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1.
BMC Med Educ ; 23(1): 843, 2023 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-37936105

RESUMEN

INTRODUCTION: Medical Education studies suggest that medical students experience depression, anxiety and psychopathological symptomatology in a proportion higher than in the rest of the population. In the present study, we aimed to conduct a nationwide analysis to describe student's perceptions of Educational Climate in Spanish medical schools, and its relationship with psychopathological symptomatology. METHODS: The study was carried out in 2022 in all 44 medical schools in Spain, and analyses the academic climate, and psychopathological symptomatology among medical students (n = 4374). To measure these variables, we used the Dundee Ready Education Environment Measure (DREEM) for academic climate, and the SA-45 (Symptom Assessment-45 Questionnaire was used to assess psychopathological symptomatology. RESULTS: The mean DREEM global score was low, 95.8 (SD 22.6). Worse perception of the academic climate has been found in females (t -2.21, p 0.027), in students of the clinical academic years (t 16.9, p < 0.001), and public medical schools ( t 15.6, p < 0.001). The SA45 general index score was high (p90) in 25.6% of participants. In respect of gender, female students presented higher levels of SA45 general index score, depression, interpersonal sensitivity, somatization, anxiety, obsession-compulsion, and phobic anxiety symptoms. Higher DREEM global and subscale scores corresponded to a higher SA-45 global index score and higher SA-45 subscale scores. CONCLUSIONS: Our study suggests a correlation between a poor perception of academic climate, increased depression, anxiety, and other psychopathological symptoms, with a pattern that varies between different faculties. The perception of academic climate varied between medical schools, as did the psychopathological symptoms scores. Our finding suggests the prevalence of these variables in medical students is, at least in part, attributable to factors directly related to the learning atmosphere.


Asunto(s)
Educación de Pregrado en Medicina , Trastornos Mentales , Estudiantes de Medicina , Humanos , Femenino , Aprendizaje , Encuestas y Cuestionarios , Percepción Social
2.
Lipids ; 58(4): 197-206, 2023 07.
Artículo en Inglés | MEDLINE | ID: mdl-37291984

RESUMEN

Extremely variable prevalence rates of atherogenic dyslipidaemia (AD) in type 2 diabetes (T2DM) subjects have been reported. The primary aim was to assess AD prevalence in Spanish T2DM subjects. Secondary objectives were to evaluate the differential clinical characteristics between T2DM subjects with and without AD, to describe lipid profile evolution and use of lipid-lowering treatment in clinical practice by the Spanish Lipid Units. Data was obtained from the National Registry of Dyslipidaemias of the Spanish Atherosclerosis Society, from a multicentric sub-study focused on AD prevalence in T2DM subjects (PREDISAT study). The inclusion criteria were subjects diagnosed of T2DM with age ≥18 years old. A total of 385 T2DM subjects with a mean age of 61 years and 246 (64%) men were included. The mean follow-up was 22 ± 7.4 months. At baseline, 41.3% of the T2DM subjects presented AD, this percentage decreasing to 34.8% with therapeutic intervention. AD prevalence varied in different age groups and appeared to be more prevalent in younger T2DM subjects. Those with AD had a more atherogenic lipid profile at baseline, with higher total cholesterol, triglyceride and non-(high-density lipoprotein) HDL cholesterol levels at baseline, together with lower HDL cholesterol concentrations, without achieving lipid subfraction goals during follow-up. Although almost 90% of the AD subjects were under lipid-lowering treatment, most were receiving only one drug, being statins the most used treatmentA high AD prevalence in T2DM subjects was observed, being age a determinant factor, with a modest decline during follow-up. Although almost 90% of the AD subjects were under lipid-lowering drugs, most were only receiving monotherapy with statins.


Asunto(s)
Aterosclerosis , Diabetes Mellitus Tipo 2 , Dislipidemias , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Masculino , Humanos , Persona de Mediana Edad , Adolescente , Femenino , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , HDL-Colesterol , Dislipidemias/tratamiento farmacológico , Dislipidemias/epidemiología , Dislipidemias/complicaciones , Aterosclerosis/tratamiento farmacológico , Aterosclerosis/epidemiología
3.
Clin Investig Arterioscler ; 35(4): 206-217, 2023.
Artículo en Inglés, Español | MEDLINE | ID: mdl-36889989

