Age and Maturation Matter in Youth Elite Soccer, but Depending on Competitive Level and Gender.

This study aimed to explore the relevance of the relative age effect (RAE), maturity status and anthropometry, and their influence on coaches' assessment of players' performance, analyzing both genders and different types of academies (elite vs. non-elite). The sample included 603 soccer players (385 male), from the under 12 (U12), under 14 (U14) and under 16 (U16) categories, belonging to elite and nonelite teams. Coaches' assessment of players' performance, chronological age, anthropometric characteristics, maturity offset (MO) and peak height velocity (PHV) were registered. Our results showed that RAE was present in both genders within the elite, but not in the nonelite academies. Early maturity players were overrepresented in the male elite, but not in the female academies. No relationship was found between RAE and anthropometry in male elite academies. Male elite players showed better anthropometric characteristics than nonelite players, while this pattern of results was not found for female players. The coaches' assessment on players' current performance was not influenced by the chronological age nor anthropometry, but it was linked to the PHV. Coaches from nonelite academies rated better in current assessment of performance the taller players. Our findings suggest that maturity status and RAE play an independent and important role in the talent selection process.

Glycine Max (L.) Merr isoflavone gel improves vaginal vascularization in postmenopausal women.

Objective: This study aimed to analyze the effects of isoflavones from Glycine max (L.) Merr (soy) used topically as a vaginal gel on the induction of vascularization of the vaginal tissue in postmenopausal women.Study design: A placebo-controlled, randomized, double-blind trial was conducted with 22 postmenopausal women, randomly allocated for treatment with Glycine max (L.) Merr isoflavone 4% vaginal gel daily for 12 weeks or with placebo gel for the same period.Main outcome measure: Vaginal microbiopsies were collected before and after the 12-week treatment. Immunohistochemistry analyses were performed to provide a blood vessel count per field in the vaginal tissue, pre and post intervention.Results: The isoflavone group exhibited a significant increase in blood vessels per field relative to baseline, whereas the placebo group showed no difference compared to baseline. There was a significant difference in the increase of the number of blood vessels between the isoflavone and placebo groups.Conclusion: The results showed that local administration of Glycine max (L.) Merr isoflavone gel promoted a significant improvement in the number of blood vessels in the vaginal tissue of postmenopausal women.

Effect of urine contamination on stallion semen freezing ability.

Urospermia is a common ejaculatory dysfunction of stallions. Current practice suggests that urine contaminated semen should not be used for cryopreservation. The aim of this study was to determine effects of urine contamination on semen freezing. Sixty-five ejaculates from eight stallions were divided into no urine (CONT), low (20% urine, LOW), and high (50% urine, HIGH) samples. Semen was extended with a commercial cooling extender, cushion-centrifuged, resuspended to 200 million/mL in a commercial egg-yolk based extender, and cryopreserved in liquid nitrogen. A subset of ejaculates (n = 20) were split in two after cushion-centrifugation, and one half of the ejaculate was submitted to a single-layer gradient centrifugation before cryopreservation. Sperm motility parameters were assessed pre- and post-freezing with an automated sperm analyzer. Semen pH, creatinine, and urea concentrations were assessed in raw samples, after urine contamination and after centrifugation and extension. Statistical analyses were performed with ANOVA and Tukey's posthoc. There were significant reductions in total and progressive sperm motilities (i.e., %TM and %PM, respectively) with increasing urine contamination pre-freezing (%TM 67 ±â€¯1.7, %PM 50 ±â€¯2.2, CONT), (%TM 60.3 ±â€¯1.7, % PM 42.5 ±â€¯2.1, LOW), and (%TM 41.3 ±â€¯2, %PM 21.3 ±â€¯1.5, HIGH). Post-thaw motilities for CONT (%TM 54 ±â€¯2.3, %PM 40.8 ±â€¯3.3) and LOW (%TM 51.7 ±â€¯1.8, %PM 36.2 ±â€¯2.1) were not different, but were higher than the HIGH (%TM 31.5 ±â€¯1.2, %PM 17.1 ±â€¯1.0) (p < 0.05). Post-thaw sperm viability was significantly lower in the HIGH (54.7 ±â€¯2.4) than in the CONT (63.8 ±â€¯2.3) or LOW (64.6 ±â€¯3.4) groups. Semen creatinine and urine levels were significantly higher with increasing urine contamination and were significantly decreased after centrifugation and resuspension in freezing extender. Pre-treatment semen pH was significantly lower than semen contaminated with low or high amounts of urine, and pH decreased significantly after centrifugation and resuspension. Gradient centrifugation did not improve %TM in the control group, but it did improve pre-freeze %TM and %PM in the low and high groups and improved significantly post freezing %TM and %PM in the high urine contaminated group. Semen contaminated with a small amount of urine may be suitable for freezing, whereas highly contaminated semen might not be usable. Although urine was mostly removed in this fashion, the initial exposure to high quantities was sufficient to decrease sperm motility pre- and post-freezing, whereas low urine contamination was not as detrimental.

