[Comparison and agreement of the Cockcroft-Gault and MDRD equations to estimate glomerular filtration rate in diagnosis of occult chronic kidney disease]. / Comparación y concordancia de las ecuaciones de estimación de filtrado glomerular de Cockcroft-Gault y MDRD en el diagnóstico de enfermedad renal crónica oculta.

INTRODUCTION AND OBJECTIVES: The estimation of Glomerular Filtration Rate (GFR) by Cockroft-Gault or simplified MDRD functions is a powerful tool for the Chronic Kidney Disease (CKD) diagnosis. The aims of the present study are: 1)-To analyze the accuracy between Cockcroft-Gault and simplified MDRD equations in the Hidden Renal Failure (HRF) diagnosis; and 2)-To know the profile and coronary risk of patients diagnosed of HRF for each equation. PATIENTS AND METHODS: Ten year follow-up of a cross sectional study. A total of 845 patients between 35 and 74 years old (average age 55 years, 56.7% female) without evidence of cardiovascular disease and taken care in a urban primary health center. HRF was defined as an estimated GFR <60 ml/min/1.73 m2 in patients with normal values of creatinine (<1.3 mg/dl in women and <1.4 mg/dl in men ) RESULTS: 8.3% of studied population had HRF by Cockroft-Gault formula and 11.6% using MDRD. The HRF patients diagnosticated with Cockroft-Gault function were older (67.4 vs 64.4 years, p<0.001) and had a higher coronary risk using either the original Framingham equation and REGICOR function. Furthermore, those HRF patients diagnosticated using MDRD function had a higher body mass index (29.6 vs 26.3 kg/m2, p<0.001) and were women in a greater percentage. Kappa index of agreement of these two equations for diagnosis of HRF was 0,55. The HRF patients diagnosticated exclusively by the use of Cockroft-Gault function were mainly men (75%), older (69.1 vs 61.9 years, p<0.001) and they had a high coronary risk in the Framingham equation (32.7%) and REGICOR function (13.1%) CONCLUSIONS: Cockroft-Gault and MDRD equations present a moderate agreement in HRF diagnosis (stage 3 of CKD) in patients between 35 and 74 years old. If we only use the MDRD function, a group of HRF patients would be excluded. This population was mainly male (75%), older (69 years old), with a high coronary risk estimated by original Framingham and REGICOR equations, and confirmed in the ten years follow-up of these patients.

Occurrence of adenosine 2',5'-bisphosphate in rat liver.

Adenosine 2',5'-bisphosphate (pAp) is present in liver from 2-day-fasted rats, at a concentration of around 1 microM. pAp was obtained through perchloric acid extraction of the liver followed by two successive DEAE-cellulose chromatographies and an ion-pair high-pressure liquid chromatography. Both pAp extracted from liver and that obtained from a commercial source showed the same pattern of hydrolysis by alkaline phosphatase, i.e., more 5'-AMP than 2'-AMP was obtained as an intermediate of the reaction.

Detection of specific glucose-3-phosphatase activity in rat liver.

Sugar-3-phosphates are related to aspects of diabetes which depend on protein glycosylation events. Sorbitol-3-phosphate and fructose-3-phosphate occur in normal and diabetic individuals, and glucose-3-phosphate is a potential intermediate in their biosynthesis. Almost nothing is known about enzyme pathways for their metabolic turnover. We have found that part of the phosphohydrolytic activity on glucose-3-phosphate in rat liver supernatants corresponds to a specific, Mg(2+)-dependent, glucose-3-phosphatase much less or not active on other phosphate esters, including glucose-1-phosphate, glucose-6-phosphate, fructose-1-phosphate, fructose-6-phosphate and p-nitrophenyl-phosphate. This finding opens a route to a better understanding of the metabolism and role of sugar-3-phosphates.

[The temporary work incapacities of professional administrative workers and nurses]. / Incapacidades laborales transitorias de los colectivos profesionales administrativos y de enfermería.

We show the results of a retrospective study designed to assess the features of transient job disability (TJD) episodes of workers from two groups (clerks and nurses) from an urban health basic zone with 24,536 inhabitants, out of which 6,009 were active workers registered in social security databases. Population pyramid and job distribution in active workers were obtained from a random sample including 5% of the active population, out of which 17% were clerks and 5.54% nurses. There were 1098 TJD episodes in 1990; 32.4% of them involved clerks and 8.3% nurses. The mean length of episodes was 28.2 days in nurses and 27.8 days among clerks, compared to 32.4 days in the active population. These differences remained (p < 0.001) even after excluding TJD episodes of pregnant women, in whose case the mean length of episodes involving male or female workers was the same. The percentage of TJD episodes was higher among female nurses and clerks, than among the whole female population. Influenza was responsible for 20.5% of TJD in clerks against 14.3% among nurses and 14.8% in the whole active population. We conclude that, in the groups studied, the rate of job absenteeism was higher than in the whole population, and higher in female than in males. However, in the whole population, there were no differences in TJD rates between males and females. We discuss that several factors other than illness may explain the differences among groups.

