Implementación del método simplificado Apnealink™Air® por médicos de atención primaria para el diagnóstico del síndrome de apnea-hipopnea durante el sueño / Implementation of simplified diagnostic method Apnealink™Air® to diagnose sleep apnea by general practioners of primary care

Objetivo: Valorar la interpretación de ApnealinkTM® (AL) por médicos de atención primaria (MAP), y la alcanzada mediante poligrafía respiratoria (PGR) en la Unidad de Sueño Hospitalaria (USH) en pacientes con alta probabilidad de síndrome de apnea e hipopnea del sueño (SAHS). Métodos: Se recogen aleatoriamente, durante tres meses, pacientes seleccionados en USH para estudio mediante PGR, con elevada probabilidad de SAHS que aceptaron repetir estudio mediante AL. La USH corregía la PGR según normativa SEPAR; el MAP corregía el AL y planteaba manejo. Se analizaron los pacientes con estudios válidos(tiempo registro ≥ 240 min) para ambos dispositivos, comparándose resultados. Se consideró el estudio AL automático y corregido, considerando un índice de desaturación de oxihemoglobina (ODI) al 4% (ODI 4%), (AL 4%) y al 3% (ODI 3%), (AL 3%). Cuando ODI 4% era ≥ 12/h, se estableció diagnóstico SAHS moderado/grave, suponiendo un IAH ≥ 15/h. Para interpretar AL con ODI 3% y tratamiento, se siguieron criterios SEPAR. Se compararon los resultados para las mismas variables del AL frente a PGR. Resultados: Se incluyeron 43 pacientes válidos para AL, 45 para PGR y 41 válidos para ambos estudios. El estudio AL 4% mostró 27 (62,8%) positivos (OR 5,5, p < 0,05), que el AL 3% corroboró con IAH ≥ 15/h. La PGR detectó 19 (42,2%) con IAH ≥ 15/h; el AL 3% detectó 31 (72%). El análisis del AL 4% y AL 3% comparado con PGR no mostró diferencias de diagnóstico o manejo. Se compararon los resultados para las mismas variables del AL frente a PGR.Conclusiones: Existe equivalencia entre las decisiones del MAP y la USH. El AL sería un buen método diagnóstico de SAHS en atención primaria, en pacientes seleccionados con alta probabilidad de SAHS (AU)

Objectives: To assess diagnosis and therapeutic decisions-making by General Practitioners (GP) using ApnealinkTM® (AL) in patients with high suspicion of obstructive sleep apnea (OSA), in comparison with conclusions of Hospital Sleep Unit (HSU) specialists based on home respiratory polygraphy (PGR) results. Methods: This study involved patients previously selected by HSU for sleep testing by PGR. After it, patients were offered to complete AL test. PGR was checked at HSU; AL was checked by hemoglobin desaturation index of 4% (4% ODI), (4% AL) and 3% (3% ODI) patients with positive test to proceed with CPAP; and those with negative test for further testing. Automatically adjusted 4% AL, was considered valid as it was demonstrated to be equivalent to manual AL. Results were compared by automatically adjusted 3%AL against PGR results. Results: 48 patients were collected. 43 had AL valid test, 45 had PGR valid study, and 41 had both valid test. 27 patients (62,8%) had positive 4% AL (OR 5,51, p < 0,05), that showed AHI ≥ 15/h at 3% AL test; and 19 patients (42,2%) had a positive PGR test. 31 (72%) patients had a positive 3% AL. AL had shown to be a good screening method of SAHS. Conclusions: There is equivalence between the decisions of GP and HSU. AL is a good diagnostic tool and screening method for OSA in primary care when it is used in patients with high suspicion of moderate-severe OSA (AU)

[Implementation of simplified diagnostic method Apnealink™Air® to diagnose sleep apnea by general practioners of primary care]. / Implementación del método simplificado Apnealink™Air® por médicos de atención primaria para el diagnóstico del síndrome de apnea-hipopnea durante el sueño.

