en la práctica clínica y de gran importancia socio sanitaria. En España constituye, en pacientes mayores de 65 años, la primera causa de ingreso hospitalario en los Servicios de Medicina Interna (MI). Objetivo: determinar el perfil de los pacientes ingresados en un servicio de MI por IC. Material y métodos: Se trata de un estudio retrospectivo descriptivo. Se analizaron las siguientes variables: sexo, edad, motivo del ingreso, etiología, factores de riesgo asociados, cumplimiento de los criterios diagnósticos de Framingham, tipo de IC, tratamiento al alta, estancia media, número de reingreso y el tipo de disfunción ventricular (ecocardiografía). Método estadístico, el test Chi-cuadrado de Pearson o el test exacto de Fisher. Aquellos valores de p < 0,05 han sido considerados estadísticamente significativos. Resultados: Se analizaron un total de 104 pacientes. El porcentaje con IC, fue del 13,76%. El 52,88% fueron hombres, con una edad media de 82,92 ± 7,24 años para las mujeres y 72,16 ± 17,78 años para los hombres. Motivo principal de ingreso: disnea (74%). Factores de riesgo asociados: la HTA como más prevalente (70,13%). En cuanto a la etiología el primer lugar lo ocupa la HTA con el 68,57%. Los tipos de IC más frecuente fueron la global (33,65%) y la izquierda (33,65%). El 5,17% de las mujeres y el 20,69% de los hombres presentaron disfunción sistólica (p 0,023). Presentaban disfunción diastólica el 32,76% de las mujeres y el 41,38% de los hombres. Al alta la mayoría de los pacientes recibieron como tratamiento de fondo diuréticos y digitálicos. La estancia media fue de 15,49 días y los reingresos alcanzaron el 26,67% . Conclusión: El diagnóstico y el tratamiento de la IC en el servicio de MI es aceptable. Sería importante potenciar el uso de betabloqueantes e inhibidores de la aldosterona

Introduction: The Heart Failure (HF) is a very common clinic syndrome in the clinical practise, and a great sanitary social problem. In Spain, it is the main cause of hospitalization in Internal Medicine Services in patients over 65 years old, due to its high comorbidity, in many cases. Objective: To determine the profile of admitted patients with HF to an Internal Medicine Service. Material and methods: It is a retrospective and descriptive study. The following variables were analysed: sex, age, cause of admission, aetiology, risk factors, Framingham diagnostic criteria, type of HF, treatmenton- released, average stay, number of readmissions and the type of ventricular dysfunction (echocardiography). Chi-square test of Pearson or Fisher test were used as statistical methods. P < 0.05 was considered to be statistically relevant. Results: 104 patients were analysed. The percentage of HF was 13.76%. 52.88% were men with an average age of 72.16 ± 17.78 year. Average age for women was 82.92 ±7.24 year. The main cause of admission was dysnea (74%). Hypertension was the principal risk factor (70.13%). When it comes to aetiology, HTA (68.57%) was the main one. Global and left HF (33.65% either) were the most common type of HF. 5.17% of women and 20.69% of men suffered from systolic dysfunction (p < 0.023). 32.76% of women and 41.38% of men had diastolic dysfunction. The base treatment-on-release for the majority of patients consisted of diuretics and digoxin. Patients stayed 15.49 days on average, and the number of readmitted ones came up to 26.67%. Conclusions: The diagnosis and treatment of HF in an Internal Medicine Service is acceptable. It will be very important to promote the use of beta blockers and angiotensina-converting enzyme inhibitors

Seudotumor testicular y síndrome constitucional / Testicular pseudotumor and constitutional syndrome

No disponible

Estudio de la enfermedad arterial periférica en pacientes con diabetes mellitus tipo 2, mediante la medida del índice tobillo/brazo / Evaluation of peripheral arterial disease in patients with type 2 diabetes through the forearm-ankle index

