Right bundle branch block: Prevalence, incidence, and cardiovascular morbidity and mortality in the general population.

Background: Right bundle branch block (RBBB) is among the most common electrocardiographic abnormalities. Objectives: To establish the prevalence and incidence of RBBB in the general population without cardiovascular events (CVE) and whether RBBB increases cardiovascular morbidity and mortality compared with patients with a normal electrocardiogram (ECG). Methods: A historical study of two cohorts including 2981 patients from 29 primary health centres without baseline CVE. Cox (for CVE) and logistic (for cardiovascular factors) regression was used to assess their association with RBBB. Results: Of the patients (58% women; mean age 65.9), 92.2% had a normal ECG, 4.6% incomplete RBBB (iRBBB) and 3.2% complete RBBB (cRBBB). Mean follow-up was five years. Factors associated with appearance of cRBBB were male sex (HR = 3.8; 95%CI: 2.4-6.1) and age (HR = 1.05 per year; 95%CI: 1.03-1.08). In a univariate analysis, cRBBB was associated with an increase in all-cause mortality but only bifascicular block (BFB) was significant after adjusting for confounders. cRBBB tended to increase CVE but the results were not statistically significant. Presence of iRBBB was not associated with adverse outcomes. Patients with iRBBB who progressed to cRBBB showed a higher incidence of heart failure and chronic kidney disease. Conclusion: In this general population cohort with no CV disease, 8% had RBBB, with a higher prevalence among men and elderly patients. Although all-cause mortality and CVE tended to increase in the presence of cRBBB, only BFB showed a statistically significant association with cRBBB. Patients with iRBBB who progressed to cRBBB had a higher incidence of CVE. We detected no effect of iRBBB on morbidity and mortality.

Diagnosis of right bundle branch block: a concordance study.

BACKGROUND: Right bundle branch block is one of the most common electrocardiographic abnormalities. Most cases of right bundle branch block are detected in asymptomatic patients in primary care, so a correct interpretation of electrocardiograms (ECGs) at this level is necessary. The objective of this research is to determine the degree of concordance in the diagnosis of incomplete and complete right bundle branch block between four primary care researchers and a cardiologist. METHODS: The research design is a retrospective cohort study of patients over 18 years of ages of patients over 18 years of ages who underwent an ECG for any reason and were diagnosed with right bundle branch block by their physician. The physicians participating, 4 primary care researchers and a cardiologist were specialized in interpreting electrocardiographic records. The diagnosis of incomplete and complete right bundle branch block was recorded and other secondary variables were analysed. In case of diagnostic discordance between the researchers, the ECGs were reviewed by an expert cardiologist, who interpreted them, established the diagnosis and analysed the possible causes for the discrepancy. RESULTS: We studied 160 patients diagnosed with right bundle branch block by their general practise. The patients had a mean age of 64.8 years and 54% of them were men. The concordance in the diagnosis of incomplete right bundle branch block showed a Fleiss' kappa index (k) of 0.71 among the five researchers and of 0.85 among only the primary care researchers. The k for complete right bundle branch block was 0.93 among the five researchers and 0.96 among only the primary care researchers. CONCLUSION: The interobserver agreement in the diagnosis of right bundle branch block performed by physicians specialized in ECG interpretation (primary care physicians and a cardiologist) was very good. The variability was greater for the diagnosis of incomplete right bundle branch block.

Documento de consenso sobre el abordaje de la enfermedad de Chagas en Atención Primaria de salud de áreas no endémicas / Consensus document for the detection and management of Chagas disease in Primary Health Care in non-endemic areas

La tripanosomiasis americana o enfermedad de Chagas es una enfermedad infecciosa endémica en América Latina continental, causada por el protozoo Trypanosomacruzi. En las últimas décadas, debido a los movimientos poblacionales, se ha expandido más allá de las zonas endémicas, siendo España el país europeo con más inmigrantes latinoamericanos. Durante años puede permanecer asintomática, pero cuando se manifiesta clínicamente puede ser grave (miocardiopatía dilatada, megacolon, megaesófago). Así como, debido a su transmisión vertical, la detección en embarazadas es una alta prioridad. Se han elaborado guías de detección de Trypanosomacruzi en circunstancias específicas (bancos de sangre, maternidades, coinfección con VIH, trasplante de órganos); pero detectamos falta de información dirigida a los profesionales de atención primaria. Para facilitar la detección y manejo de esta enfermedad se consideró la necesidad de realizar este documento, redactado y consensuado por médicos de familia, pediatras de Atención Primaria y especialistas en Salud Internacional (AU)