OBJECTIVES: To assess diagnosis and therapeutic decisions-making by General Practitioners (GP) using ApnealinkTM® (AL) in patients with high suspicion of obstructive sleep apnea (OSA), in comparison with conclusions of Hospital Sleep Unit (HSU) specialists based on home respiratory polygraphy (PGR) results. METHODS: This study involved patients previously selected by HSU for sleep testing by PGR. After it, patients were offered to complete AL test. PGR was checked at HSU; AL was checked by hemoglobin desaturation index of 4% (4% ODI), (4% AL) and 3% (3% ODI) patients with positive test to proceed with CPAP; and those with negative test for further testing. Automatically adjusted 4% AL, was considered valid as it was demonstrated to be equivalent to manual AL. Results were compared by automatically adjusted 3%AL against PGR results. RESULTS: 48 patients were collected. 43 had AL valid test, 45 had PGR valid study, and 41 had both valid test. 27 patients (62,8%) had positive 4% AL (OR 5,51, p < 0,05), that showed AHI ≥ 15/h at 3% AL test; and 19 patients (42,2%) had a positive PGR test. 31 (72%) patients had a positive 3% AL. AL had shown to be a good screening method of SAHS. CONCLUSIONS: There is equivalence between the decisions of GP and HSU. AL is a good diagnostic tool and screening method for OSA in primary care when it is used in patients with high suspicion of moderate-severe OSA.

Tabaquismo en los estudiantes de alto nivel académico en la Comunidad de Madrid y comparación con estudio previo similar realizado en 2014 / High level of student smokers in Madrid compared with a similar previous study of 2014

El tabaquismo es un problema de salud pública que afecta a los jóvenes, influenciado por el entorno y el nivel cultural. OBJETIVOS: Determinar la prevalencia de tabaquismo en estudiantes de bachillerato de excelencia (BE) con alto nivel académico en la Comunidad Autónoma de Madrid, en el curso 2018-2019. Valorar influencias del ambiente sociocultural en la iniciación del tabaquismo. Comparar con estudios previos realizados en alumnos de BE y la población general. POBLACIÓN Y MÉTODOS: Estudio transversal en alumnos de BE de la Comunidad Autónoma de Madrid. Mediante encuesta anónima se interrogó sobre el consumo de tabaco, alcohol y otras sustancias tóxicas; influencia del entorno, amigos y familiares en el inicio. Comparar con estudios previos. RESULTADOS: Se recogieron 740 jóvenes de 16,57±0,61 años; eran 430 (58,1%) mujeres y fumaban 53 (7,18%). Reconocían la influencia inicial de amigos 39 (78%). Consumían alcohol 349 (47,48%); y otras sustancias 109 (15,27%). Ser fumador se relacionó con consumir alcohol y otras drogas, tener madre, hermanos y amigos fumadores. Respecto a estudios previos, no se modificó la prevalencia de tabaquismo. CONCLUSIONES: La prevalencia del tabaquismo en estudiantes de alto nivel académico del BE de la Comunidad Autónoma de Madrid continúa siendo inferior a la de jóvenes de su edad y no existen variaciones respecto a informes previos. El inicio está relacionado con el tabaquismo de amigos, hermanos y de la madre; con el consumo de alcohol y otras drogas. La educación y los programas preventivos son muy importantes en el inicio y prevención del tabaquismo

Smoking is a public health problem that affects young people, and influenced by the environment and cultural level. OBJECTIVES: To determine smoking prevalence among high-level baccalaureate students in the Autonomous Community of Madrid during the 2018-2019 academic year. To assess the influence of the socio-cultural environment on the onset of youth smoking. To compare the results with previous studies conducted on students of baccalaureate of excellence (BE) and the general population. POPULATION AND METHODS: Cross-sectional study on BE students in the Autonomous Community of Madrid. Using an anonymous questionnaire, they were asked about tobacco, alcohol and drug consumption, as well as the influence of the environment, friends, and family in the beginning. To compare with previous studies. RESULTS: A total of 740 valid questionnaires were collected, of which 430 (58.1%) were female, an overall mean age of 16.57±0.61 years, and 53 (7.18%) were smokers. The majority 39 (78%) of smokers acknowledged their friends' influence at its onset. Alcohol was consumed by 349 (47.48%) and other drugs by 109 (15.27%). Being a smoker was related to alcohol, other drugs, a smoking mother, smoking siblings and smoking friends. CONCLUSIONS: Smoking prevalence among students of BE in Autonomous Community of Madrid continues to be lower than the prevalence of adolescents of their age and there are no variations from previous reports. Starting smoking is related to smoking by friends, siblings, and the mother and with the consumption of alcohol and other substances. Education is very important in the beginning and prevention of smoking, and it is necessary to implement prevention programs at early ages in order to promote their effectiveness, and aimed at young people, parents and teachers