RESUMEN

In patients who have achieved optimal LDL-C control, there remains a residual risk of atherothrombotic cardiovascular disease (ACVD) related to alterations in lipid metabolism, where alterations in triglyceride-rich lipoproteins and the cholesterol they contain, called remnant cholesterol, play a major role. Remnant cholesterol has an association with residual risk of ACVD that is independent of LDL-C and has been demonstrated in epidemiological and Mendelian randomisation studies, and in analyses of clinical trials of lipid-lowering drugs. Remnant triglyceride-rich lipoproteins particles are highly atherogenic, due to their ability to enter and be retained in the arterial wall, their high cholesterol content, and their ability to generate "foam cells" and an inflammatory response. Assessment of remnant cholesterol may provide information on residual risk of ACVD beyond the information provided by LDL-C, Non-HDL-C, and apoB, particularly in individuals with hypertriglyceridaemia, type 2 diabetes, or metabolic syndrome. In the REDUCE-IT study, icosapent ethyl was shown to have a preventive effect against ACVD in very high cardiovascular risk patients with hypertriglyceridaemia treated with statins and target LDL-C. New lipid-lowering drugs will help to define efficacy and criteria in the treatment of excess remnant cholesterol and hypertriglyceridaemia in the prevention of ACVD.


Asunto(s)
Aterosclerosis , Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Hipertrigliceridemia , Humanos , LDL-Colesterol , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Colesterol/metabolismo , Aterosclerosis/etiología , Aterosclerosis/prevención & control , Aterosclerosis/tratamiento farmacológico , Triglicéridos , Hipolipemiantes/uso terapéutico , Lipoproteínas/metabolismo , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/tratamiento farmacológico , Hipertrigliceridemia/complicaciones , Hipertrigliceridemia/tratamiento farmacológico , Factores de Riesgo
4.
Clin Investig Arterioscler ; 35(4): 178-184, 2023.
Artículo en Inglés, Español | MEDLINE | ID: mdl-36717323

RESUMEN

OBJECTIVES: GALIPEMIAS is a study designed to establish the prevalence of familial dyslipidemia in the general population of Galicia. The objective of the present study was to assess the prevalence of atherogenic dyslipidemia (AD), its relationship with other cardiovascular risk (CVR) factors, and the degree of lipid control. METHODS: Cross-sectional study carried out in the general population over 18 years of age residing in Galicia and with a health card from the Galician Health Service (N=1,000). Selection of the sample by means of random sampling by conglomerates. The AD prevalence adjusted for age and sex and the related variables were analyzed. RESULTS: The prevalence of AD adjusted for age and sex was 6.6% (95% CI: 5.0-8.3%). Arterial hypertension, altered basal glycemia, type 2 diabetes mellitus and cardiovascular disease were more frequent in subjects with AD than in the rest of the population. 47.5% of the subjects with AD had a high or very high CVR. Lipid-lowering drugs were received by 38.9% (30.5% statins) of the participants with AD (46.1% of those with high and 71.4% of those with very high CVR). 25.4% of the subjects with AD had target LDL-c levels, all of them with low or moderate CVR. CONCLUSIONS: The prevalence of AD in the general adult population of Galicia is not negligible, and it was related to several CVR factors and cardiovascular disease. Despite this, this lipid alteration was underdiagnosed and undertreated.


Asunto(s)
Aterosclerosis , Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Dislipidemias , Adulto , Humanos , Adolescente , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Factores de Riesgo , Prevalencia , Estudios Transversales , HDL-Colesterol , Aterosclerosis/diagnóstico , Dislipidemias/tratamiento farmacológico
5.
Endocrinol Diabetes Nutr (Engl Ed) ; 69(1): 52-62, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35232560

RESUMEN

The renin-angiotensin system (RAS) is one of the most complex hormonal regulatory systems, involving several organs that interact to regulate multiple body functions. The study of this system initially focused on investigating its role in the regulation of both cardiovascular function and related pathologies. From this approach, pharmacological strategies were developed for the treatment of cardiovascular diseases. However, new findings in recent decades have suggested that the RAS is much more complex and comprises two subsystems, the classic RAS and an alternative RAS, with antagonistic effects that are usually in equilibrium. The classic system is involved in pathologies where inflammatory, hypertrophic and fibrotic phenomena are common and is related to the development of chronic diseases that affect various body systems. This understanding has been reinforced by the evidence that local renin-angiotensin systems exist in many tissue types and by the role of the RAS in the spread and severity of COVID-19 infection, where it was discovered that viral entry into cells of the respiratory system is accomplished through binding to angiotensin-converting enzyme 2, which is present in the alveolar epithelium and is overexpressed in patients with chronic cardiometabolic diseases. In this narrative review, preclinical and clinical aspects of the RAS are presented and topics for future research are discussed some aspects are raised that should be clarified in the future and that call for further investigation of this system.


