Adherencia a la dieta mediterránea en pacientes afectos de glaucoma primario de ángulo abierto / Mediterranean diet adherence by patients with primary open angle glaucoma

Objetivo: Estudiar la adherencia a la dieta mediterránea (dM) en pacientes diagnosticados de glaucoma primario de ángulo abierto (GPAA). Material y métodos: Se realizó un estudio observacional para valorar la adherencia a la dM en los pacientes diagnosticados de GPAA que acuden a la consulta del Servicio de Oftalmología del Complejo Hospitalario Universitario de Canarias. Consistió en la realización de una encuesta -personal o telefónica-, compuesta de 14 ítems validados por el estudio PREDIMED. Resultados: Se encuestó a 100 pacientes, 50 hombres y 50 mujeres. El grupo de los hombres tenía una edad media de 69,58 años y el de las mujeres, de 67,42 años. Los hombres presentaban mayores comorbilidades que las mujeres (tabaco 28 vs. 6%), hipertensión arterial (60 vs. 56%), diabetes (32 vs. 12%). La adherencia a la dM en hombres fue baja en 9 pacientes (18%), moderada en 37 pacientes (74%) y alta en 4 pacientes (8%). En las mujeres la adherencia a la dM fue baja en 14 pacientes (28%), media en 34 pacientes (68%) y alta en 2 pacientes (6%). El total de adherencia a la dM de los pacientes es baja en el 23%, moderada en el 71% y alta en el 6%. Conclusiones: Los pacientes diagnosticados de GPAA en nuestra área de atención sanitaria presentan en su mayoría una adherencia moderada a la dM. El papel del facultativo es importante y debe mejorar, para proporcionar la información adecuada sobre la dM y sus beneficios respecto al GPAA (AU)

Objective: To study the adherence to the Mediterranean diet in patients affected by primary open angle glaucoma (POAG). Materials and methods: An observational study was conducted to assess the adherence to the Mediterranean diet in patients affected by POAG, and who attended the Ophthalmology Department of the Canary Islands University Hospital. The study included completing a 14-item questionnaire validated by the PREDIMED Study, in person or by telephone. Results: A total of 100 questionnaires were completed successfully by 50 males and 50 females. The mean age was 69.58 years for the males and 67.42 years for women. The men had more comorbidities than women (tobacco 14 vs. 3%), arterial hypertension, and diabetes (30 vs. 28%, and 16 vs. 6%, respectively). Adherence to the Mediterranean diet in males, was low in 9 patients (18%), moderate in 37 (74%), and high in 4 (8%) cases. In women adherence was low in 14 patients (28%), moderate in 34 (68%), and high in 2 (6%) cases. The overall adhesion to the Mediterranean diet is low in 23%, moderate in 71% and high in 6% of the cases. Conclusion: Patients who are affected by POAG have moderate adherence to the Mediterranean diet (AU)

Mediterranean diet adherence by patients with primary open angle glaucoma. / Adherencia a la dieta mediterránea en pacientes afectos de glaucoma primario de ángulo abierto.

OBJECTIVE: To study the adherence to the Mediterranean diet in patients affected by primary open angle glaucoma (POAG). MATERIALS AND METHODS: An observational study was conducted to assess the adherence to the Mediterranean diet in patients affected by POAG, and who attended the Ophthalmology Department of the Canary Islands University Hospital. The study included completing a 14-item questionnaire validated by the PREDIMED Study, in person or by telephone. RESULTS: A total of 100 questionnaires were completed successfully by 50 males and 50 females. The mean age was 69.58 years for the males and 67.42 years for women. The men had more comorbidities than women (tobacco 14 vs. 3%), arterial hypertension, and diabetes (30 vs. 28%, and 16 vs. 6%, respectively). Adherence to the Mediterranean diet in males, was low in 9 patients (18%), moderate in 37 (74%), and high in 4 (8%) cases. In women adherence was low in 14 patients (28%), moderate in 34 (68%), and high in 2 (6%) cases. The overall adhesion to the Mediterranean diet is low in 23%, moderate in 71% and high in 6% of the cases. CONCLUSION: Patients who are affected by POAG have moderate adherence to the Mediterranean diet.

