Most advisable strategy in search of asymptomatic target organ damage in hypertensive patients / Estrategia óptima de búsqueda de daño de órgano diana asintomático en el hipertenso

Objective: To evaluate the diagnostic potential of seven examinations in order to define the most suitable strategy for target organ damage (TOD) search in hypertensive patients. Methods: This is a descriptive, cross-sectional study. 153 consecutive treated and essential hypertensive patients were enrolled. Patients with established cardiovascular or chronic renal disease (stage ≥ 4) were excluded. TOD search was assessed by: glomerular filtration rate (GFR), albumin/creatinine ratio (ACR), electrocardiogram (ECG), echocardiogram (ECO), ankle-brachial index (ABI), pulse wave velocity (PWV), and carotid ultrasound (intima media thickness and presence of plaques). The rationale of our strategy ought to determine the performance of applying a set of the most widely available tests (GFR, ACR, ABI, ECG) and advise about the optimal sequence of the remaining tests. Results: The sample was 64.4 ± 7.9 years old, 45.8% males. 82.6% of the sample had any TOD at all. The resulting algorithm found a 37% TOD in relation to GFR, ACR, ABI and ECG values. Adding carotid ultrasound added up to 70% of the studied population and properly classified (TOD+/TOD−) 89% of the cohort. When performing PWV, 78% of the patients had been identified as TOD+ and 96% of the population was correctly identified. Contribution of ECO was minor. Conclusion: After running the more widely available explorations (GFR, ACR, ABI, ECG), a step-by-step strategy that included carotid ultrasound, PWV and ECO could be the best sequence for TOD search in asymptomatic hypertensive patientsien

Objetivo: Evaluar el rendimiento diagnóstico de un panel de siete pruebas de determinación de daño de órgano diana (DOD) aplicadas de forma sistemática, a fin de sugerir la estrategia óptima para la búsqueda de DOD en el hipertenso. Método: Estudio descriptivo y transversal. Se incluyeron 153 pacientes diagnosticados de hipertensión esencial bajo tratamiento farmacológico. Se excluyeron pacientes con enfermedad cardiovascular establecida o enfermedad renal crónica estadio ≥4. Se realizó una búsqueda de DOD mediante filtrado glomerular estimado (FGe), índice albúmina creatinina (IAC), hipertrofia ventricular por electrocardiograma (ECG) y ecocardiograma (ECO), índice tobillo brazo (ITB), velocidad de la onda de pulso (VOP) y ecografía carotídea (placas y grosor íntima media). Se propuso una estrategia de búsqueda de DOD en la que tras la realización de las exploraciones más accesibles (FGe, IAC, ITB y ECG) se sugiere la secuencia de exploraciones a realizar con mayor eficacia diagnóstica. Resultados: La edad media fue 64.4 ± 7.9 años, siendo el 45.8% varones. El 82.6% presentó algún tipo de DOD. Según el algoritmo propuesto, las pruebas de mayor accesibilidad diagnosticaron un 37% de DOD en la muestra. Tras añadir la ecografía carotídea, se detectó DOD en el 70%, y el 89% de la población fue apropiadamente clasificada en DOD+/DOD−. La realización de VOP incrementó la prevalencia de DOD hasta el 78%, y el 96% de la muestra fue correctamente clasificada. La contribución de la ECO fue menor. Conclusión: Tras la realización de las exploraciones más accesibles (FGe, IAC, ITB y ECG), la realización sistemática de ecografía carotídea, VOP y ECO podría ser la estrategia óptima para la búsqueda de DOD en el hipertenso

Most advisable strategy in search of asymptomatic target organ damage in hypertensive patients.

OBJECTIVE: To evaluate the diagnostic potential of seven examinations in order to define the most suitable strategy for target organ damage (TOD) search in hypertensive patients. METHODS: This is a descriptive, cross-sectional study. 153 consecutive treated and essential hypertensive patients were enrolled. Patients with established cardiovascular or chronic renal disease (stage ≥4) were excluded. TOD search was assessed by: glomerular filtration rate (GFR), albumin/creatinine ratio (ACR), electrocardiogram (ECG), echocardiogram (ECO), ankle-brachial index (ABI), pulse wave velocity (PWV), and carotid ultrasound (intima media thickness and presence of plaques). The rationale of our strategy ought to determine the performance of applying a set of the most widely available tests (GFR, ACR, ABI, ECG) and advise about the optimal sequence of the remaining tests. RESULTS: The sample was 64.4±7.9 years old, 45.8% males. 82.6% of the sample had any TOD at all. The resulting algorithm found a 37% TOD in relation to GFR, ACR, ABI and ECG values. Adding carotid ultrasound added up to 70% of the studied population and properly classified (TOD+/TOD-) 89% of the cohort. When performing PWV, 78% of the patients had been identified as TOD+ and 96% of the population was correctly identified. Contribution of ECO was minor. CONCLUSION: After running the more widely available explorations (GFR, ACR, ABI, ECG), a step-by-step strategy that included carotid ultrasound, PWV and ECO could be the best sequence for TOD search in asymptomatic hypertensive patients.