[High level of student smokers in Madrid compared with a similar previous study of 2014]. / Tabaquismo en los estudiantes de alto nivel académico en la Comunidad de Madrid y comparación con estudio previo similar realizado en 2014.

Smoking is a public health problem that affects young people, and influenced by the environment and cultural level. OBJECTIVES: To determine smoking prevalence among high-level baccalaureate students in the Autonomous Community of Madrid during the 2018-2019 academic year. To assess the influence of the socio-cultural environment on the onset of youth smoking. To compare the results with previous studies conducted on students of baccalaureate of excellence (BE) and the general population. POPULATION AND METHODS: Cross-sectional study on BE students in the Autonomous Community of Madrid. Using an anonymous questionnaire, they were asked about tobacco, alcohol and drug consumption, as well as the influence of the environment, friends, and family in the beginning. To compare with previous studies. RESULTS: A total of 740 valid questionnaires were collected, of which 430 (58.1%) were female, an overall mean age of 16.57±0.61 years, and 53 (7.18%) were smokers. The majority 39 (78%) of smokers acknowledged their friends' influence at its onset. Alcohol was consumed by 349 (47.48%) and other drugs by 109 (15.27%). Being a smoker was related to alcohol, other drugs, a smoking mother, smoking siblings and smoking friends. CONCLUSIONS: Smoking prevalence among students of BE in Autonomous Community of Madrid continues to be lower than the prevalence of adolescents of their age and there are no variations from previous reports. Starting smoking is related to smoking by friends, siblings, and the mother and with the consumption of alcohol and other substances. Education is very important in the beginning and prevention of smoking, and it is necessary to implement prevention programs at early ages in order to promote their effectiveness, and aimed at young people, parents and teachers.

Prevalencia del tabaquismo en los estudiantes de bachillerato de la Comarca de Osona (Barcelona) / Smoking Prevalence in High School Students in the Barcelona Region (De Osona District)

El entorno sociocultural influye en el tabaquismo juvenil, y actualmente parece que hay descenso de su prevalencia. Objetivos: Valorar la prevalencia del tabaquismo en estudiantes de bachillerato, la influencia del entorno en su inicio en la Comarca de Osona (Barcelona) (COB) y analizar, si existiera, su disminución. Material y métodos: Estudio transversal en alumnos de bachillerato de COB. Mediante encuesta anónima se interrogó sobre tabaquismo, influencia del entorno y contexto sociocultural en el inicio. Resultados: Participaron 842, se recogieron 714 encuestas y 705 se consideraron válidas. Tenían residencia urbana 303 (93,5%). Fumaban 159 (22,6%) y el 62% eran mujeres; 70 (44%) eran cristianos, 3 (1,9%) musulmanes, 14 (8,8%) de otras religiones y 72 (45,3%) aconfesionales. Consumían alcohol 529 (76,3%) y otras sustancias 308 (46,5%). Padecían alguna enfermedad 40 (6,1%) alumnos y 334 (47,5%) familiares. Había 207 (29,4%) padres fumadores y 152 (22%) madres. Existía tabaquismo familiar en 214 (59%) alumnos y en 582 (82,6%) amigos. Los padres tenían estudios superiores en 212 (30,1%), medios en 331 (48,7%) y primarios en 137 (20,1%); en relación con las madres en 279 (39,6%), en 294(41,7%) y en 116 (16,5%) respectivamente. Ser fumador se relacionaba con consumir alcohol (p = 0,000) y otras sustancias (p = 0,000), ser aconfesional (p = 0,000), no padecer enfermedades (p = 0,043) y con tener madre (p = 0,001), padre (p = 0,005), hermano (p = 0,006), familiares (p = 0,016) o amigos fumadores (p = 0,000). Conclusiones: La prevalencia del tabaquismo en estudiantes de bachillerato en COB es elevada, aunque ha disminuido. Fumar se relacionó con tabaquismo de progenitores, familiares y amigos, ser aconfesional, consumir alcohol y otras sustancias. Se deben implantar programas preventivos dirigidos a estudiantes, progenitores y personal docente

