RESUMO
OBJECTIVE: To determine the validity and usefulness of brain natriuretic peptide (BNP) for diagnosing left ventricular dysfunction (LVD). DESIGN: Prospective, descriptive, multi-centred study to validate the diagnostic test. SETTING: Primary care centres in the Community of Madrid, Spain. PARTICIPANTS: Consecutive sample of patients at high risk of presenting with LVD. INTERVENTIONS: Data will be gathered from anamnesis, physical examination, ECG, and chest x-ray to find the risk factor(s) for LVD and the presence or absence of symptoms of congestive heart failure according to the Framingham scale. BNP will be determined at PC clinics in all patients who meet the inclusion criteria, using the "triage BNP test." All patients included in the study will be referred to an echocardiography service for an echocardiogram, which will be the gold standard test. Two independent cardiologists will evaluate the echocardiograph without knowing the BNP values. MAIN MEASUREMENTS: BNP concentrations will be compared against the kind and degree of LVD. ROC curves analysis will test the capacity of BNP to diagnose LVD. Optimal sensitivity and specificity value will be calculated by means of the position on the curve resulting from the minimum distance at the cut-off point for best sensitivity and specificity. Then, sensitivity, specificity, and positive and negative predictive values will be calculated. DISCUSSION: BNP can complement the information provided by other diagnostic tests. It should be included as an important factor in the taking of clinical-therapeutic decisions.
Assuntos
Peptídeo Natriurético Encefálico/sangue , Disfunção Ventricular Esquerda/sangue , Disfunção Ventricular Esquerda/diagnóstico , Humanos , Estudos Multicêntricos como Assunto , Atenção Primária à Saúde , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
La patología inflamatoria articular puede suponer la forma de inicio de cualquier enfermedad inflamatoria oligo o poliarticular. La artriris reactiva es una inflamación articular que acontece tras un proceso infeccioso que tiene lugar en otra localización. Presentamos el caso de un varón de 39 años que tras una infección gastrointestinal desarrolló un cuadro de oligoartritis. Se requirieron varias pruebas complementarias como analítica de sangre con reactantes de fase aguda, radiografía y coprocultivo. El tratamiento consistió en reposo funcional y la administración de antiinflamatorios no esteroideos (AU)