Immune-modulatory effects of dietary Saccharomyces cerevisiae cell wall in broiler chickens inoculated with Escherichia coli lipopolysaccharide.

1. An experiment was conducted to study the effect of yeast (Saccharomyces cerevisiae) cell wall (YCW) supplemented in diets of broiler chickens challenged with Escherichia coli lipopolysaccharide (LPS). 2. One-day-old broiler chicks were randomly distributed into 24 cages (6 replicate cages; 8 birds/cage) and were inoculated with 0 or 1 mg/kg body weight E. coli-LPS (d 4 and 9) and 0 or 500 mg YCW/kg feed, resulting in a 2 × 2 factorial arrangement of treatments. Experimental diets did not include coccidiostats, in-feed antibiotics or enzymes. 3. On d 21, the inoculation of E. coli-LPS reduced weight gain and feed intake and increased feed conversion ratio (FCR) of birds, an effect maintained until 28 d. In contrast, chickens given diets with YCW improved the FCR at both 21 and 28 d of age. 4. E. coli-LPS challenge reduced the relative weight of bursa of Fabricius, except when chickens were given YCW, which resulted in an interaction. Supplementation of broiler diets with YCW exacerbated the cellular immune response as measured by the delayed cutaneous hypersensitivity response test. 5. The results of this study suggested a benefit on feed efficiency when YCW was added to diets fed to broiler chickens challenged with E. coli-LPS. Part of the mode of action of YCW might be related to better maintenance of immune status in response to microbial challenge.

Effects of different yeast cell wall supplements added to maize- or wheat-based diets for broiler chickens.

1. Three experiments were carried out to study the effects of two experimental yeast cell wall (YCW) supplements, one from the yeast extract industry and the other from the brewery industry, added to maize or wheat based-diets, on performance and intestinal parameters of broiler chickens (Ross 308). 2. In the first and second experiments, a completely randomised block design with 4 experimental treatments was used: T-1) Negative control, no additives T-2) Positive control, avilamycin group (10 mg/kg feed), T-3) Yeast extract-YCW (500 mg/kg), and T-4) Brewery-YCW (500 mg/kg feed). There were 6 replicates of 20 (experiment 1) and 22 (experiment 2) chicks per treatment. 3. In experiment 1 (wheat based diets), yeast extract-YCW increased BW and daily feed intake (42 d). The effects were comparable to those of avilamycin. In experiment 2 (maize based diet), avilamycin, yeast extract-YCW and brewery-YCW treatments improved the feed conversion ratio with respect to the negative control group (0 to 14 d). 4. At 24 d, in both experiments, the ileal nutrient digestibility and ileal bacterial counts were not affected by any experimental treatment. In maize diets, lower intestinal viscosity was obtained with avilamycin, yeast extract-YCW and brewery-YCW than with the negative control. In wheat diets, yeast extract-YCW and brewery-YCW reduced intestinal viscosity. 5. A third experiment was conducted to study the effect of yeast extract-YCW on animal performance, intestinal mucosa morphology and intestinal viscosity. A 2 x 2 factorial arrangement of treatments was used; one factor was the dietary yeast extract-YCW supplementation (0 or 500 mg/kg feed) and the other the cereal in the diet (maize or wheat). 6. At 43 d, the heaviest BW was in chickens fed on yeast extract-YCW compared to those given the negative control. At 22 d, yeast extract-YCW increased villus height, mucus thickness and number of goblet cells with respect to negative control. 7. Results of these experiments suggest that supplementation of yeast extract-YCW to broiler chicken diets increased animal performance by favouring intestinal mucosal development.

Use of yeast cell walls; beta-1, 3/1, 6-glucans; and mannoproteins in broiler chicken diets.