[Comparing the ranges of defect measured with standard white on white and Pulsar perimetries]. / Comparación del rango de medida de defectos entre la perimetría estándar blanco/blanco y la perimetría Pulsar.

OBJECTIVES: Normal thresholds on Pulsar perimetry fall faster than those of standard perimetry in the peripheral visual field. Two related studies were performed. Firstly, the frequency distributions of glaucoma defects on standard automated perimetry (SAP) and the relationship of the centre and periphery (Study A) were studied first, followed by an attempt to establish the limits of pulsar perimetry (Study B). MATERIAL AND METHOD: A: frequency of defects was calculated in 78.663 SAP perimetries (G1-TOP, Octopus 1-2-3, Haag-Streit). Study B: 204 eyes with mean defect (MD-SAP) lower than 9 dB were examined 8.92 ± 4.19 times with SAP (TOP-32, Octopus 311) and temporal modulation perimetry (T30W, Pulsar Perimeter, Haag-Streit). RESULTS: Study A: 50.7% of the SAP examinations showed MD values lower than 9 dB and 32.7% bellow 6 dB. The MD correlation of the central 20° with the MD of the most peripheral points was r=0.933. Study B: in cases with MD-TOP-32 lower than 6 dB, SAP had the maximum possibility of detecting defect in 0.02% of points and Pulsar in 0.29%. In subjects with MD-TOP-32 between 6 and 9 dB frequencies were 0.38% in SAP and 3.5% in Pulsar (5.1% for eccentricities higher than 20°). CONCLUSIONS: Pulsar allows detecting defects, without range limitations, in the initial half of SAP frequencies expected on glaucoma patients. In order to study the progression of deeper defects the examination should focus on the central points, where the dynamic range of both systems is more equivalent.

Comparación del rango de medida de defectos entre la perimetría estándar blanco/blanco y la perimetría Pulsar / Comparing the ranges of defect measured with standard white on white and Pulsar perimetries

Objetivo: Los umbrales normales de la perimetría Pulsar caen más rápidamente en el campoperiférico que los estándar. Se han realizado dos estudios relacionados, en primer lugar seha investigado la distribución de frecuencias de los defectos glaucomatosos en perimetríaautomática estándar (SAP), y la relación de los periféricos con los centrales (estudio A). Acontinuación se han tratado de definir los límites de examen Pulsar (estudio B).Material y métodos: Estudio A: las frecuencias se calcularon en 78.663 perimetrías SAP (G1-TOP, Octopus 1-2-3, Haag-Streit). Estudio B: 204 ojos con defecto medio (MD-SAP) inferiora 9 dB se examinaron 8,92±4,19 veces con SAP (TOP-32, Octopus 311) y con perimetría demodulación temporal (T30W, Perímetro Pulsar, Haag-Streit).Resultados: Estudio A: el 50,7% de los estudios SAP presentaron valores de MD inferiores a9 dB y el 32,7% inferiores a 6 dB. La correlación delMDde los 20◦ centrales con respecto alMDde los más periféricos fue de r = 0,933. Estudio B: en los casos con valores de MD-TOP-32 inferioresa 6 dB, SAP alcanzó sus posibilidades máximas de detección de defecto en el 0,02% delos puntos y Pulsar en el 0,29%. En los sujetos con MD-TOP-32 situado entre 6 y 9dB las frecuenciasfueron 0,38% en SAP y 3,5% en Pulsar (5,1% para excentricidades superiores a 20◦).Conclusiones: Pulsar permite detectar defectos, sin limitación de rango, en la mitad inicialde las frecuencias de defecto SAP esperables en el paciente glaucomatoso. Para estudiar laprogresión de defectos más profundos el análisis deberá centrarse en los puntos centrales,donde el rango dinámico de ambos sistemas es más equivalente(AU)