Asunto(s)
COVID-19 , Enfermedades Cardiovasculares , Humanos , Sistema Renina-Angiotensina/fisiología , SARS-CoV-2
6.
Endocrinol Diabetes Nutr ; 69(1): 52-62, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34723133

RESUMEN

The renin-angiotensin system (RAS) is one of the most complex hormonal regulatory systems, involving several organs that interact to regulate multiple body functions. The study of this system initially focused on investigating its role in the regulation of both cardiovascular function and related pathologies. From this approach, pharmacological strategies were developed for the treatment of cardiovascular diseases. However, new findings in recent decades have suggested that the RAS is much more complex and comprises two subsystems, the classic RAS and an alternative RAS, with antagonistic effects that are usually in equilibrium. The classic system is involved in pathologies where inflammatory, hypertrophic and fibrotic phenomena are common and is related to the development of chronic diseases that affect various body systems. This understanding has been reinforced by the evidence that local renin-angiotensin systems exist in many tissue types and by the role of the RAS in the spread and severity of COVID-19 infection, where it was discovered that viral entry into cells of the respiratory system is accomplished through binding to angiotensin-converting enzyme 2, which is present in the alveolar epithelium and is overexpressed in patients with chronic cardiometabolic diseases. In this narrative review, preclinical and clinical aspects of the RAS are presented and topics for future research are discussed some aspects are raised that should be clarified in the future and that call for further investigation of this system.


El sistema renina angiotensina es uno de los sistemas de regulación hormonal más complejos, pues participan varios órganos qué interactúan entre sí para regular múltiples funciones corporales. En un inicio el estudio de este sistema se enfocó en investigar su papel en la regulación, tanto de la función cardiovascular como de las enfermedades relacionadas. A partir de este enfoque se desarrollaron estrategias farmacológicas para el tratamiento de enfermedades cardiovasculares. Sin embargo, en las últimas décadas y con nuevos hallazgos se ha planteado que el sistema renina angiotensina es un sistema mucho más complejo constituido por 2 subsistemas, uno clásico y otro alternativo que tienen efectos antagónicos, normalmente en equilibrio. El predominio del sistema clásico está involucrado en enfermedades donde los fenómenos inflamatorios, hipertróficos y fibróticos son comunes y se relacionan con el desarrollo de enfermedades crónicas que afectan diversos sistemas. Esto se ha reforzado por la evidencia de que existen sistemas renina angiotensina locales en muchos tejidos, y por el papel del sistema renina angiotensina en la propagación y severidad de la infección por la COVID-19, en donde se descubrió que el ingreso del virus en el sistema respiratorio se realiza a través de la enzima convertidora de angiotensina 2, presente en el epitelio alveolar y que se sobreexpresa en pacientes con enfermedades cardiometabólicas crónicas. En la presente revisión narrativa se presentan aspectos preclínicos y clínicos de ese sistema y se plantean algunos aspectos que se deben aclarar en el futuro y que demandarán más investigación de este sistema.

7.
J Pers Med ; 11(10)2021 Sep 28.
Artículo en Inglés | MEDLINE | ID: mdl-34683113

RESUMEN

Over the recent years, advances in the development of anti-cancer treatments, particularly the implementation of ICIs (immune checkpoint inhibitors), have resulted in increased survival rates in NSCLC (non-small cell lung cancer) patients. However, a significant proportion of patients does not seem respond to immunotherapy, and some individuals even develop secondary resistance to treatment. Therefore, it is imperative to correctly identify the patients that will benefit from ICI therapy in order to tailor therapeutic options in an individualised setting, ultimately benefitting both the patient and the health system. Many different biomarkers have been explored to correctly stratify patients and predict response to immunotherapy, but liquid biopsy approaches have recently arisen as an interesting opportunity to predict and monitor treatment response due to their logistic accessibility. This review summarises the current data and efforts in the field of ICI response biomarkers in NSCLC patients and highlights advantages and limitations as we discuss the road to clinical implementation.