Introducción: El diagnóstico temprano de la enfermedad arterial periférica (EAP) es el primer paso para la prevención de las amputaciones en las extremidades inferiores. Objetivo: El objetivo de este estudio es la detección de EAP en pacientes ambulatorios con diabetes mellitus tipo 2 (DM2) mediante un método Doppler, valorando el índice tobillo/brazo (ITB). Material y métodos: Se realizó un estudio prospectivo observacional sobre 109 pacientes con DM2 que acudieron sucesivamente a la consulta externa de Medicina Interna del Hospital Clínico Universitario de Valladolid. Se recogieron las características de la enfermedad y los parámetros antropométricos. Se determinaron diferentes parámetros analíticos y se valoró el grado de la EAP mediante el ITB. Los datos fueron analizados mediante el programa SPSS versión 12.0. Las pruebas utilizadas han sido la de la *2 para las variables cualitativas y la de la t de Student para las cuantitativas. Como prueba no paramétrica se empleó la U de Mann-Whitney. Se consideró valor significativo p < 0,05. Resultados: El 32,5% presentaba EAP. En el 24,5% la vasculopatía era sintomática en diferentes grados y en el 8,2%, asintomática. Llama la atención, además, el alto porcentaje de obesidad (86,9%) y la dislipemia en la totalidad de la muestra. Se apreciaron diferencias significativas, en cuanto al sexo, en la enfermedad coronaria (p < 0,05) y en el consumo de tabaco y alcohol, que es más prevalente en varones que en mujeres (p < 0,001). Conclusiones: El cálculo del ITB es un buen método para el diagnóstico ambulatorio de la EAP, así como para valorar su intensidad y orientar el pronóstico en los pacientes con DM2 (AU)

Introduction: Early diagnosis of peripheral arterial disease (PAD) is the first step in preventing amputation of the lower limbs. Objective: The aim of this study was to detect PAD in outpatients with type 2 diabetes mellitus (DM2) using a Doppler method to rate the forearm-ankle index. Material and methods: A prospective, observational study was carried out in 109 consecutive patients with DM2 who attended the Internal Medicine Outpatient Clinic at the University Hospital of Valladolid (Spain). Disease characteristics and anthropometric parameters were recorded. Various laboratory parameters were determined and the PAD ratio was evaluated using the forearm-ankle index. Data were analyzed by the SPSS program version 12.0. The statistical distributions applied were the chi-square test for qualitative variables, Student's t­test for quantitative variables and the Mann-Whitney U-test for non-parametric variables. A p-value of less than 0.05 was accepted as indicating statistical significance. Results: PAD was found in 32.5% of the patients. PAD was symptomatic, to various degrees, in 24.5% and was asymptomatic in 8.2%. The high percentage of obesity (86.9%) and dyslipemia in the entire sample was notable. Significant differences were found in sex, coronary disease (p < 0.05), smoking and alcohol consumption, which was more prevalent in men than in woman (p < 0.001). Conclusions: The forearm-ankle index is an effective method for diagnosing PAD in outpatients, evaluating its intensity and indicating prognosis in patients with DM2 (AU)

Grado de cumplimiento de los objetivos de control metabólico y de los factores de riesgo cardiovascular en pacientes diabéticos tipo 2 en un área de Atención Primaria / Degree of fulfillment of the objectives of control metabolico and the factors of diabetic cardiovascular risk in patients type 2 in an area of Primary Attention

La diabetes mellitus tipo 2 (DM2) representa un importante problema de salud pública, debido a su elevada prevalencia y alta morbimortalidad, que se incrementa, aún más, por su asociación a determinados factores de riesgo cardiovascular (FRV). Por ello es importante una acción conjunta sobre todas estas alteraciones, ya que su control previene las manifestaciones vasculares. Objetivo: Se basa en la detección y determinación del grado de control de los factores de riesgo asociados a pacientes con DM2, según los datos dados por las diferentes organizaciones internacionales, estudiados en un Centro de Salud de Valladolid. Método: Se trata de un estudio transversal descriptivo para evaluar el control de distintos FRV en pacientes diagnosticados y tratados de DM2 de acuerdo a los diferentes criterios establecidos. La muestra está formada por 74 pacientes adultos (41 varones y 33 mujeres), incluidos en el Programa de Diabetes Mellitus de un “cupo” perteneciente al Centro de Salud de Rondilla 2, del Área Este de Atención Primaria de Valladolid, para la consulta programada de control de riesgo cardiovascular. Resultados y conclusiones: Se detecta un pobre control de la mayoría de los FRV, por lo que deberán indicarse medidas de control más estrictas, con el fin de prevenir las complicaciones vasculares relacionadas con ellos

Diabetes mellitus type is one of de most important health problem in the world, due to its high prevalence and morbidity and its relation with several cardiovascular risk factors. That´s why a global action, aimed to prevent these vascular syndromes, is needed. Objective: the goal of this study is to detect and determine how cardiovascular risk factor are controlled in diabetic type 2 patients, according to the date supplied by several international organization that have been studied at a Health Centre of Valladolid. Methods: It is a descriptive cross-sectional study to evaluate the control of several cardiovascular risk factors in diabetic patients according to the different stablished criteria. The sample is formed by 74 adult patients (41 men and 33 women), included in the Diabetes Mellitus Programm at Health Centre of Rondilla 2, at East Area of Primary Care of Valladolid, in the programmed consultation of cardiovascular risk factors control. Results and conclusion: I has been observed that the majority of these cardiovascular risk factors are not well controlled. In this way, stringent mesures of control should be considered in order to prevent the cardiovascular complications related to them

