Clinical profile of severe hypercholesterolemia in 156,000 adults in primary care. / Perfil clínico de la hipercolesterolemia severa en 156.000 adultos en atención primaria.

OBJECTIVE: To examine the frequency of severe hypercholesterolemia (HS) and its clinical profile, and the phenotype of familial hypercholesterolemia (FH), in the primary-care setting in a large health area of the Community of Madrid (CAM). MATERIAL AND METHODS: Multicenter study of subjects with a health card assigned to 69 health centers (Northwest/CAM area). HS was defined as cholesterol ≥300mg/dL or LDL-cholesterol ≥220mg/dL in any analysis performed (1-1-2018 to 12-30-2021); and FH phenotype as c-LDL ≥240mg/dL (≥160mg/dL if lipid-lowering treatment) with triglycerides <200mg/dL and TSH <5µIU/mL. RESULTS: 156,082 adults ≥18years with an available lipid profile were analyzed. 6187 subjects had HS (3.96% of the laboratory tests studied, 95%CI: 3.87-4.06%). The mean evolution time of the diagnosis of hyperlipidemia in the computerized clinical record was 10.8years, 36.5% had hypertension, 9.5% diabetes and 62.9% overweight/obesity. 83.7% were taking lipid-lowering drugs (65.7% low/moderate and 28.6% high/very high intensity). 6.1% had cardiovascular disease (94.2% treated with lipid-lowering agents), with LDL-cholesterol <55, <70 and <100mg/dL of 1.8%, 5.8% and 20.2%, respectively (vs. 1%, 2.3% and 11.2% if no cardiovascular disease). 1600 subjects had FH phenotype (95%CI: 1.03%, 0.98-1.08%). CONCLUSIONS: Four out of 100 patients analyzed in primary care have HS, with high treatment level, but insufficient intensity, and poor achievement of treatment goals. One in 100 have the FH phenotype. The identification of both dyslipidemias by computerized records would allow their more precise and early detection and establish cardiovascular preventive strategies.

Risk of bias in dentistry-related randomized controlled trials in spanish language journals

Objectives: To assess the risk of bias (RoB) of randomized controlled trials (RCTs) published in dental journals in the Spanish language. Methods: A systematic retrospective survey was conducted of all RCTs published from 1980 to 2019 in dentistry Spanish and Latin American journals. We extracted data and performed RoB assessments using the Cochrane Risk of Bias tool. Results: 292 RCTs published in 51 journals were included. The best-rated domains were incomplete outcome data, selective reporting, and other biases. The domains assessed with higher proportions of an unclear or high risk of bias were sequence generation, allocation concealment, and blinding of outcome assessment. There is a low proportion of RCTs published in Spanish language journals. However, the number has been increasing over the years, and the low risk of bias assessment rates across domains show an increasing trend. Conclusions: A low percentage of Spanish-language dental journals issue RCTs. Our assessment of these RCTs' RoB suggests higher difficulties in the design and conduction phase than in the posterior reporting stage.

Statistical Evaluation of Metaproteomics and 16S rRNA Amplicon Sequencing Techniques for Study of Gut Microbiota Establishment in Infants with Cystic Fibrosis.