8.
Clin Investig Arterioscler ; 33 Suppl 2: 43-49, 2021 May.
Artículo en Inglés, Español | MEDLINE | ID: mdl-34006353

RESUMEN

Familial combined hyperlipidaemia (FCH) is the most prevalent form of familial hyperlipidaemia with a multigenic origin and a complex pattern of inheritance. In this respect, FCH is an oligogenic primary lipid disorder due to interaction of genetic variants and mutations with environmental factors. Patients with FCH are at increased risk of cardiovascular disease and often have other associated metabolic conditions. Despite its relevance in cardiovascular prevention, FCH is frequently underdiagnosed and very often undertreated. In this review, emphasis is placed on the most recent advances in FCH, in order to increase its awareness and ultimately contribute to improving its clinical control.


Asunto(s)
Hiperlipidemia Familiar Combinada , Hiperlipoproteinemia Tipo II , Enfermedades Cardiovasculares/etiología , Humanos , Hiperlipidemia Familiar Combinada/diagnóstico , Hiperlipidemia Familiar Combinada/genética , Hiperlipidemias/genética
10.
Clin Investig Arterioscler ; 32(5): 209-218, 2020.
Artículo en Inglés, Español | MEDLINE | ID: mdl-32037300

RESUMEN

In general, both European and American clinical guidelines have addressed the management of atherogenic dyslipidaemia in an unconvincing and even superficial way, largely because of the available therapeutic limitations. Consequently, this type of dyslipidaemia is underdiagnosed, under-treated, and under-controlled. Given the recent presentation of the 2019 guidelines of the European Atherosclerosis Society and the European Society of Cardiology on the management of dyslipidaemias, it seems appropriate to examine its position with respect to atherogenic dyslipidaemia and/or its main components, the increase in triglyceride-rich lipoproteins, and the decrease of high-density lipoprotein cholesterol.


Asunto(s)
Aterosclerosis/prevención & control , Dislipidemias/terapia , Guías de Práctica Clínica como Asunto , Aterosclerosis/etiología , HDL-Colesterol/sangre , Dislipidemias/sangre , Dislipidemias/complicaciones , Europa (Continente) , Humanos , Triglicéridos/sangre
11.
PLoS One ; 15(1): e0226251, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31905205

RESUMEN

BACKGROUND: Peripheral venous catheters (PVCs) require adequate maintenance based on heparin or saline locks in order to prevent complications. Heparin has proven effective in central venous catheters, although its use in PVCs remains controversial. Our hypothesis was that saline locks are as effective as heparin locks in preventing problems with PVCs. The objective of the present study was to compare phlebitis and catheter tip colonization rates between PVCs locked with saline and those locked with heparin in patients admitted to an internal medicine department (IMD). METHODS: We performed a 19-month prospective, controlled, open-label, randomized clinical study of patients with at least 1 PVC admitted to the IMD of our hospital. The patients were randomized to receive saline solution (PosiFlush®, group A) or heparin (Fibrilin®, group B) for daily maintenance of the PVC. Clinical and microbiological data were monitored to investigate the frequency of phlebitis, catheter tip colonization, and catheter-related bloodstream infection (C-RBSI), as well as crude mortality, days of hospital stay, and days of antimicrobial treatment. RESULTS: We assessed 339 PVCs (241 patients), of which 192 (56.6%) were locked with saline (group A) and 147 (43.4%) with heparin (group B). The main demographic characteristics of the patients were distributed equally between the 2 study groups. The median (IQR) catheter days was 5 (3-8) for both groups (p = 0.64). The frequency of phlebitis was 17.7% for group A and 13.3% for group B (p = 0.30). The frequency of colonization of PVC tips was 14.6% and 12.2% in groups A and B, respectively (p = 0.63). Only 2 episodes of C-RBSI were detected (1 patient in group A). Saline lock was not an independent factor for phlebitis or catheter colonization. CONCLUSIONS: Our study revealed no statistically significant differences in the frequency of phlebitis and catheter tip colonization between PVCs locked with saline and PVCs locked with heparin. We suggest that PVC can be maintained with saline solution, as it is safer and cheaper than heparin.