[Degree of fulfillment of the objectives of metabolic control and cardiovascular risk factors in patients with type 2 diabetes in an area of primary attention]. / Grado de cumplimiento de los objetivos de control metabólico y de los factores de riesgo cardiovascular en pacientes diabéticos tipo 2 en un área de Atención Primaria.

UNLABELLED: Diabetes mellitus type is one of de most important health problem in the world, due to its high prevalence and morbidity and its relation with several cardiovascular risk factors. That s why a global action, aimed to prevent these vascular syndromes, is needed. OBJECTIVE: the goal of this study is to detect and determine how cardiovascular risk factor are controlled in diabetic type 2 patients, according to the date supplied by several international organization that have been studied at a Health Centre of Valladolid. METHODS: It is a descriptive cross-sectional study to evaluate the control of several cardiovascular risk factors in diabetic patients according to the different established criteria. The sample is formed by 74 adult patients (41 men and 33 women), included in the Diabetes Mellitus Program at Health Centre of Rondilla 2, at East Area of Primary Care of Valladolid, in the programmed consultation of cardiovascular risk factors control. RESULTS AND CONCLUSION: I has been observed that the majority of these cardiovascular risk factors are not well controlled. In this way, stringent measures of control should be considered in order to prevent the cardiovascular complications related to them.

[Observational study of patients admitted to an Internal Medicine service]. / Estudio observacional de los pacientes ingresados en un Servicio de Medicina Interna.

OBJECTIVES: To analyse the entered more frequent disease in an Internal Medicine Department, the reasons for hospital admission diagnosis at discharge (according to entrance symptom's guide), the group of affected population and its correlation among them. PATIENTS AND METHODS: Over a total of 758 internal medicine admissions of the University Hospital of Valladolid during the year 1999 based on the information of discharge and clinical histories, a descriptive and observational epidemic study was made using the variables of sex, age, reason for admission (guide symptom) and diagnosis at discharge. The obtained results were represented by mean of diagrams of sectors and bars according to the analyzed variables. The data synthesis was made by measures of central tendency and dispersion. SPSS 10.0 version for windows program was used for the statistical study. The non parametric analysis for independent samples was made by the test of median and the U of Mann Whitney, and the parametric by chi-squired test and resistance of Kolmogorov-Smirnov. RESULTS: The median of age is 70 years. Rank 84 years. Interquartile rank 23, fashion in men 75 years and in women 86. The distribution in sex men 51%, women 49%. The more frequent reasons for entrance are dyspnea (35%) and neurological focus (11%). The more frequent diagnosis at discharge are dyspnea and chronic obstructive lung disease worsened by respiratory infection (11%), pneumonia (8%) and acute ischemic stroke (7%). CONCLUSIONS: In-patients in this service, are advanced in years (mainly women) (alpha = 0.05). The age does not get a normal distribution (alpha = 0.05). The frequency of the distribution in sex is similar. The most frequent reason for admission is dyspnea (35%). The most frequent diagnoses at discharge are chronic obstructive lung disease (11%), pneumonia (8%) and acute ischemic stroke (7%). The primary and secondary prevention and an improvement of the therapeutic measures of chronic cardiopulmonary disease would reduce significantly the welfare pressure in Internal Medicine Department and they would improve the population's life quality given that we are opposed to the diseases which are among the four first mortality causes in the world.

[Urgent care of the diabetic patient in the province of Valladolid]. / Asistencia urgente del paciente diabético en el área este de la provincia de Valladolid.

OBJECTIVE: To know the cause of admissions of diabetic patients at an emergency room in eastern Valladolid in a year. METHODS: It is a retrospective and transversal study that analysed a number of the admission of diabetic patients at an emergency room because of a direct complication of diabetes mellitus or another different cause. We used t and chi 2 as statistic tests, considering 0.05 as significance. RESULTS: Up to 2,433 (2.4%) were diabetes mellitus emergencies. 17.1% because of a direct complication, most of them metabolic complications (24.6% hyperglycaemia). CONCLUSION: We emphasize the high prevalence of direct complications as emergency admissions in our hospital.