[Do physicians' strikes influence the utilization profile of hospital emergency services?]. / Influyen las huelgas de médicos en el perfil de utilización de los servicios de urgencias hospitalarios?

BACKGROUND: To assess the differences in appropriateness of consultations and demographic outline of people attended in a hospital emergency facility (HEP) along the hospital physicians strike period in spring 1995. METHODS: Observational cross-sectional study in Health Area 1 in the province of Badajoz. 8964 patients assisted along the strike period were compared with 8024 attended in the same period of 1994 (no strike). RESULTS: The patients average was 169.13 (SD 27.35) a day in the strike period, during the control period this mean was 151.39 (SD 19.78) patients a day (p < 0.001). Demographic variables of patients were similar in both groups, with similar mean ages and gender proportion in all age and residence site groups. Most of patients went to the HEF self-promoted (70.1% and 65.8%) and without ambulance (92% and 90.8%) in both periods (strike and control). The outcome of medical care was home discharge in 85.35% during the strike period and 83.81% in the control period, with admission rates of 13.1% and 14.15% (p < 0.01). CONCLUSIONS: There are no significant differences in the HEF use features completely explained by the physicians strike.

[Quality and characteristics of antibiotics prescriptions in an emergency hospital service]. / Calidad y características de la prescripción de antibióticos en un servicio hospitalario de urgencias.

BACKGROUND: To assess the quality of the prescribing of antibiotics to patients treated at a hospital emergency department (HED). METHODS: Retrospective study of the 8600 patients treated and released from a HED throughout the January-April 1996 period. Those patients for whom antibiotics were prescribed as stated on the release form were included. The parameters employed for assessing the prescribing quality were: illness subject to being treated with antibiotics, proper antibiotic, dosage, proper frequency and length of time over which the antibiotic is to be taken. Each one of these parameters was assigned a mark affording the possibility of quantifying quality on a 0-100 point scale. The assessment of the extent to which proper treatment was prescribed was made based on the recommendations described on four guides to the use of antibiotics. RESULTS: Antibiotics were prescribed to 609 (7.1%) of the patients, basically for treating urinary tract infections (17.7%), the prevention of wound infection (13.1%) and for the treatment of repeated attacks of chronic obstructive pulmonary disease (COPD) (10.3%). The antibiotic most often prescribed was cloxacillin (22.5%), followed by ciprofloxacin (13.4%) and clarithromycin (13.2%). Of all of the patients treated with antibiotics, 10.8% had no illness or any indication subject to being treated with these medications, and 32% of those patients who did indeed meet these requirements were prescribed an unsuitable antibiotic. Pneumonia was the illness for which the best quality of treatment was provided. The average mark for the prescriptions did not total 80 points in any of the guides. CONCLUSIONS: Antibiotics are medications frequently prescribed in HED's. Major errors are found to exist with regard to the indication, selection and length of the treatments initiated with these medications, as a result of which it is advisable that sustained educational measures be taken.

Desenlaces maternos, fetales y perinatales de las gestantes con diabetes en manejo con bomba de insulina en el Hospital Universitario San Ignacio / Maternal, fetal and perinatal outcomes of pregnant women with diabetes on insulin pump management at the Hospital Universitario San Ignacio

Antecedentes: La diabetes en el embarazo se asocia a un incremento considerable en la morbimortalidad materna, fetal y perinatal. Objetivo: Determinar los desenlaces maternos, fetales y perinatales de las gestantes con diagnóstico de diabetes pre gestacional en manejo con bomba de insulina en el Hospital Universitario San Ignacio. Método: Estudio de corte transversal en 24 gestantes con diagnóstico de diabetes en manejo con bomba de insulina quienes asistieron a control por Endocrinología y Alto Riesgo Obstétrico en el Hospital Universitario San Ignacio, entre Septiembre de 2009 y Diciembre de 2015. Resultados: La complicación materna más frecuente fue la hipoglicemia sintomática (50%), en segundo lugar los trastornos hipertensivos asociados al embarazo (45,8%). Las complicaciones neonatales más frecuentes fueron el síndrome de dificultad respiratoria del recién nacido (37,5%) y la hiperbilirrubinemia (37,5%). La hemoglobina glicosilada mayor del 6% se relacionó con el 71% de pacientes con macrosomía fetal. Conclusiones: La bomba de infusión de insulina representa una estrategia relativamente nueva dentro de los protocolos de manejo de diabetes pre gestacional y embarazo. Representaría una opción de manejo segura y fácil para el control de la glicemia en pacientes con indicaciones precisas.