Asunto(s)
Anticoagulantes/administración & dosificación , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Periférico/efectos adversos , Catéteres Venosos Centrales/efectos adversos , Heparina/administración & dosificación , Flebitis/prevención & control , Solución Salina/administración & dosificación , Anciano , Anciano de 80 o más Años , Infecciones Relacionadas con Catéteres/microbiología , Femenino , Humanos , Medicina Interna , Masculino , Persona de Mediana Edad , Flebitis/etiología , Pronóstico , Estudios Prospectivos
12.
Am J Cardiovasc Drugs ; 20(4): 325-332, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31650523

RESUMEN

Pooled data from randomized clinical trials on lipid-lowering therapy have provided valuable information and clinical insights. Although cardiovascular disease is a common cause of death, mortality data have rarely been prominent in key lipid trials. The 4S, LIPID and HPS trials were the first to demonstrate a reduction in overall mortality. Lower- versus higher-intensity statin trials and non-statin lipid-lowering trials with ezetimibe and proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors proved that additional lipid lowering significantly reduces the occurrence of cardiovascular events. However, only the ODYSSEY OUTCOMES trial showed a reduction in all-cause mortality. The aim of the present narrative review was to contrast these results with those of other key lipid trials: those assessing statins compared with placebo, those evaluating intensive- versus moderate-intensity lipid-lowering therapy and, finally, those investigating non-statin lipid-lowering therapies.


Asunto(s)
Enfermedades Cardiovasculares/mortalidad , LDL-Colesterol/sangre , Enfermedades Cardiovasculares/sangre , Ezetimiba/uso terapéutico , Humanos , Lípidos/sangre , Proproteína Convertasa 9/metabolismo , Ensayos Clínicos Controlados Aleatorios como Asunto , Prevención Secundaria/métodos
13.
Rev. colomb. radiol ; 31(1): 5294-5298, mar, 2020. ilus, graf
Artículo en Inglés, Español | LILACS, COLNAL | ID: biblio-1292801

RESUMEN

El gliosarcoma es un tumor raro del sistema nervioso central y de alto grado de malignidad. La OMS lo clasifica como variante del glioblastoma (grado IV) y es de mal pronóstico. Histológicamente se caracteriza por tener componentes gliales y mesenquimatosos. El cuadro clínico varía dependiendo de su localización y tamaño, los signos y síntomas más frecuentes son convulsiones, cefalea y déficit neurológico focal. El acercamiento diagnóstico inicial es la tomografía computarizada que aporta datos de sospecha; sin embargo, la resonancia magnética constituye el pilar diagnóstico, con importantes elementos de diagnóstico que se vuelven más significativos con el uso de secuencias funcionales como la tractografía. Se presenta un caso clínico con revisión de la literatura y los hallazgos más significativos en los estudios de imagen.


Gliosarcoma is a rare and highly malignant central nervous system tumor. It is classified by the WHO as a variant of glioblastoma (grade IV) and has a poor prognosis. Histologically it is characterized by having both glial and mesenchymal components. Clinically, it varies depending on the location and size of the tumor, the most frequent symptoms being seizures, headaches and focal neurological deficit. The initial diagnostic approach is computed tomography, which provides suspicionus data; however, magnetic resonance is the diagnostic pillar, providing important data that becomes more significant with the use of functional sequences such as tractography. A clinical case is presented with a literature review and the most significant findings in the imaging studies.


Asunto(s)
Gliosarcoma , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X
14.
Clin Investig Arterioscler ; 31 Suppl 2: 28-33, 2019 Dec.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31806265