Análisis, por Simulación, de los Esfuerzos Cortantes en la Superficie del Iris, en Presencia de Lentes Fáquicos Intraoculares / Analysis, by Simulation, of shear stresses on the Surface of Iris, in Presence of Intraocular Factor Lenses

Resumen: En este estudio, se presenta una metodología para evaluar lentes fáquicos intraoculares, cuando el flujo del humor acuoso es asimétrico, debido a modificaciones en el área de salida del fluido. El objetivo es determinar el efecto que tienen las asimetrías del flujo del humor acuoso en el esfuerzo cortante sobre el iris y la córnea en presencia de un lente fáquico intraocular. Se considera la geometría del ojo propuesta por Repetto et al.,7 y se resuelve el flujo del humor acuso con y sin lente empleando simulaciones mediante el método de elemento finito. Para validar el método, se compara la solución numérica obtenida con los resultados de Tychsen et al.8 obteniendo valores del mismo orden. Los resultados obtenidos son perfiles de velocidad, líneas de corriente y esfuerzos cortantes en las superficies del iris y la córnea. El modelo no toma en cuenta las variaciones de la temperatura, por lo que no se consideran los efectos de flotación. Los resultados muestran que las asimetrías tienen un gran impacto en la dinámica del humor acuoso e incrementan los esfuerzos cortantes; sin embargo no son suficientes como para causar desprendimiento de las céluas del iris o de la córnea.

Abstract: The study presents a methodology to evaluate intraocular phakic lenses, considering asymmetric aqueous humor flow due to modified conditions of the fluid outlet area. The main objective is to determine the effect of asymmetries on shear stresses with and without phakik lenses. A finite element numerical simulation was developed using the eye geometry proposed by Repetto et al.6 The numerical method was tested with the results obtained by Tychsen et al.8, giving results of the same order of magnitude. Velocity profiles, pressure distribution and shear stress at the solid boundaries are shown. The model does not take into account temperature variations. Therefore no buoyancy effects were considered. The results show that the induced asymmetries have a significant impact on aqueous humor velocity and on shear forces; however the shear stresses are not sufficient to cause cell detachment so the lens can be considered as harmless.

Innovación en la prevención cardiovascular: la polipíldora / Innovation in cardiovascular prevention: the combined pill

No disponible

Gender differences in prognostic factors for oral cancer.

The aim of this study was to assess gender differences in prognostic factors among patients treated surgically for oral squamous cell carcinoma (OSCC). The medical records of 477 eligible patients (345 males, 132 females) obtained from the Brazilian Cancer Institute were reviewed. Survival was calculated by Kaplan-Meier method. Cox regression models were used to obtain adjusted hazard ratios (aHR) for males and females. Multivariate analysis showed that past tobacco use (aHR 0.2, 95% confidence interval (CI) 0.1-0.7) and regional metastasis (aHR 2.3, 95% CI 1.5-3.5) in males, and regional metastasis (aHR 2.2, 95% CI 1.2-4.3), distant metastasis (aHR 6.7, 95% CI 1.3-32.7), and hard palate tumours (aHR 11.8, 95% CI 3.3-47.7) in females, were associated with a higher risk of death. There were no differences in survival between males and females. Regional metastasis was found to be a negative prognostic factor in OSCC for both genders. Past tobacco use was an independent prognostic factor for worse survival among males, while distant metastasis and hard palate tumours were independent prognostic factors for worse survival among females. Further studies are necessary to corroborate the relationships found in this study.