Newborn screening for cystic fibrosis (CF) can identify affected but asymptomatic infants. The selection of omic technique for gut microbiota study is crucial due to both the small amount of feces available and the low microorganism load. Our aims were to compare the agreement between 16S rRNA amplicon sequencing and metaproteomics by a robust statistical analysis, including both presence and abundance of taxa, to describe the sequential establishment of the gut microbiota during the first year of life in a small size sample (8 infants and 28 fecal samples). The taxonomic assignations by the two techniques were similar, whereas certain discrepancies were observed in the abundance detection, mostly the lower predicted relative abundance of Bifidobacterium and the higher predicted relative abundance of certain Firmicutes and Proteobacteria by amplicon sequencing. During the first months of life, the CF gut microbiota is characterized by a significant enrichment of Ruminococcus gnavus, the expression of certain virulent bacterial traits, and the detection of human inflammation-related proteins. Metaproteomics provides information on composition and functionality, as well as data on host-microbiome interactions. Its strength is the identification and quantification of Actinobacteria and certain classes of Firmicutes, but alpha diversity indices are not comparable to those of amplicon sequencing. Both techniques detected an aberrant microbiota in our small cohort of infants with CF during their first year of life, dominated by the enrichment of R. gnavus within a human inflammatory environment. IMPORTANCE In recent years, some techniques have been incorporated for the study of microbial ecosystems, being 16S rRNA gene sequencing being the most widely used. Metaproteomics provides the advantage of identifying the interaction between microorganisms and human cells, but the available databases are less extensive as well as imprecise. Few studies compare the statistical differences between the two techniques to define the composition of an ecosystem. Our work shows that the two methods are comparable in terms of microorganism identification but provide different results in alpha diversity analysis. On the other hand, we have studied newborns with cystic fibrosis, for whom we have described the establishment of an intestinal ecosystem marked by the inflammatory response of the host and the enrichment of Ruminococcus gnavus.

Identification and description of controlled clinical trials in Spanish language dental journals.

BACKGROUND: To identify controlled clinical trials (CCTs) published in Spanish and in Latin American dental journals, and provide access to this body of evidence in a single source. METHODS: Handsearching, following Cochrane Collaboration guidelines, of CCTs published in Spanish dental journals from Spain and Latin America. For each eligible trial, we collected the dental specialty, the interventions evaluated, whether and how randomisation was achieved, and the corresponding bibliographic reference. RESULTS: We handsearched 107 journals published in Spain and Latin America in Spanish. Over 17 051 articles, 244 (1.43%) were CCTs. These studies focused mainly on periodontics (70, 29.0%) and oral and maxillofacial surgery (66, 27.0%), assessing mostly pharmacological interventions (112, 46.0%). One hundred fifty-three studies (62.7%) used a random allocation of participants to study arms. CONCLUSIONS: A significant number of dental journals published in Spain and Latin America in Spanish language present original research relevant to inform clinical practice. These journals are not indexed in the major electronic databases. PRACTICAL IMPLICATIONS: References to the identified CCTs are now available in CENTRAL, the Cochrane Collaboration repository for these studies. We call for adherence to the CONSORT statement in dentistry to improve reporting of CCTs in journals published in Spanish language.

Fractura por avulsión de tipo II de la tuberosidad posterior del calcáneo (en pico de pato). Serie de casos / Type II avulsion fracture of calcaneal tuberosity (duck beak). Case series

Introducción El objetivo del estudio es conocer la incidencia, los resultados tras la cirugía y la necesidad de rehabilitación de las fracturas por avulsión de tipo II de la tuberosidad posterior del calcáneo. Materiales y métodos Se realizó un estudio observacional de tipo serie de casos. Se revisaron retrospectivamente todas las fracturas de calcáneo diagnosticadas en nuestro hospital en los últimos 12 años y se seleccionaron aquellas que fueron clasificadas como fracturas por avulsión de la tuberosidad del calcáneo (pico de pato). Resultados Encontramos 10 fracturas con un patrón de fractura por avulsión de la tuberosidad del calcáneo (pico de pato), que corresponden al 4% de todas las fracturas de calcáneo revisadas. Todas fueron tratadas mediante reducción abierta y fijación interna. Un caso fue tratado de forma urgente debido a signos de sufrimiento de partes blandas. Cuatro casos presentaron complicaciones posquirúrgicas. Tres casos requirieron tratamiento específico de rehabilitación. Ningún paciente necesitaba ayuda técnica un año después de la cirugía. Discusión Es razonable esperar un aumento de la incidencia en los próximos años debido al envejecimiento de la población y la prevalencia en aumento de diabetes y osteoporosis. El fragmento desplazado producido por el tendón aquíleo puede poner en peligro la viabilidad cutánea y afectar a la cicatrización posterior. A menudo, no se necesita un protocolo rehabilitador específico. Nivel de evidencia clínica. Nivel IV.