RESUMEN

Although cholesterol linked to low-density lipoproteins (c-LDL) is well established as a risk factor for cardiovascular disease, there is often a more complex dyslipidaemia pattern that contributes to the formation of atherosclerotic plaque. Non-HDL cholesterol (c-NO-HDL) is used to estimate the total amount of atherogenic lipoproteins in plasma, some of which are not usually determined in daily clinical practice. c-NO-HDL is easily calculated from the subtraction of total plasma cholesterol from the cholesterol content carried by high density lipoproteins. The c-NO-HDL has a predictive value superior to that of C-LDL to estimate the risk of major cardiovascular events in epidemiological studies. Genetic studies by analysis of the complete genome, together with those based on Mendelian randomisation, point to the aetiological character of c-NO-HDL on ischaemic heart disease (IHD). Intervention studies, and the meta-analyses derived from them, close the causal circle between c-NO-HDL and IHD, by demonstrating that any intervention that decreases the concentrations of the former reduces the incidence of arteriosclerotic heart disease. The European ESC/EAS 2016 guide for the management of dyslipidaemia considers c-NO-HDL as a therapeutic target with a Class IIa recommendation (should be performed) Level B (data from a single randomised clinical trial [RCT]) or from several non-RCTs), and sets its target at less than 100 or 130mg/dL for those patients with very high risk or high risk, respectively. These achievable c-NO-HDL values are easily calculated by adding 30mg/dL to the c-LDL targets.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Colesterol/sangre , Dislipidemias/sangre , Enfermedades Cardiovasculares/etiología , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Dislipidemias/tratamiento farmacológico , Estudio de Asociación del Genoma Completo , Humanos , Hipertrigliceridemia/sangre , Lipoproteínas/sangre , Análisis de la Aleatorización Mendeliana , Mutación , Isquemia Miocárdica/etiología , Isquemia Miocárdica/genética , Isquemia Miocárdica/prevención & control , Guías de Práctica Clínica como Asunto , Riesgo , Medición de Riesgo
15.
Clin Investig Arterioscler ; 31(2): 75-88, 2019.
Artículo en Inglés, Español | MEDLINE | ID: mdl-30262442

RESUMEN

There is no doubt about the relationship between LDL-c and cardiovascular risk, as well as about the benefits of statin treatment. Once the objective of LDL-c has been achieved, the evidences that demonstrate the persistence of a high cardiovascular risk, a concept called residual risk, are notable. The residual risk of lipid origin is based on atherogenic dyslipidemia, characterized by an increase in triglycerides and triglyceride-rich lipoproteins, a decrease in HDL-c and qualitative alterations in LDL particles. The most commonly used measures to identify this dyslipidemia are based on the determination of total cholesterol, triglycerides, HDL, non-HDL cholesterol and remaining cholesterol, as well as apolipoprotein B100 and lipoprotein (a) in certain cases. The treatment of atherogenic dyslipidemia is based on weight loss and physical exercise. Regarding pharmacological treatment, we have no evidence of cardiovascular benefit with drugs aimed at lowering triglycerides and HDL-c, fenofibrate seems to be effective in situations of atherogenic dyslipidemia.


Asunto(s)
Aterosclerosis/complicaciones , Enfermedades Cardiovasculares/etiología , Dislipidemias/complicaciones , Aterosclerosis/terapia , Enfermedades Cardiovasculares/fisiopatología , Enfermedades Cardiovasculares/prevención & control , Colesterol/sangre , Dislipidemias/terapia , Fenofibrato/administración & dosificación , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Hipolipemiantes/administración & dosificación , Lípidos/sangre , Factores de Riesgo , Triglicéridos/sangre
16.
J Environ Manage ; 241: 558-566, 2019 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-30318158

RESUMEN

We studied the fire record and its environmental consequences during the Holocene in the Central Ebro Basin. This region is very sensitive to environmental changes due to its semiarid conditions, lithological features and a continuous human presence during the past 6000 years. The study area is a 6 m buried sequence of polycyclic soils developed approximately 9500 years ago that is exceptionally well preserved and encompasses four sedimentary units. The content and size distribution of macroscopic charcoal fragments were determined throughout the soil sequence and the analysis of the composition of charcoal, litter and sediments via analytical pyrolysis (Py-GC/MS). The high amount of charcoal fragments recovered in most horizons highlights the fire frequencies since the beginning of the Neolithic, most of which were probably of anthropogenic origin. In some soil horizons where charcoal was not found, we detected a distribution pattern of lipid compounds that could be related to biomass burning. On the other hand, the low number of pyrolysates in the charcoal could be attributed to high-intensity fires. No clear pattern was found in the composition of pyrolysates related to the age of sediments or vegetation type. The most ancient soil (Unit 1) was the richest in charcoal content and contains a higher proportion of larger fragments (>4 mm), which is consistent with the burning of a relatively dense vegetation cover. This buried soil has been preserved in situ, probably due to the accumulation of sedimentary materials because of a high-intensity fire. In addition, the pyrogenic C in this soil has some plant markers that could indicate a low degree of transformation. In Units 2-4, both the amount of charcoals and the proportions of macrofragments >4 mm are lower than those in Unit 1, which coincides with a more open forest and the presence of shrubs and herbs. The preservation of this site is key to continuing with studies that contribute to a better assessment of the consequences of future disturbances, such as landscape transformation and climate change.