High doses of lercanidipine are better tolerated than other dihydropyridines in hypertensive patients with metabolic syndrome: results from the TOLERANCE study.

AIMS/INTRODUCTION: The TOlerabilidad de LERcanidipino 20 mg frente a Amlodipino y Nifedipino en CondicionEs normales de uso study was aimed to compare the tolerability of high doses of lercanidipine with amlodipine and nifedipine gastro-intestinal therapeutic system (GITS) in the treatment of hypertension in daily clinical practice. PATIENTS/METHODS: Essential hypertensives >or= 18 years, treated during at least 1 month with lercanidipine 20 mg, amlodipine 10 mg or nifedipine GITS 60 mg, after a previous treatment course of at least 1 month with half the dose of the corresponding drugs were included. We present the data of the subgroup of patients with metabolic syndrome (MetS). RESULTS: Three hundred and thirty-seven of the 650 study population fulfilled criteria of MetS, 233 (69.1%) on lercanidipine and 104 (30.9%) on amlodipine/nifedipine GITS. Overall, a significantly lower proportion of lercanidipine-treated patients showed adverse reactions (ARs) when compared with patients receiving other-dihydropyridines (DHPs) (60.1% vs. 73.1%, p = 0.003). Similarly, the most common vasodilation-related ARs (oedema, swelling, flushing and headache) were significantly less frequent in lercanidipine group (all p < 0.01). CONCLUSION: In conclusion, lercanidipine appears to exhibit a better tolerability profile and less vasodilation-related ARs compared with other DHPs in hypertensive patients with MetS.

[Biotechnologic drugs and chemotherapy for infectious diseases]. / Fármacos biotecnológicos y quimioterapia antiinfecciosa.

Developments in biotechnology in recent years have enabled the discovery of new pharmacological agents for the treatment and prophylaxis of infectious diseases. The agents obtained from these biotechnological procedures possess specific characteristics which significantly distinguish them from drugs obtained by chemical synthesis. These properties cover the entire development process, from investigation and production up to their administration to patients. The pharmokinetics of these preparations influence their administration routes and dosage regimens. The discovery of these drugs has led to major advances in the treatment and prophylaxis of infectious processes which until very recently had no effective treatment. The investigation and production of these drugs requires the use of highly technical resources resulting in high costs and therefore a more expensive drug on the market compared to other drugs. Nevertheless, well documented pharmoeconomic studies show that the use of this type of drug for certain symptoms may be highly cost effective. This article includes some of the possible applications of biotechnology in the infectious disease field, although the current situation indicates that more detailed and broader applications may be elaborated on in ensuing issues. The future of these drugs in chemical therapy for the treatment and prophylaxis of infectious diseases is exceedingly promising and many of these drugs are currently under laboratory investigation, more so than those under development from a chemical synthesis approach.

Fármacos biotecnológicos y quimioterapia antiinfecciosa / Biotechnologic drugs and chemotherapy for infectious diseases

El desarrollo de la biotecnología en los últimos años ha propiciado nuevas posibilidades farmacológicas para el tratamiento y la profilaxis de las enfermedades infecciosas. Los fármacos que se obtienen por procedimientos biotecnológicos presentan unas características específicas que los diferencian sensiblemente de los medicamentos que se obtienen por síntesis química. Estas propiedades abarcan desde todo el proceso de investigación y producción hasta la conservación y la administración a los pacientes. La farmacocinética de estos preparados condiciona sus vías de administración y esquemas posológicos. Las nuevas indicaciones de estos fármacos suponen un notable avance en la terapia y la profilaxis de procesos infecciosos para los que hasta hace muy poco tiempo no teníamos tratamientos suficientemente eficaces. La investigación y la producción de los medicamentos biotecnológicos exige el empleo de recursos altamente tecnificados, lo que lleva a que los costes sean altos y los precios de su puesta en el mercado más elevados que los de otros fármacos. Sin embargo, estudios de farmacoeconomía bien realizados demuestran que el uso de este tipo de fármacos en indicaciones bien enfocadas puede ser altamente rentable. En este artículo se citan algunos aspectos de las posibilidades de la biotecnología en el campo de las enfermedades infecciosas, pero evidentemente la realidad es mucho más amplia. El futuro de los medicamentos biotecnológicos en el campo de la quimioterapia, de las enfermedades infecciosas y su profilaxis, es muy prometedor y en el momento actual se encuentran en desarrollo numerosos fármacos que superan ampliamente a los de síntesis química en la misma situación