Objectives: Normal thresholds on Pulsar perimetry fall faster than those of standard perimetryin the peripheral visual field. Two related studies were performed. Firstly, the frequencydistributions of glaucoma defects on standard automated perimetry (SAP) and the relationshipof the centre and periphery (Study A) were studied first, followed by an attempt toestablish the limits of pulsar perimetry (Study B).Material and method: A: frequency of defects was calculated in 78.663 SAP perimetries (G1-TOP, Octopus 1-2-3, Haag-Streit). Study B: 204 eyes with mean defect (MD-SAP) lower than9 dB were examined 8.92±4.19 times with SAP (TOP-32, Octopus 311) and temporal modulationperimetry (T30W, Pulsar Perimeter, Haag-Streit).Results: StudyA: 50.7% of the SAP examinations showedMDvalues lower than 9 dB and 32.7%bellow 6 dB. The MD correlation of the central 20◦ with the MD of the most peripheral pointswas r = 0.933. Study B: in cases with MD-TOP-32 lower than 6 dB, SAP had the maximumpossibility of detecting defect in 0.02% of points and Pulsar in 0.29%. In subjects with MDTOP-32 between 6 and 9 dB frequencies were 0.38% in SAP and 3.5% in Pulsar (5.1% foreccentricities higher than 20◦).Conclusions: Pulsar allows detecting defects, without range limitations, in the initial half ofSAP frequencies expected on glaucoma patients. In order to study the progression of deeperdefects the examination should focus on the central points, where the dynamic range ofboth systems is more equivalent(AU)

Detection of morphological and functional progression in initial glaucoma.

BACKGROUND: To observe the prospective follow-up results of functional and morphological data in patients with early, moderate and suspected glaucoma. METHODS: Eyes (n=156; average mean defect (MD)=2.2 dB) were examined every 3 months for an average of 3.6 years. Progression was estimated using regression analysis of the indices rim area and Glaucoma Probability Score of the Heidelberg retinal tomograph, mean thickness of the fibre layer using laser polarimetry with corneal compensation, MDs of standard, Pulsar and frequency doubling technology perimetries, and the threshold noiseless trend (TNT) program for the standard and Pulsar perimetries. RESULTS: TNT showed more than twice the diagnostic capacity of other methods. The maximum diagnostic sensitivity was obtained with TNT Pulsar. This procedure indicated progression in 40% of cases after seven examinations, and presented the lowest number of cases of progression not confirmed in two consecutive examinations. Most of the progressions of initial glaucoma were diffuse, without changes in the lens or loss of visual acuity. Heidelberg retinal tomograph and laser polarimetry made few diagnoses of progression. The diagnostic agreement between different methods was low, but higher between functional than morphological procedures. CONCLUSION: Functional indices, especially Pulsar, showed better detection of progression than morphological indices.

Prevalencia de obesidad a los 14 años en cuatro consultas de atención primaria. Evolución desde los dos años / Prevalence of obesity in 14-year-olds in four primary care centers. Trendsin weight changes since the age of two years old

Introducción. La obesidad infantil es un diagnóstico cada vez más frecuente en las sociedades occidentales. Su aparición se relaciona con determinados cambios en los estilos de vida. Por sus implicaciones en cuanto a persistencia en etapas posteriores de la vida y relación con diversas entidades patológicas, como la enfermedad cardiovascular y la diabetes, se ha convertido en uno de los problemas de salud infantil más importantes. El objetivo de este estudio ha sido conocer la prevalencia de obesidad y sobrepeso en 2003 en la población de 14 años atendida en las consultas de pediatría de un centro de atención primaria, así como la evolución ponderal de esta cohorte desde los 2 años de edad. Pacientes y métodos. Se realiza un estudio longitudinal de los 277 niños nacidos en 1989, determinando su índice de masa corporal (IMC) a los 2, 3, 4, 6, 8, 11 y 14 años. Se considera obesidad un IMC > P95, y sobrepeso IMC > P85, según las tablas de los Centers for Diseases Control and Prevention (CDC) de 2000. Resultados. La prevalencia de obesidad a los 14 años es del 13,2 % (15,2 % en niños y 11,5 % en niñas). La prevalencia de sobrepeso es de 17,4 % (18,7 % en niños y 16,2 % en niñas). Las diferencias entre sexos no son significativas en ninguna de las edades en que se realizan determinaciones. Conclusiones. La prevalencia de obesidad y sobrepeso a los 14 años en los niños de nuestras consultas es importante y comparable a la registrada en otras zonas de España. Las consultas de pediatría de atención primaria deben tener un papel relevante en la prevención y control de la misma