Background The objective of the study is to know the incidence, the results of the surgery and the need for rehabilitation of type II avulsion fractures of the posterior tuberosity of the calcaneus. Materials and methods An observational study of a series of cases was carried out. We retrospectively reviewed all the calcaneal fractures diagnosed in our hospital in the last 12 years and selected the ones classified as avulsion fractures of the tuberosity of the calcaneus (duck beak). Results We found 10 fractures with an avulsion fracture pattern of the calcaneal tuberosity (duck beak), which correspond to 4% of all the calcaneal fractures reviewed. All were treated by an open reduction and internal fixation. One case was treated urgently due to signs of suffering of soft tissue. Four cases presented post-surgical complications. Three cases required specific rehabilitation treatment. Usually, there is no a unique formula to establish a rehabilitation program after surgery. Discussion It is likely to expect an increase rate of this particular fracture according to that elderly population increase with associated osteoporosis and diabetes. The displaced fragment produced by the Achilles' tendon may compromise scaring after surgery. Often a specific rehabilitative protocol is not needed. Evidence level. IV.

Antibiotic resistance and population structure of cystic fibrosis Pseudomonas aeruginosa isolates from a Spanish multi-centre study.

The first Spanish multi-centre study on the microbiology of cystic fibrosis (CF) was conducted from 2013 to 2014. The study involved 24 CF units from 17 hospitals, and recruited 341 patients. The aim of this study was to characterise Pseudomonas aeruginosa isolates, 79 of which were recovered from 75 (22%) patients. The study determined the population structure, antibiotic susceptibility profile and genetic background of the strains. Fifty-five percent of the isolates were multi-drug-resistant, and 16% were extensively-drug-resistant. Defective mutS and mutL genes were observed in mutator isolates (15.2%). Considerable genetic diversity was observed by pulsed-field gel electrophoresis (70 patterns) and multi-locus sequence typing (72 sequence types). International epidemic clones were not detected. Fifty-one new and 14 previously described array tube (AT) genotypes were detected by AT technology. This study found a genetically unrelated and highly diverse CF P. aeruginosa population in Spain, not represented by the epidemic clones widely distributed across Europe, with multiple combinations of virulence factors and high antimicrobial resistance rates (except for colistin).

Disease Recurrence and Second Tumors in Long-term Survivors of Lung Cancer.

INTRODUCTION AND OBJECTIVES: As cancer survival improves, the appearance of multiple tumors in a single patient is becoming more common. The aim of this study was to analyze long-term evolution, focusing particularly on disease recurrence and second primary tumors, in patients with lung cancer (LC) and ≥ 3 years overall survival. MATERIAL AND METHODS: Retrospective study of 1,769 patients with LC. A total of 218 (136 treated with surgery and 82 with other treatments), followed up for between 5 and 23 years were enrolled. LC progress and intercurrent diseases were recorded. RESULTS: A total of 65 patients presented tumor relapse, of which 60.9% occurred in the first 3 years; 26 patients developed secondary primary tumors (84.6% after 5 years) and 24 developed 2 or more second extrapulmonary tumors (66.6% after 5 years), most of which were smoking-related. The incidence of second primaries was greater than the expected incidence of cancer in the general population matched for age and sex. CONCLUSION: The multiple carcinogenic effect of smoking persists and manifests in various organs, more than 5 years after the diagnosis of LC, even in patients with long survival. After 5 years, a second tumor is more likely than a relapse of the primary disease, and the lung is the most common site of development of a second tumor.