Developments in biotechnology in recent years have enabled the discovery of new pharmacological agents for the treatment and prophylaxis of infectious diseases. The agents obtained from these biotechnological procedures possess specific characteristics which significantly distinguish them from drugs obtained by chemical synthesis. These properties cover the entire development process, from investigation and production up to their administration to patients. The pharmokinetics of these preparations influence their administration routes and dosage regimens. The discovery of these drugs has led to major advances in the treatment and prophylaxis of infectious processes which until very recently had no effective treatment. The investigation and production of these drugs requires the use of highly technical resources resulting in high costs and therefore a more expensive drug on the market compared to other drugs. Nevertheless, well documented pharmoeconomic studies show that the use of this type of drug for certain symptoms may be highly cost effective. This article includes some of the possible applications of biotechnology in the infectious disease field, although the current situation indicates that more detailed and broader applications may be elaborated on in ensuing issues. The future of these drugs in chemical therapy for the treatment and prophylaxis of infectious diseases is exceedingly promising and many of these drugs are currently under laboratory investigation, more so than those under development from a chemical synthesis approach

Pharmacokinetic/pharmacodynamic serum and urine profile of cefditoren following single-dose and multiple twice- and thrice-daily regimens in healthy volunteers: a phase I study.

The objectives of this randomized, double-blind study were to evaluate the pharmacokinetics, and the pharmacodynamic and gastrointestinal (GI) tolerance of cefditoren pivoxil in healthy adult male volunteers when it is administered three times a day. Twenty healthy volunteers were included in the study. On day 1, 10 subjects received a 200-mg single dose of cefditoren pivoxil and 10 received a 400-mg dose. After a washout period of 8 days, eight subjects received cefditoren pivoxil 400 mg b.i.d., eight received 400 mg t.i.d., and four received placebo for 10 days. Medication was taken 30 min after meals. Blood and urine collections were carried out on days 1, 9, 14 and 19. Volunteers were asked about any GI change, especially about bowel habits, nausea, vomiting and abdominal pain. The maximum cefditoren concentration (C(max)) had a mean value of 3.77+/-0.66 mg/l, and was reached between 1.5 and 3 h in the thrice-daily administration. In the twice-daily regimen, the C(max) was 3.27+/-0.64 mg/l. The mean time above breakpoint minumum inhibitory concentration (MIC), calculated with data from each pharmacokinetic profile, was always above 40%, in both the twice- and thrice-daily regimens. The half-life of cefditoren was 1.19+/-0.2 h and 1.36+/-0.2 h in the twice-daily and thrice-daily regimens, respectively. The C(max) of cefditoren in urine was reached between 2 and 4 h postadministration, with a mean value of 154.53 mg/l in the twice-daily regimen, and 186.59 mg/l in the thrice-daily administration. There were no differences between the groups in the incidence of GI adverse events. The present data show that the administration of cefditoren pivoxil 400 mg t.i.d. is possible because it is well tolerated, and it increases the probability of success when the MIC of the causative bacteria is close to the susceptibility breakpoint. The high concentrations of active drug in the urine enable cefditoren to be considered as a useful candidate for the treatment of uncomplicated urinary tract infections (UTIs).

Pharmacokinetic/pharmacodynamic serum and urine profile of cefditoren following single-dose and multiple twice- and thrice-daily regimens in healthy volunteers: a phase I study

