Influence of the Mediterranean diet during pregnancy in the development of wheezing and eczema in infants in Pamplona, Spain

Background: This study examined the relationship between different food groups and the adherence to a Mediterranean diet during pregnancy and the risk of wheezing and eczema in children aged 12-15 months. Methods: The study involves 1087 Spanish infants from the International Study of Wheezing in Infants (Estudio Internacional de Sibilancias en Lactantes, EISL). The study of the association of the different food consumption and Mediterranean diet with wheezing, recurrent wheezing and eczema was performed using different models of unconditional logistic regression to obtain adjusted prevalence odds ratios (OR) and 95% confidence intervals (95% CI). Results: No association was found between a good adherence to the Mediterranean diet during pregnancy and the development of wheezing (p = 0.372), recurrent wheezing (p = 0.118) and eczema (p = 0.315). The consumption once or twice a week of white fish (OR: 1.95[1.01-3.75]), cooked potatoes (OR: 1.75[1.22-2.51]) and industrial pastry (OR: 1.59[1.13-2.24]), and the consumption more than three times a week of industrial pastry (OR: 1.47 [1.01-2.13]) during pregnancy increases the risk of "wheezing" at 12 months. Instead, high fruit consumption during the pregnancy has a protective effect against "wheezing" in 12-month-old infants (OR: 0.44 [0.20-0.99]). No statistically significant differences were observed between food intake during pregnancy and "recurrent wheezing". No statistically significant differences were observed between the consumption of any food during pregnancy and the presence of eczema at 12 months. Conclusions: The present study showed that the consumption of Mediterranean diet during pregnancy did not have a protective effect for wheezing, recurrent wheezing or eczema (AU)

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Trastornos hipertensivos en el embarazo: repercusión a largo plazo en la salud cardiovascular de la mujer / Hypertensive disorders during pregnancy: Cardiovascular long-term outcomes

La hipertensión en el embarazo (HE) produce daño materno y fetal, pero también puede suponer el inicio de alteraciones vasculares y metabólicas futuras. El riesgo relativo de padecer hipertensión crónica tras HE es de entre 2,3 y 11, y la probabilidad de desarrollo posterior de diabetes tipo2 se multiplica por un factor de 1,8. Las mujeres con historia previa de preeclampsia/eclampsia tienen doble riesgo de ictus y mayor frecuencia de arritmias y hospitalización por insuficiencia cardíaca. Asimismo, se observa un riesgo 10 veces mayor de enfermedad renal terminal a largo plazo. El riesgo relativo de muerte cardiovascular es 2,1 veces mayor que el del grupo sin problemas hipertensivos del embarazo, aunque en partos pretérmino asociados a hipertensión gestacional o hipertensión preexistente el riesgo es entre 4 y 7 veces superior. El periodo posparto supone una gran oportunidad para intervenir sobre los estilos de vida, la obesidad, hacer un diagnóstico temprano de HTA crónica y de DM y facilitar los tratamientos necesarios para prevenir complicaciones cardiovasculares de la mujer

Pregnancy-induced hypertension (PIH) induces maternal and fetal damage, but it can also be the beginning of future metabolic and vascular disorders. The relative risk of chronic hypertension after PIH is between 2.3 and 11, and the likelihood of subsequent development of type 2 diabetes is multiplied by 1.8. Women with prior preeclampsia/eclampsia have a twofold risk of stroke and a higher frequency of arrhythmias and hospitalization due to heart failure. Furthermore, a tenfold greater risk for long-term chronic kidney disease is observed as well. The relative risk of cardiovascular death is 2.1 times higher compared to the group without pregnancy-induced hypertension problems, although the risk is between 4 and 7 times higher in preterm birth associated with gestational hypertension or pre-existing hypertension The postpartum period is a great opportunity to intervene on lifestyle, obesity, make an early diagnosis of chronic hypertension and DM and provide the necessary treatments to prevent cardiovascular complications in women

[Hypertensive disorders during pregnancy: Cardiovascular long-term outcomes]. / Trastornos hipertensivos en el embarazo: repercusión a largo plazo en la salud cardiovascular de la mujer.

