Lung Ultrasound Performed by Primary Care Physicians for Clinically Suspected Community-Acquired Pneumonia: A Multicenter Prospective Study.

PURPOSE: We investigated whether lung ultrasound (US) performed in primary care is useful and feasible for diagnosing community-acquired pneumonia (CAP) compared with chest radiography, as most previous research has been conducted in hospital settings. METHODS: We undertook a prospective observational cohort study of lung US performed in 12 primary care centers. Patients aged 5 years and older with symptoms suggesting CAP were examined with lung US (by 21 family physicians and 7 primary care pediatricians) and chest radiograph on the same day. We compared lung US findings with the radiologist's chest radiograph report as the reference standard, given that the latter is the most common imaging test performed for suspected CAP in primary care. The physicians had varied previous US experience, but all received a 5-hour lung US training program. RESULTS: The study included 82 patients. Compared with chest radiography, positive lung US findings (consolidation measuring >1 cm or a focal/asymmetrical B-lines pattern) showed a sensitivity of 87.8%, a specificity of 58.5%, a positive likelihood-ratio of 2.12, and a negative likelihood-ratio of 0.21. Findings were similar regardless of the physicians' previous US training or experience. We propose a practical algorithm whereby patients having consolidation measuring greater than 1 cm or normal findings on lung US could skip chest radiography, whereas patients with a B-lines pattern without consolidation (given its low specificity) would need chest radiography to ensure appropriate management. Lung US was generally performed in 10 minutes or less. CONCLUSION: Point-of-care lung US in primary care could be useful for investigating suspected CAP (avoiding chest radiography in most cases) and is likely feasible in daily practice, as short training programs appear sufficient and little time is needed to perform the scan.

Prevalencia de diabetes en una población adulta de Madrid (España). Estudio MADRIC (MADrid RIesgo Cardiovascular) / Prevalence of diabetes in an adult population in the region of Madrid (Spain). The Madrid Cardiovascular Risk study

Objetivo Estimar la prevalencia de diabetes mellitus y de glucemia basal alterada en una población adulta de Madrid. Métodos Estudio transversal de base poblacional. Incluyó 1344 adultos (31-70 años de edad), seleccionados aleatoriamente del censo de usuarios de 14 centros de salud de la Comunidad de Madrid. Se realizaron las siguientes determinaciones: cuestionario clínico, exploración física y análisis de sangre basal (glucemia, triglicéridos y colesterol). Se consideraron diabéticos aquellos previamente diagnosticados por su médico, así como los que presentaron una glucemia basal ≥ 126mg/dl en ausencia de un diagnóstico previo de diabetes. Con una glucemia entre 100 y 125mg/dl en ausencia de diabetes se clasificaron como glucemia basal alterada. Resultados Las prevalencias de diabetes y de glucemia basal alterada, ajustadas por edad y sexo, fueron del 6,6% (intervalo de confianza del 95% [IC95%]: 5,9-8,7) y del 14,1% (IC95%: 12,1-15,8), respectivamente. Un 17,2% [IC95%: 10,9-23,5] de los diabéticos detectados no habían sido diagnosticado previamente de esta enfermedad. Los factores asociados de modo independiente con la diabetes fueron la edad, el sexo masculino, la presencia de obesidad abdominal y la hipertensión arterial. Conclusiones En nuestra población de Madrid, la prevalencia de diabetes es similar a la de otras regiones españolas. Es destacable el alto porcentaje de sujetos con una glucemia basal alterada, lo cual, asociado a la obesidad, conlleva un alto riesgo de desarrollar diabetes en el futuro (AU)

Objective To estimate the prevalence of diabetes mellitus and impaired fasting glycemia in an adult population living in Madrid (Spain).Methods In this cross-sectional, population-based survey, we studied 1,344 adults aged 31-70 years, randomly selected from the population living in 14 primary care districts of the Madrid region. All participants underwent a clinical evaluation that included a clinical interview, physical examination and fasting blood analysis (glycemia, cholesterol and triglyceride levels). The participants were considered to be diabetic if they had been previously diagnosed with diabetes by their general physician or had a fasting glycemia ≥ 126mg/dl without a previous diabetes diagnosis. Impaired fasting glycemia was defined as fasting glycemia between 100mg/dl and 125mg/dl in non-diabetic participants. ResultsThe sex- and age-adjusted prevalence figures for diabetes and impaired fasting glucose were 6.6% (95% CI: 5.9-8.7) and 14.1% (95% CI: 12.1-15.8), respectively. A substantial proportion of diabetic patients [17.2% (95% CI: 10.9-23.5)] had not been previously diagnosed. The variables independently associated with diabetes were age, male gender, abdominal obesity and hypertension. Conclusions Our prevalence figure for diabetes is similar to those reported in other Spanish regions. The high frequency of impaired fasting glucose is worrisome, particularly when combined with obesity, as this association confers a high risk for developing diabetes mellitus (AU)

[Prevalence of diabetes in an adult population in the region of Madrid (Spain). The Madrid Cardiovascular Risk study]. / Prevalencia de diabetes en una población adulta de Madrid (España). Estudio MADRIC (MADrid RIesgo Cardiovascular).

OBJECTIVE: To estimate the prevalence of diabetes mellitus and impaired fasting glycemia in an adult population living in Madrid (Spain). METHODS: In this cross-sectional, population-based survey, we studied 1,344 adults aged 31-70 years, randomly selected from the population living in 14 primary care districts of the Madrid region. All participants underwent a clinical evaluation that included a clinical interview, physical examination and fasting blood analysis (glycemia, cholesterol and triglyceride levels). The participants were considered to be diabetic if they had been previously diagnosed with diabetes by their general physician or had a fasting glycemia ≥ 126 mg/dl without a previous diabetes diagnosis. Impaired fasting glycemia was defined as fasting glycemia between 100mg/dl and 125 mg/dl in non-diabetic participants. RESULTS: The sex- and age-adjusted prevalence figures for diabetes and impaired fasting glucose were 6.6% (95% CI: 5.9-8.7) and 14.1% (95% CI: 12.1-15.8), respectively. A substantial proportion of diabetic patients [17.2% (95% CI: 10.9-23.5)] had not been previously diagnosed. The variables independently associated with diabetes were age, male gender, abdominal obesity and hypertension. CONCLUSIONS: Our prevalence figure for diabetes is similar to those reported in other Spanish regions. The high frequency of impaired fasting glucose is worrisome, particularly when combined with obesity, as this association confers a high risk for developing diabetes mellitus.