Prevalence of cardiovascular risk factors in an urban adult population from southern Spain. IMAP Study.

AIMS: To study the prevalence of cardiovascular risk factors in an urban population of Malaga, Spain and its relationship with educational level. METHODS: A cross-sectional study was performed with a random representative sample of 2270 individuals from the adult population (18­80 years) from a specific Health-Care Centre in Malaga City. All participants underwent a clinical interview, including social-demographical information and a physical examination. A blood sample was also drawn. RESULTS: The mean age of the participants was 43.6 ± 15.6 years and 57.6% had a low educational level. The prevalence of cardiovascular risk factors was: smoking 27.7%, hypertension 33.1%, diabetes 7.1% and dyslipidaemia 65.4%. Over 60% were either overweight or obese, and 76.7% had a sedentary lifestyle. Except for smoking and a low-HDL cholesterol, the prevalence of the other cardiovascular risk factors increased with age. A low educational level was associated with a high prevalence of cardiovascular risk factors, and this association was significant with regard to smoking, obesity, abdominal obesity and hypertriglyceridaemia. CONCLUSIONS: The population studied presents a high prevalence of cardiovascular risk factors, especially dyslipidaemia and obesity. The low academic level was associated with an increased prevalence of smoking, obesity and dyslipidaemia. People with a low socio-cultural level are a priority target for introducing policies to prevent and control cardiovascular disease.

Analysis of 27,248 hospital discharges for heart failure: a study of an administrative database 1998-2002.

AIMS: To describe the epidemiology of hospital admissions for heart failure in 32 hospitals. To define the profile of those attended by Internal Medicine (IM). METHODS AND RESULTS: Analysis of the Minimum-Basic-Data-Set registry of 32 public Spanish hospitals, during 1998-2002, identifying those cases whose main or secondary diagnosis was heart failure, with attention to age, sex, length of stay, season, outcome, number of diagnoses, Diagnostic Related Groups (DRG), and coded procedures. There were 2,787,008 discharges, 27,248 with heart failure (15,737 IM, 7,735 Cardiology and 3,776 other services). Discharges for heart failure increase from 1998 to 2002 (r(2) = 0.7232). Of the total, 44% were men (average age 70.98 years; 95% CI 70.08-70.47) and 56% were women (74.77 years; 95% CI 74.61-74.93; p < 0.0001). The global in-hospital mortality rate was 11.1% and we found differences between Cardiology and MI. MI patients were older (74 years compared to 69, p < 0.0001), had greater comorbidity, a similar length of stay (11.1 days), and a lower number of coded diagnostic procedures. Associated pathologies were different. Seasonal variation is clear. CONCLUSION: The incidence of discharges for heart failure is high and steadily increasing, although this is more evident in IM. The populations attended by the two services are different, which makes it difficult to ascertain differences in handling. The results are slightly different from those reported in other countries.

[Internal Medicine hospital departments of Andalucian Public Health System. A description of the clinical activity in 2002]. / Servicios hospitalarios de Medicina Interna. Una descripción de la actividad en el Sistema Público de Andalucía en 2002.

BACKGROUND: Description of the patients admitted in the general Internal Medicine (IM) departments of the Public Health System in Andalusia (Spain) (PHSA) during 2002. PATIENTS AND METHODS: It is an analysis of the Minimum Basic Set of Data (MBSD) and its management by the Diagnostic Related Groups (DRG) of admission episodes in Andalusian public hospitals. We divided the hospitals into group 1: more than 600 beds; group 2: between 200 and 600 beds, and group 3: less than 200 beds. RESULTS: IM services discharged 80,514 patients (total in PHSA, 558,114); 25.9%, 29.6% and 44.5% from groups 1, 2 y 3, respectively; 87.4% were admitted from the emergency room. Gross mortality rate was 10.23%. Average age was 72 years, 8 years more than in the other medical departments. Mean diagnosis per episode was 5.4. The most frequent pathologies (33%) were chronic obstructive pulmonary disease, congestive heart failure, brain stroke and coronary heart disease. Adjusted length of stay was 9.35 days, this being somewhat longer in big hospitals. Mean weight of the episodes (DRG weight) of IM services was 20% higher than the mean of the rest and it accumulates 18.02% of the total weight. Real hours of outpatient clinics was 5.45% of the total. CONCLUSIONS: The activity of the general IM services is very high in relative and absolute terms. Higher age and the multiple pathologies are typical characteristics of IM patients in Andalusia. Author claim it is very important to be careful with the clinical and administrative records. Interventions on prevalent diseases in IM services may produce positive and valuable results due to their high volume.

[A superior vena cava syndrome secondary to a pleural fibrous mesothelioma]. / Síndrome de cava superior secundario a mesotelioma fibroso pleural.

Benign fibrous or pleural mesothelioma are rare tumors that seem to originate in the mesenchyma (subpleural fibromas). They are usually discovered by chance and the prognosis for the patient is favorable after surgery. If the tumors are large, extrapulmonary signs may be present (hypertrophic osteoarthropathy, hypoglycemia). We describe a case of unusually large fibrous mesothelioma of the pleura that presented as superior vena cava syndrome, a complication not described in the literature.

[Double primary pulmonary neoplasms: epidermoid and oat cell pulmonary carcinoma with metachronous presentation]. / Doble neoplasia pulmonary primitiva: carcinoma epidermoide y oat-cell pulmonar de presentación metacrónica.

The finding of a double primitive pulmonary neoplasm in the same patient is a fact rarely published, between 0.5 and 3.5% depending on the series, most of them surgical or necropsies series. We present the case of a patient who after being diagnosed of bronchial epidermoid carcinoma and treated with radiotherapy, developed, one year later, a relapsing homolateral pleural effusion due to an oat-cell type carcinoma. We review the incidence of this association in the scientific literature, outlining the difficulty to establish the diagnosis in patients non treated with radical surgery.