Formación de técnicos en optometría y óptica / Formation of technicians in optometry and optics

El servicio de Óptica y Optometría se incorporó a la Misión Barrio Adentro en el estado de Zulia en el mes de mayo de 2004, como iniciativa del Comandante en Jefe Fidel Castro Ruz, con el objetivo de solucionar el problema de salud visual en aquellos pacientes que presentaban errores refractivos no corregidos que podían ser solucionados con el uso de lentes correctivos. Se le asignó como recurso humano a cada una de las 61 ópticas ubicadas en el estado 1 optometrista y 2 técnicos de Óptica, estos últimos en su mayoría, egresados de un curso intensivo de habilidades básicas en el manejo del taller de Óptica. Se realizó estudio descriptivo que deja memoria escrita del proceso llevado a cabo por la Misión Barrio Adentro en el Estado de Zulia, para la superación docente del personal de Óptica. Se obtuvo como resultado la formación de 89 técnicos básicos y 32 técnicos de nivel medio en optometría y óptica.

The optometric and optical service was included in Misión Barrio Adentro program implemented in Zulia state, Venezuela in May, 2004 at the initiative of Commander in Chief Fidel Castro Ruz. The objective was to solve the visual health problems of those patients suffering uncorrected refractive errors that may be eliminated through use of corrective lenses. One optometrist and 2 optical technicians were then appointed to work in each of the 61 optical centers located in the state; most of the technicians graduated from an intensive course of basic skill development in the handling of optical workshops. A descriptive study was conducted to leave written memories of this process and to help to the upgrading of the optical staff. The result was the formation of 89 basic technicians and 32 middle-level technicians in optometry and optics.

Complete pulmonary vein isolation using balloon cryoablation in patients with paroxysmal atrial fibrillation.

Electrical isolation of the pulmonary veins and disconnection of the left atrial musculature from their arrhythmogenic effects is the cornerstone of definitive and curative treatment in patients with symptomatic recurrent paroxysmal atrial fibrillation that is refractory to antiarrhythmic therapy. The type of lesion produced by balloon cryoablation is such that the tissue architecture is preserved and thrombus formation and the risk of pulmonary vein stenosis are reduced. We report on immediate outcomes in the first five patients who underwent treatment. These cases represent initial experience with the technique in Spain. A total of 20 pulmonary veins were treated and complete acute electrical isolation was achieved in all cases (100%). Patients were discharged from hospital within 72 hours of the procedure, and there were no complications. In conclusion, balloon cryoablation of the pulmonary veins is a practical, safe and effective technique for achieving the electrophysiologic goal of acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation.

Prophylactic closure of trocar orifices with an intraperitoneal mesh (ventralex) in laparoscopic bariatric surgery.

Laparoscopic surgery reduces, but not eliminates, the rate of incisional hernia. It is accepted that large trocar orifices should be sutured, in order to prevent future herniation. In morbidly obese patients, the closure of the anterior fascia is a very difficult job, and it does not prevent from preperitoneal herniation. Ventralex composite mesh is a very easy-to-place device, which closes satisfactorily both the peritoneal opening and the subcutaneous trocar pathway. We recommend its use for large diameter orifices and Hasson orifices in bariatric patients.

[Stage IIIA and IIIB non-small cell lung cancer: results of chemotherapy combined with radiation therapy and analysis of prognostic factors]. / Carcinoma de pulmón no microcítico. Estadios IIIA y B. Resultados del tratamiento combinado (quimioterapia y radioterapia) y análisis de factores pronósticos.

OBJECTIVE: Most patients with stage III non-small cell lung cancer (NSCLC) are not candidates for surgery but can benefit from chemotherapy combined with radiation therapy. The objective of the present study was to analyze the results of sequential chemotherapy and radiation therapy and the prognostic value of initial clinical and laboratory variables. PATIENTS AND METHODS: We carried out a retrospective study of 92 patients with stage III NSCLC treated with a sequential regimen of chemotherapy (carboplatin-etoposide, carboplatin-gemcitabine, and carboplatin-paclitaxel), and radiation therapy (6000 cGy in daily doses of 200 cGy, 5 d/wk). Response to therapy, overall survival, and the prognostic value of epidemiological, clinical, and laboratory variables were evaluated using univariate and multivariate analyses. RESULTS: Median survival time was 14 months, with a 3-year survival rate of 16.1%. Poor performance status (score of 2 on the Eastern Cooperative Oncologic Group [ECOG] scale), anemia, and elevated serum concentrations of carcinoembryonic antigen were predictive of poorer survival in the multivariate analysis. In the univariate analysis, weight loss and diagnosis before the year 2000 were also associated with poorer prognosis (P<.01). TNM stage was not significantly correlated (P=.08). Toxicity was low, with 1 death and few cases of grade 3 or 4 toxicity according to World Health Organization criteria. CONCLUSIONS: The use of chemotherapy combined with radiation therapy should be considered contraindicated in cases of poor performance status (ECOG scale score of 2). Weight loss, an elevated serum concentration of carcinoembryonic antigen, and a hemoglobin concentration of 12 g/dL or less carry a poor prognosis.