Asunto(s)
Incendios , Suelo , Carbón Orgánico , Bosques , España
17.
Diabetes Metab Syndr Obes ; 11: 683-697, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30464566

RESUMEN

Metabolic syndrome (MetS), a disorder with a high and growing prevalence, is a recognized risk factor for cardiovascular disease (CVD) and type 2 diabetes. It is a constellation of clinical and metabolic risk factors that include abdominal obesity, dyslipidemia, glucose intolerance, and hypertension. Unfortunately, MetS is typically underrecognized, and there is great heterogeneity in its management, which can hamper clinical decision-making and be a barrier to achieving the therapeutic goals of CVD and diabetes prevention. Although no single treatment for MetS as a whole currently exists, management should be targeted at treating the conditions contributing to it and possibly reversing the risk factors. All this justifies the need to develop recommendations that adapt existing knowledge to clinical practice in our healthcare system. In this regard, professionals from different scientific societies who are involved in the management of the different MetS components reviewed the available scientific evidence focused basically on therapeutic aspects of MetS and developed a consensus document to establish recommendations on therapeutic goals that facilitate their homogenization in clinical decision-making.

18.
Clin Investig Arterioscler ; 30(4): 188-192, 2018.
Artículo en Inglés, Español | MEDLINE | ID: mdl-29789212

RESUMEN

Fibrates are drugs that reduce triglycerides, elevate high-density lipoproteins, as well as decrease small, dense LDL particles. The results of a study have recently been published by the Cochrane Collaboration on fibrates efficacy and safety in the primary prevention of cardiovascular disease. This study includes a systematic review and a meta-analysis of 6 studies (16,135 patients) that evaluated the clinical benefits of fibrates compared to placebo use or other lipid-lowering drugs. This review showed evidence of a protective effect of the fibrates compared with placebo as regards a reduction 16% of a compound objective of death due to cardiovascular disease, non-fatal myocardial infarction, or non-fatal cerebrovascular accident (NNT: 112), and that reduce coronary morbidity and mortality by 21% (NNT: 125). In addition, fibrates could reduce previously established diabetic retinopathy. However, fibrates do not influence total mortality, or non-cardiovascular mortality. Its joint use with statins does not benefit patients without established cardiovascular disease, compared to the use of statins in monotherapy. Fibrates are safe, although they can elevate serum creatinine levels.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Ácidos Fíbricos/uso terapéutico , Hipolipemiantes/uso terapéutico , Enfermedades Cardiovasculares/etiología , Creatinina/sangre , Quimioterapia Combinada , Ácidos Fíbricos/administración & dosificación , Ácidos Fíbricos/efectos adversos , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipolipemiantes/administración & dosificación , Hipolipemiantes/efectos adversos , Lípidos/sangre , Prevención Primaria
19.
Clin Investig Arterioscler ; 30(1): 30-35, 2018.
Artículo en Inglés, Español | MEDLINE | ID: mdl-29395493

RESUMEN

Fibrates are a group of drugs that are known mainly for reducing triglycerides, increasing high density lipoproteins (HDL), and reducing the fraction of small, dense LDL particles. The results of a Cochrane Collaboration study have recently been published on their efficacy and safety in the secondary prevention of severe cardiovascular accidents, including coronary and cerebrovascular disease. The study included randomised clinical trials in which the fibrate was compared with placebo or with no treatment. Clinical trials comparing two different fibrates were excluded. The clinical trials evaluated included a total of 16,112 patients (13 trials). The meta-analysis (including all the trials with fibrates) showed evidence of a protective effect of the fibrates compared with placebo as regards a compound objective of non-fatal stroke, non-fatal myocardial infarction, and death of cardiovascular origin (hazard ration of 0.88, with a 95% confidence interval of 0.83 to 0.94; in 16,064 individuals included in 12 studies). Thus, the results showed, with a moderate level of evidence, that fibrates could be effective in secondary prevention considering a compound objective of non-fatal stroke, non-fatal myocardial infarction, and death of cardiovascular origin.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Ácidos Fíbricos/uso terapéutico , Hipolipemiantes/uso terapéutico , Enfermedades Cardiovasculares/etiología , Ácidos Fíbricos/efectos adversos , Humanos , Hipolipemiantes/efectos adversos , Infarto del Miocardio/etiología , Infarto del Miocardio/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Prevención Secundaria/métodos , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control
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