Chagas disease is caused by the protozoan Trypanosoma cruzi. Although it is commonly transmitted by an insect vector in continental Latin-America, in recent decades, due migration, it has been diagnosed in other countries such as Spain, the European country with a largest immigrant population of Latin Americans. For a long time, the patient remains asymptomatic, but some years after this stage, the symptoms can be serious (dilated cardiomyopathy, megacolon, megaesophagus). In addition, detection in pregnant women has a high priority because of the route of vertical transmission. Several specific guidelines about Chagas disease have been developed (blood banks, maternal hospitals, HIV co-infection, organ transplant). But lack of information to primary care professionals has been detected. We consider this document written and agreed by family physicians, pediatricians and specialists in International Health will be useful (AU)

[Odynophagia, fever and rash in a 33 year-old woman]. / Odinofagia, fiebre y exantema en mujer de 33 años.

Hand-Foot-Mouth disease is a viral exanthematous disease primarily caused by Coxsackie virus that mainly affects children under 10 years-old during the spring or summer. It is a rare disease in adults, and rarer still in the immunocompetent. We report the case of a 33-year-old immunocompetent adult affected bys Hand Foot Mouth disease.

Odinofagia, fiebre y exantema en mujer de 33 años / Odynophagia, fever and rash in a 33 year-old woman

La enfermedad boca-mano-pie es una enfermedad exantemática viral producida principalmente por virus Coxsackie que afecta en su mayoría a niños menores de 10 años en época de primavera o verano. Es una enfermedad infrecuente en adultos y más infrecuente en personas inmunocompetentes. Presentamos el caso de una mujer de 33 años, inmunocompetente, afectada de enfermedad boca-mano-pie (AU)

Hand-Foot-Mouth disease is a viral exanthematous disease primarily caused by Coxsackie virus that mainly affects children under 10 years-old during the spring or summer. It is a rare disease in adults, and rarer still in the immunocompetent. We report the case of a 33-year-old immunocompetent adult affected bys Hand Foot Mouth disease (AU)

[Effectiveness of self-monitoring of blood pressure in white coat hypertension diagnosis. Rationale and design]. / Efectividad de la automedida de la presión arterial en el diagnóstico de la hipertensión clínica aislada. Justificación y diseño del estudio.

OBJECTIVE: To assess the effectiveness of blood pressure self-monitoring at home in front of 24-h blood pressure ambulatory measurement in isolated clinical hypertension diagnosis. DESIGN: Comparative study of repeated measurements of self-monitoring home BP and 24-h ambulatory BP measurement in a hypertensive patients sample. SETTING AND SUBJECTS TO STUDY: Mild-moderate essential hypertensive patients newly diagnosed or previously diagnosed in which suspect isolated clinical hypertension (BP>140/90 mm Hg in clinical setting repeatedly). It needs a sample of 182 hypertensive patients seen at urban primary health care. PRINCIPAL MEASUREMENTS: We compute the isolated clinical hypertension prevalence, the sensibility, specificity and positive and negative predictive values, with 95% confidence intervals. DISCUSSION: Prove the effectiveness of blood pressure self-monitoring at home in insolated clinical hypertension diagnosis, can involve an important cost saving for health care system as in hypertensive patient management (medicines and office visits), as in diagnosis equipment.

Automedida de la presión arterial domiciliaria y telemedicina. ¿Qué nos depara el futuro? / Self-management of blood pressure at home and tele-medicine: what does the future hold for us?

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[Demographic characterization, consultation reasons and prevalent morbidity in the African immigrating community of the Maresme district]. / Caracterización demográfica, motivos de consulta y morbilidad prevalente en la comunidad de inmigrantes africanos de la comarca del Maresme.

BACKGROUND: To know the demographic condition, main symptoms and diagnosis in adult African immigrants from a reference Hospital. PATIENTS AND METHOD: A prospective protocol between 1984-1994. RESULTS: 1,321 immigrants were considered. Most of them had an unstable job and illegal situation and they did not speak any European language. Abdominal pain was the most common symptom. The most frequent diagnoses were parasitic/infections and digestive and haematological diseases. CONCLUSIONS: Immigration is not a risk for public health. The illegal situation carries poor sanitary conditions. The clinical protocols help to overcome cultural and idiomatic barriers.