The socio-cultural setting influences youth smoking and its prevalence presumibly has decreased. Objectives: To assess smoking prevalence in high school students, as well as the environmental influence on its onset in the Osona Disrtict of Barcelona (ODB), and to determine whether it has decreased. Material and methods: A cross-sectional study was conducted on high school students in the ODB. In the anonymous questionnaire it was sked asked about smoking and the influence of the social and cultural setting on its onset. Results: A total of 842 students participated, with 714 questionnaires completed, of which 705 were included as valid. A total of 203 (93.5%) students lived in an urban setting. There were 159 smoker students and 62% were women. The smokers were 70 (44%) christians, 3 (1.9%) muslims, 14 (8.%) students with other religions, and 72 (45.3%) non-denominational students. It was detected that 529 (76.3%) of the students consumed alcohol consumers, and 308 (46.5%) consumed other substances. There were 40 (61%) students that suffered a disease, and also 334 students who had ill relatives. There were 207 (29.4%) fathers and 152 (22%) mothers who smoked and 214 (59%) students declared family smoking. Finally 582 (82.6%) had smoker friends. Among fathers, 212 (30.1%), had high level studies, 331 (48.7%) had mid- level studies, and 137 (20.1%) fathers had primary studies. Among mothers, it was 279 (39.6%), 294 (41.7%), and 116 (16.5%). respectively. Being a smoker was associated with alcohol (P = .000) and other substances consumption (P = .000), being non-denominational (P = .000), did not to suffer any disease (P = .043), with having mother (P = .001), father (P = .005), brother or sister (P = .006), and family members (P = .016) who smoked, and smoker friends (P = .000). Conclusions: smoking prevalence in high school students in the ODB is high, but has decreased. Smoking was associated with alcohol and consumption of other substances, being non-denominational, and with friends, parents, and relatives who smoked. It is necessary to establish prevention programs addressed to teenagers, parents and teachers

[Smoking Prevalence in High School Students in the Barcelona Region (De Osona District)]. / Prevalencia del tabaquismo en los estudiantes de bachillerato de la Comarca de Osona (Barcelona).

The socio-cultural setting influences youth smoking and its prevalence presumibly has decreased. OBJECTIVES: To assess smoking prevalence in high school students, as well as the environmental influence on its onset in the Osona Disrtict of Barcelona (ODB), and to determine whether it has decreased. MATERIAL AND METHODS: A cross-sectional study was conducted on high school students in the ODB. In the anonymous questionnaire it was sked asked about smoking and the influence of the social and cultural setting on its onset. RESULTS: A total of 842 students participated, with 714 questionnaires completed, of which 705 were included as valid. A total of 203 (93.5%) students lived in an urban setting. There were 159 smoker students and 62% were women. The smokers were 70 (44%) christians, 3 (1.9%) muslims, 14 (8.%) students with other religions, and 72 (45.3%) non-denominational students. It was detected that 529 (76.3%) of the students consumed alcohol consumers, and 308 (46.5%) consumed other substances. There were 40 (61%) students that suffered a disease, and also 334 students who had ill relatives. There were 207 (29.4%) fathers and 152 (22%) mothers who smoked and 214 (59%) students declared family smoking. Finally 582 (82.6%) had smoker friends. Among fathers, 212 (30.1%), had high level studies, 331 (48.7%) had mid- level studies, and 137 (20.1%) fathers had primary studies. Among mothers, it was 279 (39.6%), 294 (41.7%), and 116 (16.5%). respectively. Being a smoker was associated with alcohol (P=.000) and other substances consumption (P=.000), being non-denominational (P=.000), did not to suffer any disease (P=.043), with having mother (P=.001), father (P=.005), brother or sister (P=.006), and family members (P=.016) who smoked, and smoker friends (P=.000). CONCLUSIONS: smoking prevalence in high school students in the ODB is high, but has decreased. Smoking was associated with alcohol and consumption of other substances, being non-denominational, and with friends, parents, and relatives who smoked. It is necessary to establish prevention programs addressed to teenagers, parents and teachers.

