Arterial hypertension diagnosis: A problem? / Diagnóstico de hipertensión arterial: ¿un problema?

Introduction: Arterial hypertension (AHT), a leading risk factor in terms of attributable mortality, is a major public health problem, especially for primary care where most patients are diagnosed and followed up. Correct AHT diagnosis requires adequate theoretical knowledge and technical skills in physicians and nurses. The aim of this study was to evaluate the knowledge and skills used in initial AHT diagnosis by health professionals and to describe the factors that contribute to variability. Methodology: Cross-sectional observational study in a sample of 385 primary care physicians and nurses recruited in a Catalan health region. Using a validated questionnaire called ARC, we evaluated theoretical knowledge and analysed factors that may contribute to response variability. We also evaluated practical measurement skills using objective structured clinical examination tests. Results: Medical and nursing primary care professionals had deficient knowledge and skills for initial AHT diagnosis and measurement, despite self-perceiving their knowledge to be sufficient. However, professionals who had received postgraduate or other AHT training in the previous year scored better in the ARC questionnaire. Conclusions: The results of this study point to insufficient AHT expertise to ensure quality clinical practice, suggesting that ongoing theoretical and practical training needs to be improved. (AU)

Introducción: La hipertensión arterial (HTA) es un factor de riesgo destacado en términos de mortalidad atribuible, y un gran problema de salud pública, en especial para la atención primaria, donde se diagnostica y se realiza el seguimiento a la mayoría de los pacientes. El diagnóstico correcto de HTA requiere un conocimiento teórico y una competencia técnica adecuados por parte de médicos y enfermeros. El objetivo de este estudio fue evaluar el conocimiento y las competencias aplicados al diagnóstico inicial de HTA por parte de los profesionales sanitarios, así como describir los factores que contribuyen a la variabilidad. Metodología: Estudio observacional transversal de una muestra de 385 médicos y enfermeros de atención primaria seleccionados en una región sanitaria de Cataluña. Utilizando un cuestionario validado denominado ARC, evaluamos el conocimiento técnico y analizamos los factores que probablemente contribuyen a la variabilidad de la respuesta. También evaluamos las técnicas prácticas de medición utilizando una prueba de examen clínico objetivo. Resultados: Los profesionales médicos y enfermeros de atención primaria tenían un conocimiento deficiente para realizar el diagnóstico y la medición iniciales de HTA, a pesar de autopercibir que dicho conocimiento es suficiente. Sin embargo, los profesionales que recibieron formación de posgrado en HTA durante el último año obtuvieron una mejor puntuación en el cuestionario ARC. Conclusiones: Los resultados de este estudio señalan una experiencia insuficiente sobre HTA para garantizar una práctica clínica de calidad, lo cual demuestra que debe mejorarse la formación teórica y práctica continua. (AU)

Arterial hypertension diagnosis: A problem?

INTRODUCTION: Arterial hypertension (AHT), a leading risk factor in terms of attributable mortality, is a major public health problem, especially for primary care where most patients are diagnosed and followed up. Correct AHT diagnosis requires adequate theoretical knowledge and technical skills in physicians and nurses. The aim of this study was to evaluate the knowledge and skills used in initial AHT diagnosis by health professionals and to describe the factors that contribute to variability. METHODOLOGY: Cross-sectional observational study in a sample of 385 primary care physicians and nurses recruited in a Catalan health region. Using a validated questionnaire called ARC, we evaluated theoretical knowledge and analysed factors that may contribute to response variability. We also evaluated practical measurement skills using objective structured clinical examination tests. RESULTS: Medical and nursing primary care professionals had deficient knowledge and skills for initial AHT diagnosis and measurement, despite self-perceiving their knowledge to be sufficient. However, professionals who had received postgraduate or other AHT training in the previous year scored better in the ARC questionnaire. CONCLUSIONS: The results of this study point to insufficient AHT expertise to ensure quality clinical practice, suggesting that ongoing theoretical and practical training needs to be improved.

[The effect of age and sex on factors associated with dementia]. / Efecto de la edad y el sexo en los factores asociados a la demencia.

INTRODUCTION: There is currently no cure for dementia and its prevention is considered to be crucial. The aim is to analyse the association between risk factors and dementia, and how this varies according to age and sex. PATIENTS AND METHODS: This cross-sectional study includes 1,048,956 people aged 65 and over. Data were obtained from the SIDIAP pseudonymised clinical database. The response variable was dementia and cases were identified using a validated algorithm. Exposure to the following risk factors was assessed: smoking, coronary heart disease, cerebrovascular disease, heart failure, peripheral arterial disease, alcoholism, high blood pressure, hyperlipidaemia, diabetes, hyperthyroidism, Parkinson's disease, depressive disorder and rurality. Logistic regression models were estimated to assess the association between risk factors and dementia, and they were stratified by age, sex and both jointly. RESULTS: The association between a medical history of cerebrovascular disease, Parkinson, depressive disorder or hyperthyroidism and dementia was more pronounced in men. The inverse association between coronary heart disease, heart failure or smoking and dementia was significant only in women. A stronger association was observed in younger age groups for most risk factors, but hypertension, coronary heart disease, heart failure or smoking were negatively associated among the older age groups. CONCLUSION: Sex and age both condition the association between risk factors and dementia. We recommend promoting effective control of cardiovascular risk factors in order to prevent dementia.

