Epidemiological multicentre study on the education provided to patients with type 2 diabetes mellitus in the Spanish Health Care System. The Forma2 study.

PURPOSE: The purpose of the present study was to characterize the education that patients with type 2 diabetes mellitus receive, and to identify differences as regards the presence of insulin therapy or not. METHODS: This crossover, multicentre and descriptive study involved 1066 Spanish physicians who completed a questionnaire on Internet. RESULTS: The physicians that responded had a mean of 26.0 years of experience in healthcare, and mainly worked in a walk-in clinic in an urban area. Physicians rated the level of patient knowledge about their disease on a 5.0 point-scale. Fifty percent of them indicated that they spent between 15 and 30min in educating patients at the time of diagnosis. Previous control with HbA1c>9%, presence of microvascular complications, and a low socio-cultural level, were factors associated with spending more time in education. CONCLUSION: This is the first study designed to evaluate the education provided to patients with type 2 diabetes mellitus from Spain. The time spent and the individualization of the education are important factors associated with better long-term control of the disease, and thus with the effectiveness of the clinical management.

[Management of hypertension and diabetes in Primary Care clinical practice: ATENCION study]. / Práctica clínica en el manejo de la hipertensión y la diabetes en Atención Primaria: estudio ATENCION.

BACKGROUND AND OBJECTIVE: Cardiovascular diseases are the main cause of death in the Spanish population. The detection and control of cardiovascular risk factors are fundamental in the prevention of cardiovascular disease. The main objectives of this study are to analyse the attitudes and therapeutic decisions of Primary Care (PC) physicians when treating hypertension (HT) and diabetes mellitus type 2 (DM2), with the aim of establishing the situation and eventually proposing improvement strategies. MATERIAL AND METHOD: A national ecological, multicentre, cross-sectional, and descriptive study was conducted in 2013. A questionnaire was used and 1,028 PC physicians took part in the study. RESULTS: A total of 92.9% of the investigators consulted have indicated that they follow the guidelines for evaluation, treatment, and diagnosis of HT, and 91.4% in the case of diabetes. The latter is diagnosed as a casual finding, while HT is diagnosed through active investigation in patients with other risk factors. Combined therapy takes more than 6 months to take effect in patients with HT, and between 8 and 9 months in diabetic patients. The percentage of non-compliance is similar (10-40%) in both pathologies. Around half the physicians questioned considered interaction with the specialist to be good or excellent (46% HT and 57.3% DM2). CONCLUSIONS: Clinical practices in PC for HT and DM2 have some basic criteria in common. The interaction with the specialist is good, but there is a considerable margin for improvement.

Reference values and methods comparison of a new testosterone assay on the AxSYM system.

OBJECTIVES: We have contributed to the Design Validation Protocol of the new Abbott AxSYM Testosterone assay with a study on reference values and methods comparison. DESIGN AND METHODS: For reference values a population of 45 women and 30 men was tested. In methods comparison, 132 samples for the AxSYM vs. ACS-180, and 30 for the AxSYM vs. Elecsys were used. Pearson and intraclass concordance coefficients and Passing-Bablock test were performed for overall group, men and women. RESULTS: Reference values were 0.9-3.1 (females) and 1.0-30.2 nmol/L (males). Globally, a good agreement between methods in both the AxSYM vs. ACS-180 (slope: 0.88, y-intercept: 0.67, r = 0.961) and the AxSYM vs. Elecsys (slope: 1.08, y-intercept: 0.31, r = 0.935) studies was found. Slightly worse results were observed for women. CONCLUSIONS: The reference range of testosterone by the AxSYM system matches with those published for other methods. An acceptable agreement between the AxSYM Testosterone assay and both a classical (ACS-180) and a more recent (Elecsys) methodology was observed.

The genetic basis of porphyria cutanea tarda.

In order to confirm the genetic character of porphyria cutanea tarda (PCT), the quantitative and qualitative porphyrin excretion from 56 unrelated PCT patients and 259 relatives was analyzed by a sensitive fluorimetric thin-layer chromatographic technique. Porphyrin excretion abnormalities were observed in 111 (35.24%) of the 315 subjects studied. Of the 259 relatives, 55 (21.24%) suffered from manifest (24 cases) or subclinical (31 cases) PCT. The relatives from the older generation or a generation similar to the propositi were more frequently affected than those from a younger generation. A clear family incidence was observed in 32 families, while PCT was apparently limited to the propositi in the remaining 24. It is discussed whether these latter families correspond to the so-called "sporadic" type of PCT or include porphyric gene carriers lacking biochemical expression of the disease. While the measurements of the activity of the defective enzyme (uroporphyrinogen decarboxylase) for the genetic research of PCT turned out to be impracticable in hepatic tissue and contradictory in erythrocytes, our study confirms that the familial character of this disease may be revealed by the chromatographic analysis of the porphyrin excretion pattern.

[Calcified gastric adenocarcinoma]. / Adenocarcinoma gástrico calcificado.

A case of calcified gastric adenocarcinoma is presented. It is of clinical interest because of its rareness. Histologically a mucus-secreting adenocarcinoma with lakes of intercellular mucin was found. The need to take this lesion into account in the differential diagnosis of the calcifications in the upper left quadrant, is emphasized.