Background: Diabetes in pregnancy is associated to a considerable increase in the maternal, fetal and perinatal morbidity and mortality. Objective: Determine the maternal, fetal and perinatal outcomes of patients with pre gestational diabetes being treated with insulin pump at Hospital San Ignacio. Methods: Cross-sectional study of 24 patients diagnosed with diabetes being treated with insulin pump who assisted to controls made by Endocrinology and Obstetrical High-Risk units at Hospital San Ignacio from September 2009 to December 2015. Results: The most common maternal complication was symptomatic hypoglycemia (50%) followed by hypertensive disorders of pregnancy (45.8%). Most common neonatal complications were respiratory distress syndrome (37.5%) and hyperbilirubinemia (37.5%). Glycosylated hemoglobin higher than 6% was related with 71% of patients who developed fetal macrosomia. Conclusions: The insulin infusion pump is a relatively new strategy management of pre gestational diabetes and pregnancy. Representing a safe and easy option for glycemic control in patients with precise indications.

[Evaluation of the efficacy of a comprehensive programme of secondary prevention of cardiovascular disease in primary care: the PREseAP Study]. / Evaluación de la eficacia de un programa integral de prevención secundaria de la enfermedad cardiovascular en atención primaria: estudio PREseAP.

OBJECTIVES: To assess the efficacy of a comprehensive secondary prevention programme to reduce morbidity and mortality in patients who have suffered a cardiovascular (CV) event; to control CV risk factors and prophylactic treatment in order to prevent recurrence; and to improve the quality of life of patients with cardiovascular disease. DESIGN: Randomised, pragmatic, open clinical trial in primary care. SETTING: A total of 42 primary care centres of 8 different areas in Spain. PARTICIPANTS: Men and women below 86 years old, diagnosed with coronary disease and/or stroke and/or peripheral vascular disease in the preceding year, and who have no serious or terminal disease. INTERVENTION: Primary care centres will be randomised to following usual care (control group), or to following a comprehensive programme of secondary prevention (intervention group). MAIN MEASUREMENTS: Cardiovascular fatal events, cardiovascular non-fatal events, total mortality and health-related quality of life (SF-36).

[The diagnostic confirmation of mild arterial hypertension via ambulatory monitoring]. / Confirmación diagnóstica de hipertensión arterial ligera mediante monitorización ambulatoria.

OBJECTIVE: To compare the clinical diagnosis of light arterial hypertension with a system of out-patient monitoring of arterial pressure (OMAP). DESIGN: Observational study. SETTING: An urban health centre. PATIENTS: People diagnosed as suffering from light hypertension (diastolic pressure > 90 and < or = 104 mmHg). MEASUREMENTS AND MAIN RESULTS: The recordings obtained on a Spacelabs 90202 model over 24 hours for 42 patients diagnosed with light Arterial Hypertension were analysed. The arterial pressure load or average deviation index (the average percentage of the systolic and diastolic measurements above the established criteria: 140/90 mmHg) as well as the systolic and diastolic arterial pressures (the arithmetical mean of the valid recordings) were calculated. MEASUREMENTS AND MAIN RESULTS: At least 35.7% of the patients showed normal tension in the OMAP, presenting an arterial pressure load < or = 15% and mean systolic and diastolic arterial pressures of 117.6 +/- 7.5 and 72.7 +/- 5.6 mmHg, respectively. Out of 42 patients, 29 were male (69%) and 13 women (31%). 57% presented some degree of obesity or hypercholesterolemia and 24% were smokers. CONCLUSIONS: The high percentage of "white gown" hypertensive patients should be noted. It is important to unify OMAP analysis criteria.

Presence of diguanosine tri, tetra-, and pentaphosphates in commercial samples of GTP and guanosine 5'-tetraphosphate.

Commercial samples of GTP and guanosine 5'-tetraphosphate were analyzed, with or without previous treatment with alkaline phosphatase, by high-pressure liquid chromatography on a Hypersil ODS column. They showed the presence of diguanosine 5',5"'-Pl,Pn-tri, tetra-, and pentaphosphates in varying amounts depending on the sample, but usually in proportions of around 0.3%.