TITLE: Efecto de la edad y el sexo en los factores asociados a la demencia.Introducción. Actualmente no existe ningún tratamiento curativo para la demencia por lo que se considera que su prevención es clave. El objetivo es analizar la asociación entre los factores de riesgo y la demencia, y su variación según la edad y el sexo. Pacientes y métodos. Este estudio transversal incluye a 1.048.956 personas de 65 años o más. Los datos se obtuvieron de la base de datos clínicos pseudoanonimizados SIDIAP. La variable respuesta fue la demencia y se identificaron los casos mediante un algoritmo validado. Se evaluó la exposición a los siguientes factores de riesgo: tabaquismo, enfermedad coronaria, enfermedad cerebrovascular, insuficiencia cardíaca, arteriopatía periférica, alcoholismo, hipertensión arterial, hiperlipidemia, diabetes, hipertiroidismo, Parkinson, trastorno depresivo y ruralidad. Se calcularon modelos de regresión logística para evaluar la asociación de los factores de riesgo y la demencia, y se estratificó por edad, sexo y ambos conjuntamente. Resultados. La asociación entre los antecedentes de enfermedad cerebrovascular, el Parkinson, el trastorno depresivo o el hipertiroidismo y la demencia fue más pronunciada en los hombres. La asociación inversa entre la enfermedad coronaria, la insuficiencia cardíaca o el tabaquismo con la demencia fue significativa sólo en las mujeres. Se observó una mayor asociación en los grupos de menor edad en la mayoría de los factores de riesgo. Conclusión. El sexo y la edad condicionan la asociación de los factores de riesgo y la demencia. Recomendamos promover el control eficaz de los factores de riesgo cardiovascular para prevenir la demencia.

Efecto de la edad y el sexo en los factores asociados a la demencia / The effect of age and sex on factors associated with dementia

Introducción: Actualmente no existe ningún tratamiento curativo para la demencia por lo que se considera que su prevención es clave. El objetivo es analizar la asociación entre los factores de riesgo y la demencia, y su variación según la edad y el sexo. Pacientes y métodos: Este estudio transversal incluye a 1.048.956 personas de 65 años o más. Los datos se obtuvieron de la base de datos clínicos pseudoanonimizados SIDIAP. La variable respuesta fue la demencia y se identificaron los casos mediante un algoritmo validado. Se evaluó la exposición a los siguientes factores de riesgo: tabaquismo, enfermedad coronaria, enfermedad cerebrovascular, insuficiencia cardíaca, arteriopatía periférica, alcoholismo, hipertensión arterial, hiperlipidemia, diabetes, hipertiroidismo, Parkinson, trastorno depresivo y ruralidad. Se calcularon modelos de regresión logística para evaluar la asociación de los factores de riesgo y la demencia, y se estratificó por edad, sexo y ambos conjuntamente. Resultados: La asociación entre los antecedentes de enfermedad cerebrovascular, el Parkinson, el trastorno depresivo o el hipertiroidismo y la demencia fue más pronunciada en los hombres. La asociación inversa entre la enfermedad coronaria, la insuficiencia cardíaca o el tabaquismo con la demencia fue significativa sólo en las mujeres. Se observó una mayor asociación en los grupos de menor edad en la mayoría de los factores de riesgo. Conclusión: El sexo y la edad condicionan la asociación de los factores de riesgo y la demencia. Recomendamos promover el control eficaz de los factores de riesgo cardiovascular para prevenir la demencia.(AU)

Introduction: There is currently no cure for dementia and its prevention is considered to be crucial. The aim is to analyse the association between risk factors and dementia, and how this varies according to age and sex. Patients and methods: This cross-sectional study includes 1,048,956 people aged 65 and over. Data were obtained from the SIDIAP pseudonymised clinical database. The response variable was dementia and cases were identified using a validated algorithm. Exposure to the following risk factors was assessed: smoking, coronary heart disease, cerebrovascular disease, heart failure, peripheral arterial disease, alcoholism, high blood pressure, hyperlipidaemia, diabetes, hyperthyroidism, Parkinson’s disease, depressive disorder and rurality. Logistic regression models were estimated to assess the association between risk factors and dementia, and they were stratified by age, sex and both jointly. Results: The association between a medical history of cerebrovascular disease, Parkinson, depressive disorder or hyperthyroidism and dementia was more pronounced in men. The inverse association between coronary heart disease, heart failure or smoking and dementia was significant only in women. A stronger association was observed in younger age groups for most risk factors, but hypertension, coronary heart disease, heart failure or smoking were negatively associated among the older age groups. Conclusion: Sex and age both condition the association between risk factors and dementia. We recommend promoting effective control of cardiovascular risk factors in order to prevent dementia.(AU)