El objetivo del estudio fue valorar la farmacocinética, la farmacodinámica y la tolerabilidad digestiva del cefditoreno pivoxilo en 20 voluntarios varones adultos sanos tras su administración cada 8 horas. Durante el primer día la mitad de ellos recibieron una dosis única de 200 mg y la otra mitad 400 mg. Tras un periodo de lavado de ocho días, ocho voluntarios recibieron 400 mg cada 12 horas, otros ocho 400 mg cada 8 horas y cuatro placebo durante 10 días, siguiendo un diseño aleatorizado y doble ciego. La medicación se tomó 30 minutos después de las comidas. Se recogieron muestras de sangre y orina en los días 1, 9, 14 y 19. Se preguntó a los voluntarios si habían notado algún trastorno digestivo, sobre todo en sus hábitos intestinales, náuseas, vómitos o dolor abdominal. El valor medio de la concentración máxima de cefditoreno (Cmax) fue 3,77±0,66 mg/l y se alcanzó tras 1,5 a 3 horas con la administración tres veces al día. En el régimen de administración cada 12 horas la Cmax fue 3,27±0,64 mg/l. El tiempo medio por encima de la CMI calculado a partir de los datos derivados de cada perfil farmacocinético superó siempre el 40%, tanto cuando se administraba el fármaco cada 12 horas como cada 8 horas. La semivida del cefditoreno fue 1,19±0,2 horas y 1,36±0,2 horas para la administración cada 12 y cada 8 horas, respectivamente. La máxima concentración de cefditoreno en la orina se alcanzó entre 2 y 4 horas después de la administración, con un valor medio de 154,53 mg/l cuando se administraba cada 12 horas y 186,59 mg/l cuando se hacía cada 8 horas. No se encontraron diferencias en la incidencia de efectos adversos digestivos entre los grupos. Estos datos demuestran que se puede administrar 400 mg cada 8 horas, porque esta dosis se tolera bien y aumenta la probabilidad de tener éxito cuando la CMI de la bacteria causante se encuentra cerca del punto de corte de sensibilidad. Las elevadas concentraciones de fármaco activo en la orina permiten considerar al cefditoreno como un fármaco útil en el tratamiento de las infecciones de vías urinarias no complicadas

The objectives of this randomized, double-blind study were to evaluate the pharmacokinetics, and the pharmacodynamic and gastrointestinal (GI) tolerance of cefditoren pivoxil in healthy adult male volunteers when it is administered three times a day. Twenty healthy volunteers were included in the study. On day 1, 10 subjects received a 200-mg single dose of cefditoren pivoxil and 10 received a 400-mg dose. After a washout period of 8 days, eight subjects received cefditoren pivoxil 400 mg b.i.d., eight received 400 mg t.i.d., and four received placebo for 10 days. Medication was taken 30 min after meals. Blood and urine collections were carried out on days 1, 9, 14 and 19. Volunteers were asked about any GI change, especially about bowel habits, nausea, vomiting and abdominal pain. The maximum cefditoren concentration (Cmax) had a mean value of 3.77±0.66 mg/l, and was reached between 1.5 and 3 h in the thrice-daily administration. In the twice-daily regimen, the Cmax was 3.27±0.64 mg/l. The mean time above breakpoint minumum inhibitory concentration (MIC), calculated with data from each pharmacokinetic profile, was always above 40%, in both the twice- and thrice-daily regimens. The half-life of cefditoren was 1.19±0.2 h and 1.36±0.2 h in the twice-daily and thrice-daily regimens, respectively. The Cmax of cefditoren in urine was reached between 2 and 4 h postadministration, with a mean value of 154.53 mg/l in the twice-daily regimen, and 186.59 mg/l in the thrice-daily administration. There were no differences between the groups in the incidence of GI adverse events. The present data show that the administration of cefditoren pivoxil 400 mg t.i.d. is possible because it is well tolerated, and it increases the probability of success when the MIC of the causative bacteria is close to the susceptibility breakpoint. The high concentrations of active drug in the urine enable cefditoren to be considered as a useful candidate for the treatment of uncomplicated urinary tract infections (UTIs)

Detection and incidence of drug-induced agranulocytosis in hospital: a prospective analysis from laboratory signals.