Tipo de alimentación y desarrollo pondo-estatural en niños nacidos vivos del área del ambulatorio "El Llano", Mérida, Venezuela / Type of feeding and development of weigh and height in children from birth of the ambulatory \"El Llano\" Merida, Venezuela

Es un estudio longitudinal y prospectivo sobre el desarrollo pondo-estatural realizado en 37 niños desde el nacimiento hasta cumplir el año de edad. 20 niños constituyeron el grupo de estudio y el 17 grupo control; se correlacionó la alimentación recibida con las normas del Instituto Nacional de Nutrición (INN). El estudio fué realizado en la Unidad de Medicina Familiar del ambulatorio "El Llano", Mérida, Venezuela. La evolución del peso y la talla de los niños del grupo de estudio fué realizado en la Unidad de Medicina Familiar del ambulatorio "El Llano", Mérida, Venezuela. la evolución del peso y la talla de los niños del grupo de estudio fué normal (9.7 Kg y 74.4 cm). Según las tablas del INN los niños del grupo estudio tuvieron un porcentaje mayor de alimentación adecuada en todos los rubros, resultando significativo (X²=143.1 P<0.005). Existe una marcada tendencia en ambos grupos a introducir precozmente en la alimentación: frutas vegetales y leguminosas.

Tipo de alimentación y desarrollo pondo-estatural en niños nacidos vivos del área del ambulatorio "El Llano", Mérida, Venezuela / Type of feeding and development of weight and height in children born alive in the area of ambulatorio. \"El Llano\", Merida, Venezuela

Es un estudio clínico del desarrollo pondo-estatural realizado en 37 niños desde el nacimiento hasta cumplir el año de edad, 20 niños constituyeron el Grupo de Estudio y 17 el Grupo Control, además se correlacionó la alimentación recibida con las normas del Instituto Nacional de Nutrición (I.N.N.). El estudio fue realizado en la Unidad de Medicina Familiar del Ambulatorio El Llano, Mérida, Venezuela. La evolución del peso y la talla de los niños del Grupo de Estudio fue normal (9.7 Kg y 74.4 cm respectivamente) según las Tablas del I.N.N. Los niños del Grupo de Estudio tuvieron un porcentaje mayor de alimentación adecuada en todos los rubros, resultando muy altamente significativo estadisticamente (X2=143.1 P<0.005). Existe una marcada existencia en ambos grupos a introducir precozmente en la alimentación: frutas, vegetales y leguminosas.

Um projeto de atendimento ambulatorial e de seguimento de uma coorte de pacientes hipertensos: objetivos, funcionamento e primeiros resultados / A project of an outpatient clinic and a cohort study of hypertensive patients: objectives, rotines and first results

A hipertensäo arterial sistêmica, em decorrência direta de seus efeitos sobre múltiplos sistemas ou como fator de risco para aterosclerose, é uma importante causa de morbi-mortalidade da populaçäo adulta brasileira. A detecçäo e o manejo correto dos hipertensos devem reduzir, em muito, suas conseqüências. O Programa de Farmacologia Clínicas de Porto alegre está implementando un projeto que objetiva desenvolver rotinas de diagnóstico e tratamento de hipertensos, treinar pessoal em sua utilizaçäo e seguir a coorte dos hipertensos atendidos. A descriçäo desse projeto e seus primeiros resultados säo apresentados nessa comunicaçäo