La artroplastia invertida de hombro ante defectos óseos glenoideos / Reverse shoulder arthroplasty due to glenoid bone defects

Objetivo. La artroplastia invertida se está convirtiendo en una herramienta útil para afecciones muy variadas en el hombro. Un defecto óseo importante de la glena puede afectar a la fijación del componente glenoideo. El propósito de nuestro estudio es evaluar a medio plazo los resultados de la artroplastia invertida de hombro asociados a una glenoplastia. Material y métodos. Se realizó un estudio retrospectivo de 5 pacientes de nuestro hospital con defectos glenoideos de distinta etiología que fueron tratados mediante artroplastia invertida de hombro asociada a glenoplastia. Resultados. El seguimiento mínimo de estos pacientes fue de un año (con una media de 30,4 meses). Todos los injertos estaban radiológicamente integrados, sin observarse signos de resorción o necrosis. A los 12 meses el test de Constant era de 66,75 de media y el EVA medio era de 1. Discusión. La glenoplastia es una intervención de alta demanda técnica que consigue restaurar el remanente óseo en pacientes con defectos estructurales, permitiendo así implantar una artroplastia invertida. De esa forma podemos mejorar la función y la clínica en pacientes con diversas afecciones glenohumerales, proporcionándoles una solución (AU)

Objective. Reverse shoulder arthroplasty is becoming a useful tool for many diseases of the shoulder. Any severe glenoid bone defect may affect the fixing of the glenoid component. The aim of this paper is to evaluate the medium-term outcomes of reverse shoulder arthroplasty associated with a glenoplasty. Materials and methods. A retrospective study was conducted on 5 patients from our hospital, selected due to glenoid defects of different etiology. All of them where treated with reverse shoulder arthroplasty associated with glenoplasty with bone graft. Results. The minimum follow-up was one year (mean 30.4 months). All grafts were radiologically integrated, with no signs of resorption or necrosis being observed. At 12 months, the Constant score was 66.75 and the mean EVA score was 1. Discussion. Glenoplasty surgery is technically demanding for restoring original bone size in patients with glenoid structural defects, enabling a reverse shoulder arthroplasty to be implanted. Thus improving both the function and clinical outcomes in selected patients with glenohumeral pathology and providing them with a solution (AU)

Reverse shoulder arthroplasty due to glenoid bone defects. / La artroplastia invertida de hombro ante defectos óseos glenoideos.

OBJECTIVE: Reverse shoulder arthroplasty is becoming a useful tool for many diseases of the shoulder. Any severe glenoid bone defect may affect the fixing of the glenoid component. The aim of this paper is to evaluate the medium-term outcomes of reverse shoulder arthroplasty associated with a glenoplasty. MATERIALS AND METHODS: A retrospective study was conducted on 5 patients from our hospital, selected due to glenoid defects of different etiology. All of them where treated with reverse shoulder arthroplasty associated with glenoplasty with bone graft. RESULTS: The minimum follow-up was one year (mean 30.4 months). All grafts were radiologically integrated, with no signs of resorption or necrosis being observed. At 12 months, the Constant score was 66.75 and the mean EVA score was 1. DISCUSSION: Glenoplasty surgery is technically demanding for restoring original bone size in patients with glenoid structural defects, enabling a reverse shoulder arthroplasty to be implanted. Thus improving both the function and clinical outcomes in selected patients with glenohumeral pathology and providing them with a solution.

Vocal cord dysfunction in a child.

Vocal cord dysfunction (VCD) involves paradoxical adduction of the vocal cord during the respiratory cycle. This usually occurs during inspiration, but can also be seen in expiration. Vocal cord appositioning produces airflow obstruction sufficient to cause wheezing, shortness of breath, chest tightness, and coughing. These symptoms often imitate the respiratory alterations of asthma, thus leading to inappropriate treatment; intubation or tracheotomy may prove necessary. An 11-year-old girl was admitted with intractable dyspnea. She had been diagnosed with atopic asthma, although she failed to respond to an increase in antiasthma medication, including high-dose oral steroids. Flow-volume loops were abnormal, with evidence of variable extrathoracic airway obstruction, manifested as a flat inspiratory loop. No structural abnormalities were seen with either computed tomography (CT) or magnetic resonance imaging (MRI). Fibroscopy revealed paradoxical adduction of the vocal cords during the respiratory cycle, no obstructive disorder being observed. After the diagnosis of VCD, the clinical manifestations resolved with psychiatric treatment. Adduction was not demonstrable at repeat fibroscopy after treatment. VCD may simulate bronchial asthma; it may also be associated with that disorder, thus masking the diagnosis. It should be suspected in patients with recurrent wheezing who fail to respond to usual asthma treatment. An early diagnosis avoids unnecessary aggressive management. Treatment should consist of respiratory and phonatory exercises; psychotherapy may be useful.