Introduction. Childhood obesity is an increasingly common diagnosis in western society and is related to certain changes in lifestyle. Because of its persistence in adulthood and its relationship with several pathological entities such as cardiovascular disease and diabetes, it has become one of the most important problems in children's health. The objective of this study was to determine the prevalence of obesity and overweight in 14-year-old adolescents attending the pediatric outpatient clinics of a primary care center in 2003, and their weight changes from the age of two years old. Subjects and methods. A long-term study of 277 children born in 1989 was performed. Their body mass index (BMI) was calculated at the age of 2,3,4,6,8,11 and 14 years. Obesity was defined as a BMI > P95 and overweight as a BMI > P85 according to the Centers for Disease Control and Prevention (CDC) growth charts 2000. Results. The prevalence of obesity in 14 year-olds was 13.2 % (15.2 % in boys and 11.5 % in girls). The prevalence of overweight was 17.4 % (18.7 % in boys and 16.2 % in girls). Gender differences were not significant in any of the age groups studied. Conclusions. The prevalence of obesity and overweight in 14 year-old adolescents in our centers is considerable and is similar to that reported in other Spanish regions. The pediatric outpatient clinics of primary care centers should play an active role in the control and prevention of obesity

Combined spatial, contrast, and temporal functions perimetry in mild glaucoma and ocular hypertension.

PURPOSE: To evaluate the diagnostic ability of a new perimetric procedure in glaucoma. METHODS: Pulsar perimeter shows white circular sinusoidal grating patterns with decreasing amplitude, 5 in diameter, 500 msec in duration in 66 locations. The stimuli scale combines spatial resolution and contrast. The stimuli were shown with centrifugal wave motion at 8 cyl/deg (K6W) or pulse at 30 Hz (T30W). Fifty-six normal eyes and 82 eyes with ocular hypertension and mild glaucoma were included. These 82 cases were classified into four levels of diagnostic certainty, from 0 (ocular hypertension) to 3 (mild glaucoma). RESULTS: Mean examination time was 3:49 min. Specificity was 96.4% (T30W) and 94.6% (K6W). Sensitivities for levels 0 and 3 were 34.5% to 100% (T30W) and 24.1% to 75% (K6W). The receiver operating characteristic (ROC) curve areas for T30W at levels 1, 2, and 3 were 0.88, 0.94, and 0.99. The ROC areas for K6W were 0.83, 0.91, and 0.97. There was good correlation between both Pulsar perimetries (r=0.88), but it was lower with conventional perimetry (r=0.58 for T30W and r=0.59 for K6W). CONCLUSIONS: The novel Pulsar T30W perimetry may be helpful for the study of mild glaucoma and ocular hypertension. (Eur J Ophthalmol 2004; 14: 514-22).

[White-on-white, blue-on-yellow and blue-on-blue perimetry in normal subjects]. / Perimetrías blanco-blanco, azul-amarillo y azul-azul en sujetos normales.