[Prevalence of epidemic outbreak of tularemia in the Hospital Universitario Río Hortega (Spain) in the year 2007]. / Situación del brote epidémico de tularemia durante el año 2007 en el Hospital Universitario Río Hortega de Valladolid.

INTRODUCTION: This present research study presents the analytic results of an outbreak of tularemia (Francisella tularensis) that occurred in the Northwest areas of Castilla y León in Northern Spain in late June 2007. PATIENTS AND METHODS: Serum was obtained from 302 patients from a West Valladolid health area, attended in the University Hospital of Río Hortega of the Castilla y León Health Care Service, with suspicion of tularemia. A tube agglutination test was performed in all of them to detect anti-F. tularensis antibodies. RESULTS: Anti-F. tularensis antibodies were detected in 59 (19%) of reported cases (302 sera). The most frequent clinical presentations of the disease suggest that the main transmission pathway was through inhalation of the bacteria. CONCLUSIONS: When the 2007 outbreak of human tularemia was compared with that which occurred in 1997, we observed a lower number of positive cases in the recent outbreak as well as a difference in the transmission pathway and predominant form of clinical presentation of the disease.

[Evaluation of alpha 1-antitrypsin phenotypes in Castilla-León: study of a population of newborn infants]. / Valoración de fenotipos de alfa 1-antitripsina en Castilla-León: estudio en una población de recién nacidos.

We have screened a population of newborn babies without any previous apparent pathology in order to discover the distribution of alpha 1-anti-trypsin phenotypes (AAT) in our community. The research has been done on 457 babies born in the province of Valladolid, determining the plasma levels of AAT and the corresponding phenotype. AAT quantification was done by nephelometry, and the phenotypic study was done by the technique described by Jeppsson. It has been possible to identify 8 different phenotypes, PIM being the one that had the highest incidence rate (72.42%), followed by PIMS (19.69%). In relation to the serum levels of AAT, the highest values were found for PIM (220 +/- 60 mg/dl) and the lowest for PIZ (43 +/- 2 mg/dl). Finally, the results obtained by our laboratory are compared with those of other authors.

Follow-up studies of porphyrin excretion in porphyria cutanea tarda treated with p-aminobenzoic acid.

The treatment of porphyria cutanea tarda (PCT) with p-aminobenzoic acid (PABA) was suggested because PABA is capable of reversing the porphyrinogenic action of 3,5-dicarbethoxy-1,4-dihydrocollidine (DDC) in rats. Three patients with PCT were treated with 3 g of PABA daily during 6 and 12 months and the urinary and faecal porphyrin excretion were serially analyzed by solvent extraction techniques and by thin layer chromatography of their methyl esters. PABA treatment did not show any apparent effect on porphyrin excretion.

Studies on in vitro formation of complexes between porphyrins and chloroquine.

Gel filtration and spectrophotometric studies revealed that uroporphyrin, heptacarboxylic-, and pentacarboxylic-porphyrins form in vitro complexes with chloroquine.

Anaphylaxis associated with antiphospholipid syndrome.

BACKGROUND: To our knowledge, no previously published reports have described food-induced anaphylaxis associated with the antiphospholipid syndrome. OBJECTIVE: We undertook a study of four patients with thrombosis associated with the antiphospholipid syndrome after each patient experienced anaphylaxis attributable to ingestion of vegetal foods. METHODS: IgE antibody levels to various foods were determined in serum specimens from the study patients, and skin prick tests with the same allergens were conducted to determine their in vivo responses. Hematologic, cardiopulmonary, vascular, and rheumatologic studies were also performed. IgG anticardiolipin antibody levels were determined by ELISA. RESULTS: All four patients fulfilled the criteria for antiphospholipid syndrome and had high levels of specific IgE antibodies for certain food allergens. By immunoblot analysis, the presence of serum IgE specific for a 45-kD protein band in an almond extract was detected in these four patients who experienced food-related anaphylaxis. No specific IgE was detected in sera from normal subjects. No IgE antibodies specific for the food panallergen lipid transfer proteins were detected. CONCLUSIONS: This is the first report of severe food-precipitated anaphylaxis associated with the antiphospholipid syndrome and the first description of a patient with allergy to blackberry. The possible involvement of food panallergens distinct from lipid transfer proteins is also discussed.

Comparison of two homogeneous assays with a precipitation method and an ultracentrifugation method for the measurement of HDL-cholesterol.

We report on the performance of four HDL-cholesterol assays: a homogeneous method based on polyethylene glycol-modified enzymes/alpha-cyclodextrin sulfate (PEGME; Kyowa); a homogeneous method based on polyanion-polymer/detergent (PPD; Daiichi); the usual precipitation method with phosphotungstic acid/MgCl2 (PTA); and an ultracentrifugation (UC) procedure. The homogeneous HDL-cholesterol assays (performed with automated analyzers) were precise and correlated well with the PTA and UC assays. The specificity and accuracy of the PEGME method were better than those of the PPD method.

Pigment production by Streptococcus agalactiae in quasi-defined media.

A quasi-defined medium that supports the growth of Streptococcus agalactiae as pigmented colonies has been developed. The medium contains starch, a peptic digest of albumin, amino acids, nucleosides, vitamins, and salts. The presence of free cysteine, which could be replaced with other sulphur-containing compounds and to a lesser degree by reducing agents, was required for pigment formation.