Importancia de la educación en la prevención del tabaquismo. Prevalencia del tabaquismo en escolares de bachillerato con alto nivel académico en la Comunidad de Madrid / No disponible

El tabaquismo suele iniciarse en la adolescencia y está influenciado por el entorno y el nivel cultural de los jóvenes. Objetivos: Valorar la prevalencia del tabaquismo en jóvenes de alto nivel académico y la influencia del entorno en el inicio del tabaquismo. Población y métodos: Estudio transversal en alumnos de Bachillerato de Excelencia, de la Comunidad de Madrid, con alto nivel académico. Mediante encuesta anónima se interrogó sobre el hábito de fumar; influencia del entorno, amigos y familiares en el inicio. Resultados: Se recogieron 322 encuestas válidas, 166 (51,55%) mujeres; edad media, 16,68 ± 2,14 años y en fumadores, 16,67 ± 0,69 años. Fumaban 18 (5,59%) jóvenes: 9 (50%) mujeres y 9 (50%) hombres; comenzaron a los 14,63 ± 1,15 años. Reconocían la influencia de los amigos 11 (64,71%) alumnos. Consumían bebidas alcohólicas 173 (53,73%) y otras sustancias tóxicas 104 (32,2%). Ser fumador se relacionó con: consumir alcohol (p=0,0095), consumir otras sustancias (p<0,0001), tener madre fumadora (p=0,0072), con que el padre tenga estudios primarios (p=0,01) y tener amigo fumador (p=0,001). Conclusiones: La prevalencia del tabaquismo en los estudiantes de bachillerato de alto nivel académico de la Comunidad de Madrid fue baja. El inicio estaba influenciado por el tabaquismo de la madre, de los amigos, con el consumo de alcohol y de otras sustancias tóxicas

The starting on smoking habit usually takes place during the adolescence and in this moment the environment influence and the cultural level have a very important role.Objectives: The aim is to value the smoking habit prevalence in a group of high cultural level students and also the role of the environment influence on the smoking habit beginning. Population and methods: Transversal study of a group of high cultural level students from “Bachillerato de Excelencia” educational program, in the Madrid Region. They answered an anonymous questionnaire about their smoking habit; environment influence, friends and relatives influence on the smoking habit starting. Results: 322 valid questionnaires were included, 166 (51.55%) were women; the average age of the group was 16.68 ± 2.14 years old, the average age of the smoker students was 16.67 ± 0.69 years old. 18 (5.59%) students were smokers: 9 (50%) of them were women and 9 (50%) were men; They started to smoke when they were 14.63 ± 1.15 years old. 11 (64.71%) students of this group recognised the friends influenced on the smoking habit starting. 173 (53.73%) students consumed alcohol and 104 (32.2%) students consumed other toxic substances. Being smoker is related with alcohol consuming (p=0.0095) and is also related with the consumption of toxic substances ( p<0.0001), having a smoker mother (p=0.0072), having a father with elementary studies (p=0.01) and having smoker friend (p=0.001). Conclusions: The smoking habit prevalence among high cultural students in the Madrid Region was low. The smoking beginning was influenced by his smoker friend, smoker mother, smoking habit and with alcohol consumption and other toxic substances consumption

Prevalencia de tabaquismo en escolares de bachillerato con alto nivel académico en un instituto madrileño / No disponible