PURPOSE: To compare blue-on-blue differential contrast perimetry (BB), in accordance with E. Land "Retinex" theory, with white-on-white (WW) and blue-on-yellow (BY) perimetries on normal subjects. METHODS: An Octopus 101 perimeter was modified for BB perimetry, using a 4cd/m2 background and stimulus Goldmann size V. Fifty healthy subjects (10 per decade, from 20 to 70 years) were examined twice with each type of perimetry (WW, BB, BY) using the TOP strategy. RESULTS: The results obtained with WW, BY and BB perimetry were respectively: Reduction of sensitivity per year: 0.13, 0.27 and 0.13 dB; correlation coefficient (r) of threshold with age (and error of estimation of Y over X): -0.63 (2.24 dB), -0.70 (3.77 dB) and -0.80 (1.32 dB); threshold fluctuation: 2.21, 3.03 and 2.03 dB; percentage of points deviated more than 5dB from the expected value for the patient age: 8.1, 16.0 and 4.2%. CONCLUSIONS: Perimetric results are more stable with BB strategy than with the other two types of perimetry. BY perimetry gives the worst results: threshold reduction with age is twice higher, individual fluctuation is 50% higher and points away from the mean value are much more frequent. Overlapping between blue and yellow filters is minimal in Octopus. Therefore, an absolute threshold is examined, which is much more unstable than WW or BB differential thresholds.

Perimetrías blanco-blanco, azul-amarillo y azul-azul en sujetos normales / White-on-white, blue-on-yellow and blue-on-blue perimetry in normal subjects

Objetivo: Comparar la perimetría de contraste diferencial azul sobre azul (AZ-AZ) acorde con la teoría "Retinex" de E. Land, con las perimetrías blanco-blanco (BL-BL) y azul-amarillo (AZ-AM) en sujetos normales. Método: Un perímetro Octopus 101 fue modificado para perimetría AZ-AZ, usando fondo de 4 cd/m2 y estímulo V de Goldmann. 50 sujetos sanos (10 por década entre 20 y 70 años) fueron examinados dos veces con los tres tipos de perimetría, usando estrategia TOP. Resultados: Para BL-BL, AZ-AM y AZ-AZ se obtuvo respectivamente: pérdida de sensibilidad por año: 0,13, 0,27 y 0,13 dB; coeficiente de correlación (r) del umbral con la edad (y error de estimación de Y sobre X): -0,63 (2,24 dB), -0,70 (3,77 dB) y -0,80 (1,32 dB); fluctuación del umbral: 2,21, 3,03 y 2,03 dB; porcentaje de puntos desviados a más de 5 dB del valor previsto para la edad: 8,1, 16,0 y 4,2 por ciento. Conclusiones: La perimetría AZ-AZ produce resultados más estables que los otros dos tipos de perimetría. La perimetría AZ-AM produce los peores resultados: la reducción del umbral con la edad es dos veces superior, la fluctuación individual un 50 por ciento superior y mucho más frecuentes los puntos alejados del valor medio. En el perímetro Octopus el solapamiento entre los filtros azul y amarillo es mínimo. Por lo tanto se examina un umbral absoluto, mucho mas inestable que el umbral diferencial BL-BL o AZ-AZ (AU)

[Giant fibrolipoma of the floor of the mouth. Presentation of a clinical case]. / Fibrolipoma gigante del piso de la boca. Presentación de un caso clínico.

The fibrolipoma is a benign tumor variant of the lipoma, characterized by the presence of adipose and fibrous tissues. The authors report a case of a big oral fibrolipoma in a 72 year old woman. After surgery, a mass of 13 x 8 x 6 cm was obtained. The tumor had an implantation pedicle of 1 cm, on the floor of the mouth. The microscopic evaluation showed the presence of polygonal cells grouped into nests and separated by fibrous connective tissue septa. We have not found any report in the literature related to a fibrolipoma located on the floor of the mouth with the characteristics presented in this work.

[Antibiotic prescribing patterns in primary health care. Do pediatricians use antibiotics rationally?]. / Patrones de prescripción de antibióticos en atención primaria. Usamos racionalmente los antibióticos en pediatría?