AIMS: Our objectives were to assess the detection and incidence of drug-induced agranulocytosis in two university hospitals using hematology laboratory data. METHODS: A prospective study was undertaken at Toulouse University Hospital (France) and Navarra University Hospital (Spain) for 1 year (from 1 May 2004 to 30 April 2005). Using a computerized process and hematology laboratory data, all neutrophil counts with a value less than 500/mm(3) were registered, allowing identification of inpatients suffering from agranulocytosis during the period of the study. Medical records of all selected patients were then consulted. Cytostatic drugs were excluded from this study. RESULTS: During the period of the study, 225,659 neutrophil counts were performed in both hospitals, of which 2,835 (1.26%) had a neutrophil count less than 500/mm(3), corresponding to 739 patients. Seventeen patients were excluded because of lack of data, and 20 cases of infants younger than 3 months were excluded. Among the remaining patients (n = 702), 23 cases of drug-induced agranulocytosis (excluding cytostatic drugs) were suspected. All cases were classified as "serious" since they led to death in 2 cases, hospitalization or prolongation of hospitalization in 19 cases and threatening of vital prognosis in 2 cases. Withdrawal of suspected drugs was done in all cases with regression of neutropenia in 21 cases. According to hospitalization data, the annual incidence of drug-induced agranulocytosis was 1.62 (1.0-2.6) per 10,000 inpatients in Toulouse University hospital (based on 534 cases) and 3.24 (0.9-8.3) per 10,000 inpatients in Navarra University Hospital (based on 168 cases). The involved drugs were mainly antibacterial (30.4%), immunosuppressive (17.4%), antithyroid (13.0%), antiplatelet (8.7%) and nonsteroidal anti-inflammatory (8.7%) ones. Only seven cases from Toulouse University Hospital were spontaneously reported by physicians during the same period. Thus, the underreporting coefficient (U) was 2.71 (63.2%) in France. CONCLUSION: Our survey allowed us to identify the suspected drug-induced agranulocytosis through a prospective study in a large sample of inpatients using only laboratory data analysis. We also note an important underreporting rate of this serious adverse drug reaction (ADR) to the official French pharmacovigilance system. Laboratory data analysis could be used for identifying serious ADRs.

[Albuminuria and cardiovascular risk: basal results of the KORAL-CARDIO study]. / Albuminuria y riesgo cardiovascular. Estudio KORAL-CARDIO.

BACKGROUND AND OBJECTIVES: Albuminuria is a marker of higher cardiovascular and renal risk in hypertension; it also indicates the need of a tighter control of blood pressure with drugs blocking the renin-angiotensin system. The objective of the KORAL-CARDIO study was to assess the clinical picture and management of patients with hypertension and cardiac disease and albuminuria not previously treated with angiotensin inhibitors. METHODS: A total of 2711 hypertensive patients (44% female) with ischemic or hypertensive cardiopathy or atrial fibrillation and with a positive screening test for albuminuria was included. Type 2 diabetes was also present in 42%. RESULTS: Macroalbuminuria was present in 7.2% of non diabetic and 12.7% of diabetic patients, respectively. Associated complications were: 25% and 35% body mass index over 30 kg/m2; 22% and 39% ischemic heart disease; 4% and 8% stroke; 19% and 22% atrial fibrillation; 42% and 53% high cholesterol levels; 8% and 8% grade 3 hypertension, for non-diabetics and diabetics respectively. Antihypertensive monotherapy was used in 66% of non-diabetics and in 63% of diabetics; only 7% of patients in both groups were treated with triple antihypertensive therapy. CONCLUSIONS: Cardiovascular complications are very frequently associated to albuminuria in patients with hypertension and heart disease not previously treated with angiotensin inhibitors. Blood pressure control was clearly inadequate in this group.

Impacto del tratamiento con irbesartán sobre la reducción del riesgo cardiovascular de pacientes hipertensos en España. Estudio KORAL-HTA / Impact of treatment with irbesartan on reduction of cardiovascular risk in hypertensive patients in Spain. Koral-HTA study