El tabaquismo suele iniciarse en la adolescencia y en el inicio del hábito tiene importancia la influencia del entorno y el nivel cultural de los jóvenes. El objetivo de este estudio es valorar la prevalencia del tabaquismo en jóvenes de nivel cultural elevado y la influencia del entorno socio-cultural en la iniciación al consumo de tabaco. Población y método: Estudio transversal en alumnos de Bachillerato de Excelencia, de la Comunidad de Madrid, con nivel cultural elevado. Mediante encuesta anónima se interrogó sobre el hábito de fumar; influencia del entorno, amigos y familiares en el inicio. Resultados: Participaron 137 alumnos, respondieron a las encuestas el 88,1%. Mujeres 65 (53,7%) y hombres 56 (46,3%); la edad media general era 16,6 ± 0,52 años, y en los fumadores de 17 ± 0,45 años. Fumaban 11 jóvenes (9,1%): 7 (63,6%) fueron mujeres y 4 (56,4%) hombres; comenzaron a fumar de media a los 13,6 ± 1,8 años. Reconocieron la influencia de los amigos en el inicio del hábito 10 (91%) alumnos. Consumían bebidas alcohólicas 62 (51%) alumnos y otras sustancias tóxicas 47 (38,8%) alumnos. En 36 (29,8%) casos los padres eran fumadores, en 34 (28,1%) lo eran las madres, en 12 (12,4%) fumaban los hermanos y, los amigos en 91 (75,2%) alumnos. La edad media de los fumadores fue superior con p= 0,016. Ser fumador se relacionó con: consumir alcohol (p= 0,036) y tener hermano fumador (p= 0,00). Conclusiones: La prevalencia de tabaquismo en los estudiantes de bachillerato de alto nivel académico de la Comunidad de Madrid fue del 9,1%; inferior a la descrita para jóvenes de su edad. El inicio estaba influenciado por el tabaquismo de hermanos y con el consumo de alcohol

The starting on smoking habit usually takes place during the adolescence and in this moment the environment influence and the cultural level have a very important role. Objectives: The aim is to value the smoking habit prevalence in a group of high cultural level students and also the role of the environment influence on the smoking habit beginning. Population and methods: Transversal study of a group of high cultural level students from "Bachillerato de Excelencia" educational program, in the Madrid Region. They answered an anonymous questionnaire about their smoking habit; environment influence, friends and relatives influence on the smoking habit starting. Results: In this study participated 137 students, answered the questionnaire an 88,1% of them. 65 (53,7%) were women and 56 (46,3%) were men ; the average age of the group was 16,6 ± 0,52 years old, the average age of the smoker students was 17 ± 0,45 years old. 11 (9,1%) students were smokers: 7 (63,6%) of them were women and 4 (56,4%) were men; They started to smoke when they were 13,6 ± 1,8 years old. 10 (91%) students of this group recognised the friends influenced on the smoking habit starting. 62 (51%) students consumed alcohol and 47 (38,8%) students consumed other toxic substances. 36 (29,8%) parents were smokers and 34 (28,1%) mothers were smokers; 12 (12,4%) student brothers were smokers, among the friends 91 (75,2%) were smokers. The average age of the smoker group was higher p=0,016. Being smoker is related with alcohol consuming (p=0,036) and is also related with having and smoker brother (p=0,00). Conclusions: The smoking habit prevalence among high cultural students in the Madrid Region was 9,1%; it is lower than the average prevalence of his age group. The smoking beginning was influenced by his brother,s smoking habit and with alcohol consumption

Estimulación bicameral en una paciente con miocardiopatía hipertrófica obstructiva refractaria y mala tolerancia a la ultrafiltración extracorpórea / Dual-chamber pacing in a patient with refractory obstructive hypertrophic cardiomyopathy and intolerance to extracorporeal ultrafiltration

El tratamiento óptimo de los pacientes con miocardiopatía hipertrófica obstructiva refractaria al tratamiento médico convencional es motivo de controversia. Algunos autores han demostrado la eficacia, en cuanto a mejoría sintomática y reducción del gradiente dinámico, de la estimulación secuencial auriculoventricular en este tipo de pacientes. Se presenta el caso de una paciente trasplantada renal, con miocardiopatía hipertrófica obstructiva con gradiente subaórtico elevado, que ingresó en la unidad coronaria por insuficiencia cardíaca refractaria y deterioro de la función renal; precisó ultrafiltración extracorpórea que no toleraba de manera reiterada por episodios graves de bajo gasto. Se comentan los aspectos terapéuticos y se destaca la buena respuesta a la estimulación con marcapasos bicameral. La utilidad de la estimulación secuencial en pacientes con miocardiopatía hipertrófica obstructiva sometidos a ultrafiltración por presentar síntomas congestivos refractarios al tratamiento médico convencional no ha sido previamente comunicada (AU)