OBJECTIVES: To determine antibiotic prescribing patterns in the pediatric (infants and children) population attended to at a primary health care centre in the community of Madrid. We also wanted to determine the necessity or otherwise of antibiotic therapy and whether the selected antibiotic drug was appropriate for the pathology diagnosed. METHODS: Retrospective study of all infectious or respiratory processes diagnosed during 1 year and of the respective antibiotic cycles prescribed in all patients under the age of 4 years. The prescribing physician and the appropriateness of all therapeutic decisions, including those where the decision was not to treat with antibiotic drugs, were analyzed. RESULTS: We evaluated 910 children under the age of 4 years with a total of 3, 847 processes (mean of 4.55 +/-3.6 processes per child per year). Sixty-three percent of the children received at least one cycle of antibiotic drugs per year (mean 1.63+/-1.69 cycles of treatment per child per year). Of all therapeutic decisions, 85.2% were considered appropriate. In 36% of the processes antibiotics were prescribed (1,386 cycles), 46% of which were considered inappropriate either because no antibiotic therapy should have been given (71.6%) or because the chosen drug was not appropriate for the pathology (28.4%). There were significant differences among the evaluated physicians. The most correct decisions were taken by the pediatrician in the outpatient clinic, especially when compared with physicians in the emergency ward (p<0.0001). The most frequently prescribed antibiotic drugs were amoxicillin (41.2%) and amoxicillin combined with clavulanic acid (33%). Cephalosporin accounted only for 6.9% of the prescriptions. CONCLUSIONS: Antibiotic therapy is overprescribed in children, a situation that should be corrected.

Patrones de prescripción de antibióticos en atención primaria. ¿Usamos racionalmente los antibióticos en pediatría? / Antibiotic prescribing habits in primary health care. Do pediatricians use antibiotics rationally?

Objetivos: Conocer los patrones de prescripción de antibióticos en la población lactante y preescolar de un centro de salud de la Comunidad de Madrid, así como la necesidad o no de dicho tratamiento y su adecuación a la patología diagnosticada. Métodos : Se realizó un estudio retrospectivo de los procesos infecciosos y respiratorios, así como los ciclos de tratamiento antibiótico recibido, de todos los niños menores de 4 años, durante un año. Se analizó el facultativo prescriptor, así como la adecuación de las decisiones terapéuticas tanto positivas como negativas (sin tratamiento). Resultados Se evaluaron 910 niños de 0-4 años, que presentaron un total de 3.847 procesos infecciosos o respiratorios con una media de 4,55 ñ 3,6 por niño y año. El 63 por ciento de los niños recibió al menos un ciclo antibiótico al año, con una media de 1,63 ñ 1,9 ciclos por niño y año. Se consideraron adecuadas un 85,2 por ciento de las 3.847 decisiones terapéuticas. El 36 por ciento de los procesos recibieron tratamiento antibiótico, lo cual supuso un total de 1.386 ciclos antibióticos. De ellos, el 46,2 por ciento se consideró inadecuado, mayoritariamente (71,6 por ciento) porque no debieron haberse prescrito y los restantes (28,4 por ciento) porque fueron mal elegidos. Hay diferencias entre los facultativos prescriptores, siendo la prescripción más correcta cuando se evalúa al pediatra habitual responsable de la consulta frente a otros médicos fundamentalmente de servicios de urgencias (p < 0,0001). Los antibióticos más utilizados fueron amoxicilina (41,2 por ciento) y amoxicilina-clavulánico (33 por ciento). Las cefalosporinas supusieron un 6,9 por ciento del total. Conclusiones: Se detecta un uso excesivo de antibióticos en la población preescolar que debe ser corregido (AU)

Is oculokinetic perimetry useful?

An evaluation was carried out comparing Oculokinetic Perimetry (O.K.P.) with Automatic Perimetry of Thresholds (Hipocampus Perimeter) for ocular hypertension and glaucoma studying 145 eyes. The O.K.P. shows a sensitivity between 35.65 and 38.54%, a specificity of 76.67-79.59%, a + predictive value of 78.72-85.42%, and a-predictive value of 23.71-39.80%.