Pregnancy-induced hypertension (PIH) induces maternal and fetal damage, but it can also be the beginning of future metabolic and vascular disorders. The relative risk of chronic hypertension after PIH is between 2.3 and 11, and the likelihood of subsequent development of type 2 diabetes is multiplied by 1.8. Women with prior preeclampsia/eclampsia have a twofold risk of stroke and a higher frequency of arrhythmias and hospitalization due to heart failure. Furthermore, a tenfold greater risk for long-term chronic kidney disease is observed as well. The relative risk of cardiovascular death is 2.1 times higher compared to the group without pregnancy-induced hypertension problems, although the risk is between 4 and 7 times higher in preterm birth associated with gestational hypertension or pre-existing hypertension The postpartum period is a great opportunity to intervene on lifestyle, obesity, make an early diagnosis of chronic hypertension and DM and provide the necessary treatments to prevent cardiovascular complications in women.

Real world comparison of the MGuard Stent versus the bare metal stent for ST elevation myocardial infarction (the REWARD-MI study).

AIM: The MGuard Stent (MGS) was designed to prevent distal embolization of thrombus and has been shown to improve microcirculation in ST-elevation myocardial infarction (STEMI). However, there are no real world data comparing it with the bare metal stent (BMS). The aim of this study is to determine the efficacy and safety of the MGS in STEMI in the real world compared to the BMS. METHODS AND RESULTS: In total, 262 patients were included from a single centre, of which 35.9% had an MGS implanted. Two groups of 79 patients were established after propensity score matching, and they were similar in terms of baseline and periprocedural variables. The mean follow-up was 321 ± 12.94 days. There was no difference in mortality (7.6% in both groups), major adverse cardiac events (20.3% vs. 12.7%, P = 0.198), non-cardiac mortality, or non-fatal myocardial infarction (6.3% in both groups). Target lesion revascularization (TLR) was significantly higher in the MGS group (11.4% (9) vs. 1.3% (1) P < 0.01; RR 10.02 [1.23-81.16]). CONCLUSION: Our study is the first to compare the MGS with the BMS in STEMI in the real world, and it also appears to confirm that although the MGS is a safe device in STEMI that is not associated with increased mortality, it is associated with a higher long-term TLR rate. © 2014 Wiley Periodicals, Inc.

Blood pressure control and cardiovascular risk among rural and urban population in Spain

Prevalence and control of hypertension seem to be influenced by population, geographical and psychosocial factors. Aims: To investigate if the places of residence (rural or urban) determine differences in both BP level (office and 24-hour ambulatory BP monitoring (ABPM)) and cardiovascular risk (CVR). We also assess if place of residence establishes differences regarding treatment of the cardiovascular risk patients. Methods: Data of 25,989 patients from the ABPM National Registry of the Spanish Society of Hypertension were analyzed. Out of them 80.8% (n = 20,998) were from urban settings and 19.2% (n = 4991) from rural settings. Date from subjects less than 65 years of age were analyzed in order to diminish the influence of residence changes following retirement. We measured office BP, 24 h ABPM, cardiovascular risk factors and CVR. Results: The percentage of patients with BP <140/90 mmHg in the office is higher in the urban group (23.4%) compared to their rural counterparts (21.4%) (p = 0.003). This fact lost its statistical significance when BP was measured by ABPM, showing controlled 46.1% in urban and 45.9% in rural settings. The masked hypertension was higher in urban (7.2%) than in rural settings (6.4%). White coat hypertension was more frequent in rural settings (31.6% versus 29.7%, p < 0.008). According to estimates of ESH-ESC 2007 guidelines, patients from the rural setting have a higher CVR. Conclusions: There are no differences in the hypertension control depending on place of residence when this is measured by ABPM. CVR is worse in the rural environment. This fact is linked to a higher level of obesity and its associated metabolic disorders