Objetivos. Evaluar la eficacia de irbesartán para alcanzar los objetivos de presión arterial (PA) establecidos por las guías y en reducir la microalbuminuria (MAU) en pacientes hipertensos no controlados. Evaluar este efecto tanto en pacientes diabéticos como no diabéticos y en diferentes rangos de índice de masa corporal (IMC). Estudiar el impacto de este tratamiento sobre el riesgo coronario global (RCG) valorado mediante las tablas REGICOR. Métodos. KORAL-HTA es un estudio observacional, prospectivo y abierto de 1 año de seguimiento en pacientes hipertensos no controlados con al menos otro factor de riesgo cardiovascular atendidos en Unidades de Hipertensión en toda España. Resultados. Estudiamos 1.657 pacientes (el 59,5 % de hombres; edad media (desviación estándar [DE]): 60,3 [12,0] años). Un 48,4 % presentaba diabetes mellitus (DM), un 48,2 % dislipemia y MAU un 63,6 %. Un 70 % de los pacientes alcanzó los objetivos de PA (< 140/90 mmHg y < 130/80 mmHg en no DM y DM, respectivamente). La proporción de pacientes con MAU y proteinuria se redujo del 63,6 % al 48,3 % y del 19,4 % al 10,8 %, respectivamente; p < 0,01, en el grupo global, así como en los pacientes con y sin DM, y en los diferentes rangos del IMC. El RCG disminuyó desde (mediana [perc 25-75]) 5,9 (3,0-8,0) y 9,7 (5,0-12,0) basalmente, en no diabéticos y diabéticos, respectivamente, a 4,0 (3,0-5,0) y 5,0 (3,8-7,0), respectivamente, a los 12 meses (p < 0,001). Conclusiones. La reducción de la PA y la MAU con el tratamiento con irbesartán se asocia a una reducción del RCG en los pacientes hipertensos. Este estudio confirma además, en condiciones de práctica clínica, que los beneficios sobre la MAU no se limitan únicamente a los pacientes con DM, sino también a aquellos no diabéticos y son constantes en los diferentes rangos del IMC

Objectives. Evaluate the efficacy of irbesartan to reach the blood pressure objectives established in the guides and reduce microalbuminuria (MAU) in uncontrolled hypertensive patients. Evaluate this effect in both diabetic and non-diabetic patients and in different BMI ranges. Study the impact of this treatment on global coronary risk (GCR) assessed with the REGICOR tables. Methods. KORAL-HTA is an observational, prospective, open-label 1-year follow-up study in uncontrolled hypertensive patients with at least one other cardiovascular risk factor seen in hypertensive units in all Spain. Results. We studied 1,657 patients (59.5 % men; mean age (SD): 60.3 (12.0) years). A total of 48.4 % had DM, 48.2 % dyslipidemia and 63.6 % MAU. Seventy percent of the patients achieved the BP objectives (< 140/90 mmHg and < 130/80 mmHg in non-DM and DM, respectively). The proportion of patients with MAU and proteinuria decreased from 63.6 % to 48.3 % and from 19.4 % to 10.8 %, respectively; p < 0.01, in the global group and in patients with and without DM, and in the different BMI ranges. GCR decreased from (median [perc 25-75]) 5.9 (3.0-8.0) and 9.7 (5.0-12.0) at baseline, in non-diabetics and diabetics, respectively to 4.0 (3.0-5.0) and 5.0 (3.8-7.0), respectively, at 12 months (p < 0.001). Conclusions. BP and MAU decrease with Irbesartan treatment is associated to a decrease in GCR in hypertensive patients. This study also confirms under clinical practice conditions that the benefits on MAU are not only limited to patients with DM but also to the non-diabetics and are constant in the different BMI ranges

Albuminuria y riesgo cardiovascular. Estudio KORAL-CARDIO / Albuminuria and cardiovascular risk: basal results of the Koral-Cardio study

Introducción y objetivos: La presencia de albuminuria identifica a un grupo dehipertensos con mayor riesgo cardiovascular y renal y obliga a controlar mejor lapresión arterial con fármacos que bloqueen el sistema renina-angiotensina. El objetivodel estudio KORAL-CARDIO fue determinar las características clínicas y demanejo de pacientes con hipertensión, albuminuria y cardiopatía no tratados previamentecon inhibidores angiotensínicos.Pacientes y métodos: Se incluyen prospectivamente 2.711 pacientes (44% mujeres)de 64 años de media con hipertensión arterial, cardiopatía isquémica o hipertensivao fibrilación auricular con positividad en la detección cualitativa de albuminuria.El 42% tenían además diabetes mellitus de tipo 2.Resultados: El 7,2% de los no diabéticos y el 12,7% de los diabéticos teníanmacroalbuminuria; el 25% y el 35% respectivamente tenían índice de masa corporalde más de 30 kg/m2. Las complicaciones asociadas fueron: cardiopatía isquémica(22 y 39%), ictus (4 y 8%), fibrilación auricular (19 y 22%), hipercolesterolemia(42 y 53%), hipertensión de grado 3 (8% en ambos casos). Recibíantratamiento antihipertensivo monofármaco el 66% de los no diabéticos y el 63%de los diabéticos, y sólo el 7% triple terapia; otros tratamientos fueron: hipolipemiantes(41 y 57%) y antiagregantes (37 y 58% respectivamente).Conclusiones: Las complicaciones asociadas a la albuminuria en hipertensos concardiopatías, diabéticos y no diabéticos, no tratados con inhibidores angiotensínicosson muy frecuentes. El grado de control tensional fue escaso en este grupo