Two experiments were carried out to evaluate the effect of dietary addition of yeast cell wall (YCW); beta-1, 3/1, 6-glucan (BG); and mannoprotein complex (MP) purified fractions in broilers. In experiment 1, there was a control diet and 5 experimental diets containing, respectively: 10 mg of avilamycin (AVI)/kg of feed, 500 mg of YCW/kg of feed, 95 mg of MP/kg of feed, 145 mg of BG/kg of feed, and 95 mg of MP plus 145 mg of BG/kg of feed. All birds were vaccinated via drinking water against Newcastle disease virus at 9 d of age. At 42 d, chickens fed AVI, YCW, MP + BG, and BG diets had similar BW not significantly different from chickens fed the control diet. The antibody response of Newcastle disease virus vaccine was not affected by any experimental treatment. Broilers fed MP + BG diet had greater thymus weights (P

Actitud de los profesionales de Atención Primaria frente al tabaco / No disponible

OBJETIVOS. 1.o Cuantificar el número de fumadores entre los profesionales sanitarios (PS) de Atención Primaria(AP). 2.o Conocer el nivel de formación en el abordaje del fumador. 3.o Analizar los factores que pueden influir en dicho abordaje. DISEÑO. Estudio descriptivo-transversal. EMPLAZAMIENTO. Atención Primaria. PARTICIPANTES. Población diana (N): 1.250 profesionales. Población muestral (n): 297 (intervalo de confianza [IC]95%, e = 5%, p = 40%).MEDICIONES PRINCIPALES. Encuesta anónima (29ítems) y auto-cumplimentada. Variables: sociodemográficas, patrón-consumo, actitud ante su abandono, abordaje de la deshabituación. Análisis estadístico: descriptivo, t-Test, ANOVA, ji-cuadrado, regresión logística. RESULTADOS. El 56,8% son médicos (IC 95% 51,2-62%).Edad: 41,71 (IC 95% 41,1-42,3 años). El 28,7% son fumadores (17% fuma > 20 cigarrillos/día). Los fumadores (p =0,003), enfermeros/as (p = 0,007) y PS mujeres (p = 0,021)piensan que debe crearse un lugar en el centro de salud (CS) para fumadores (p = 0,003). El 17,2% no quiere abandonarlo. El 41,2% ha recibido formación en tabaco, estando más formado el médico (p = 0,0001) y el exfumador (31,8%; p =019), que es el que más recomienda el abandono a sus pacientes (24,3%; p = 0,017). La edad superior y el género masculino son los factores diferenciadores (y = -8,35+1,63 x género+ 0,69 x edad) (p = 0,0001). El 23% de los PS consideran fumar un hábito. El tabaquismo es poco valorado como factor de riesgo cardiovascular (p = 0,002). CONCLUSIONES. 1. Alto número de fumadores con consumo elevado. 2. El fumador valora la necesidad de tener un lugar para fumar. 3. El exfumador está más formado, aconseja y presenta mayor capacidad para abordar el tabaquismo. 4. Edad y género son los factores más determinantes en el abordaje del fumador

OBJECTIVES. 1. Measure number of smokers among primary health care professionals (PHCP). 2. Know the training level in the approach to the smoker. 3. Analyze the factors that may influence such approach. DESIGN. Descriptive-cross-sectional study. SITE. Primary Health Care. PARTICIPANTS. Target population (N): 1250 professionals. Sample population (N): 297 (95% CI, e = 5%, p = 40%).PRIMARY MEASUREMENTS. Anonymous survey (29items) and self-applied. Variables: sociodemographic, pattern-consumption; attitude to abandonment; de habituation approach. Statistical analysis: descriptive, T-test, ANOVA, chi-squared, logistic regression. RESULTS. 59.8% doctors (95% C 51.2%-62%). Age: 41.71(95% CI 41.1 - 42.3 years). 28.7% smokers (17% smoke > 20cig/day). Smokers (p = 0.003), ill subjects (p = 0.007) and female PHCP (p = 0.021) think that a site should be created for smokers (p = 0.003) in the health care sites (HCS). A total of 17.2% subjects do not want to quit and 41.2% have received education about smoking, it being the male doctor (p =0.0001) and ex-smoker (31.8%; p = 019), who most recommends their patient to quit smoking (24.3%; p = 0.017). Older age and male gender are the differentiating factors (y = -8.35+1.63 x gender + 0.69 x age) (p = 0.0001). A total of 23% PHCP consider that smoking is a habit. Smoking is not very evaluated as a cardiovascular risk factor (p = 0,002). CONCLUSIONS. 1. A high number of smokers with elevated consumption. 2. The smoker evaluates the need to have a place to smoke. 3. The ex-smoker is more trained, and recommends and has greater capacity to approach the smoking habit. 4. Age and gender are the most determining factors in the approach to the smoker