Social determinants of blood pressure control in a middle-income country in Latin America.

Blood pressure (BP) control is a key intervention to decrease cardiovascular diseases (CVD), the main cause of death in low and middle-income countries (MIC). Scarce data on the determinants of BP control in Latin America are available. Our objective is to explore the role of gender, age, education, and income as social determinants of BP control in Argentina, a MIC with a universal health care system. We evaluated 1184 persons in two hospitals. Blood pressure was measured using automatic oscillometric devices. We selected those patients treated for hypertension. The average BP of less than 140/90 mmHg was considered a controlled BP. We found 638 hypertensive individuals, of whom 477 (75%) were receiving antihypertensive drugs, and of those, 248 (52%) had controlled BP. The prevalence of low education was more frequent in uncontrolled patients (25.3% vs. 16.1%; P < .01). We did not find association between household income, gender, and BP control. Older patients had less BP control (44% of those older than 75 years vs. 60.9% of those younger than 40; test for trend P < .05). Multivariate regression indicates low education (OR 1.71 95% CI [1.05, 2.79]; P = .03) and older age (OR 1.01; 95% IC [1.00, 1.03]) as independent predictors of the lack of BP control. We conclude that rates of BP control are low in Argentina. In a MIC with a universal health care system low education and old age but not household income are independent predictors of the lack of BP control.

State of affairs and future challenges in laboratory medicine in Spain: an analysis of the Spanish Society of Laboratory Medicine (SEQCML).

Objectives: Laboratory Medicine is a crucial discipline that contributes to the diagnosis, management and monitoring of patients. This branch of medicine faces two major challenges: New technologies and increased demand. There is limited information available of the state of affairs in Laboratory Medicine in Spain. This study provides a picture of clinical laboratories and clinical laboratory professionals. Methods: The Spanish Society of Laboratory Medicine distributed a questionnaire among the 250 most representative centers (the ones with the largest volume of determinations and training programs), of which 174 (69.6%) returned the questionnaire providing data for 2019. Results: Laboratories were classified according to the number of determinations. In total, 37% identified themselves as small (<1 million determinations per year); 40% considered themselves medium-sized (1-5 million determinations per year) and 23% considered they were large laboratories (>5 million determinations). The level of specialization of laboratory physicians and laboratory performance were higher in large laboratories. Most requests (87%) and determinations (93%) corresponded to biochemistry and hematology. As many as 63% of physicians had an indefinite contract, and 23% were older than 60 years. Conclusions: Laboratory medicine is a consolidated discipline that is gaining relevance in Spain. It adds value to the diagnosis, prognosis and follow-up of diseases, and to treatment response monitoring. The results of this study will help us address challenges such as the need for specialized training for laboratory professionals; the emergence of technological innovations; exploitation of Big Data; optimization of quality management systems and patient safety.

[Spontaneous mediastinal hematoma as initial presentation of cystic adenoma of ectopic parathyroid]. / Hematoma mediastinal espontáneo secundario a ruptura de adenoma quístico de paratiroides ectópica.

Spontaneous mediastinal hematoma as initial presentation of cystic adenoma of ectopic parathyroid Atraumatic spontaneous mediastinal hematomas are uncommon. They are secondary to trauma, rupture of great vessels or heart and associated to iatrogenic events. We report a case of a 61 year-old woman who consults for mediastinal hematoma without previous trauma. Imaging studies ruled out cardiac or vascular lesions. At exploratory thoracotomy, a large mediastinal hematoma was evidenced without obvious mass or bleeding vessel. The material sent to the Pathology service was diagnosed as cystic adenoma of ectopic parathyroid gland. Mediastinal hematomas are related to traumatic causes, cardiac or great vessels rupture or iatrogenic proceedings. Once these causes are ruled out, an injury of ectopic parathyroid tissue must be considered in the differential diagnosis because mediastinum is the most frequent ectopic location. Histopathological and immunohistochemical studies are useful in determining the cause-related hematoma, as in this case determined the parathyroid origin of the lesion, and to rule out involvement by other tumors.