Background and objectives: Albuminuria is a marker of higher cardiovascularand renal risk in hypertension; it also indicates the need of a tighter control of blood pressure with drugs blocking the renin-angiotensin system. The objective ofthe KORAL-CARDIO study was to assess the clinical picture and management ofpatients with hypertension and cardiac disease and albuminuria not previously treatedwith angiotensin inhibitors.Methods: A total of 2,711 hypertensive patients (44% female) with ischemic orhypertensive cardiopathy or atrial fibrillation and with a positive screening test foralbuminuria was included. Type 2 diabetes was also present in 42%.Results: Macroalbuminuria was present in 7.2% of non diabetic and 12.7% ofdiabetic patients, respectively. Associated complications were: 25% and 35% bodymass index over 30 kg/m2; 22% and 39% ischemic heart disease; 4% and 8%stroke; 19% and 22% atrial fibrillation; 42% and 53% high cholesterol levels; 8%and 8% grade 3 hypertension, for non-diabetics and diabetics respectively. Antihypertensivemonotherapy was used in 66% of non-diabetics and in 63% of diabetics;only 7% of patients in both groups were treated with triple antihypertensivetherapy.Conclusions: Cardiovascular complications are very frequently associated to albuminuriain patients with hypertension and heart disease not previously treatedwith angiotensin inhibitors. Blood pressure control was clearly inadequate in thisgroup

Antimicrobial therapy for pulmonary pathogenic colonisation and infection by Pseudomonas aeruginosa in cystic fibrosis patients.

Pseudomonas aeruginosa colonisation has a negative effect on pulmonary function in cystic fibrosis patients. The organism can only be eradicated in the early stage of colonisation, while reduction of bacterial density is desirable during chronic colonisation or exacerbations. Monthly, or at least 3-monthly, microbiological culture is advisable for patients without previous evidence of P. aeruginosa colonisation. Cultures should be performed at least every 2-3 months in patients with well-established colonisation, and always during exacerbations or hospitalisations. Treatment of patients following the first isolation of P. aeruginosa, but with no clinical signs of colonisation, should be with oral ciprofloxacin (15-20 mg/kg twice-daily for 3-4 weeks) plus inhaled tobramycin or colistin (intravenous treatment with or without inhaled treatment can be used as an alternative), while patients with acute infection should be treated for 14-21 days with high doses of two intravenous antimicrobial agents, with or without an inhaled treatment during or at the end of the intravenous treatment. Maintenance treatment after development of chronic P. aeruginosa infection/colonisation (pathogenic colonisation) in stable patients (aged>6 years) should be with inhaled tobramycin (300 mg twice-daily) in 28-day cycles (on-off) or, as an alternative, colistin (1-3 million units twice-daily). Colistin is also a possible choice for patients aged<6 years. Treatment can be completed with oral ciprofloxacin (3-4 weeks every 3-4 months) for patients with mild pulmonary symptoms, or intravenously (every 3-4 months) for those with severe symptoms or isolates with ciprofloxacin resistance. Moderate and serious exacerbations can be treated with intravenous ceftazidime (50-70 mg/kg three-times-daily) or cefepime (50 mg/kg three-times-daily) plus tobramycin (5-10 mg/kg every 24 h) or amikacin (20-30 mg/kg every 24 h) for 2-3 weeks. Oral ciprofloxacin is recommended for patients with mild pulmonary disease. If multiresistant P. aeruginosa is isolated, antimicrobial agents that retain activity are recommended and epidemiological control measures should be established.

Tratamiento antimicrobiano frente a la colonización pulmonar por Pseudomonas aeruginosa en el paciente con fibrosis quística / No disponible

No disponible

Farmacoeconomía y tratamientode la hipertensión arterial / Drug cost-effectiveness and arterial hypertensive treatment

No disponible