La prevalencia y el control de la hipertensión parecen estar influidos por factores demográficos, geográficos y psicosociales. Objetivos: Analizar si el lugar de residencia (rural o urbano) marca diferencias tanto en los valores de PA (en consulta y en monitorización ambulatoria de 24 horas [MAPA]) como en el riesgo cardiovascular (RCV). También evaluamos si el lugar de residencia conduce a diferencias en cuanto al tratamiento de pacientes con RCV. Métodos: Se analizaron los datos de 25.989 pacientes procedentes del Registro Nacional de MAPA de la Sociedad Española de Hipertensión. De ellos, el 80,8% (n = 20.998) procedían de zonas urbanas y el 19,2% (n = 4.991) de entornos rurales. Se analizó la fecha de los pacientes menores de 65 años para disminuir la influencia de los cambios de residencia tras la jubilación. Se midió la PA en consulta, la MAPA de 24 h, los factores de riesgo cardiovascular y el RCV. Resultados: El porcentaje de pacientes con PA < 140/90 mmHg en consulta era superior en el grupo urbano (23,4%) al compararse con sus contrapartes rurales (21,4%; p = 0,003). Este valor perdía su significación estadística cuando la PA se midió mediante MAPA, con una PA controlada del 46,1% en zonas urbanas y del 45,9% en zonas rurales. La hipertensión enmascarada fue mayor en las zonas urbanas (7,2%) que en las rurales (6,4%). La hipertensión de bata blanca era más frecuente en el medio rural (31,6 frente a 29,7%; p < 0,008). Según las estimaciones delas directrices de la ESH- ESC de 2007, los pacientes en las zonas rurales presentaban un mayo RCV. Conclusiones: No existen diferencias en el control de la hipertensión en función del lugar de residencia cuando esta se mide mediante MAPA. El RCV es superior en el entorno rural. Este hecho se vincula a un nivel más elevado de obesidad y a los trastornos metabólicos que ello conlleva

Prolonged incubation time does not increase sensitivity for the diagnosis of implant-related infection using samples prepared by sonication of the implants.

We have designed a prospective study to evaluate the usefulness of prolonged incubation of cultures from sonicated orthopaedic implants. During the study period 124 implants from 113 patients were processed (22 osteosynthetic implants, 46 hip prostheses, 54 knee prostheses, and two shoulder prostheses). Of these, 70 patients had clinical infection; 32 had received antibiotics at least seven days before removal of the implant. A total of 54 patients had sonicated samples that produced positive cultures (including four patients without infection). All of them were positive in the first seven days of incubation. No differences were found regarding previous antibiotic treatment when analysing colony counts or days of incubation in the case of a positive result. In our experience, extending incubation of the samples to 14 days does not add more positive results for sonicated orthopaedic implants (hip and knee prosthesis and osteosynthesis implants) compared with a conventional seven-day incubation period.

[High cardiovascular risk due to inadequate control of risk factors in Spanish hypertensive patients seen in the Spanish primary care]. / Alto riesgo cardiovascular por el inadecuado control de los factores de riesgo de hipertensos españoles en Atención Primaria en España.

INTRODUCTION: Cardiovascular diseases are the main cause of morbidity-mortality in Spain. Hypertension and the other cardiovascular factors are important in the pathophysiological basis of this fact. Control of the main risk factors in treated hypertensives was evaluated in this study. PATIENTS AND METHODS: Multicenter study in hypertensive patients treated in Primary Care. Blood pressure, cardiovascular risk factors as well as registered target organ damage and clinical diseases were measured. Finally, global cardiovascular risk was calculated. RESULTS: Only 17.3% of pharmacologically treated hypertensives were controlled (3.9% of diabetic patients). LDL-cholesterol control deteriorated as the patient's cardiovascular risk pattern increased (90.4% in low risk and 19.9% in high-very high risk). High levels of serum creatinine were detected in 8.3%, microalbuminuria being positive in 15.6%, with 20.8% ventricular hypertrophy. A total of 31% of the patients were diabetic, 59.8% of them having HbA1c > or = 6.5%. Global CV risk was high very high in many subjects (65.4%) when European Society of Hypertension-European Society of Cardiology (ESH-ESC) guidelines were used. This percentage was 3.6% when the Spanish-validated Framingham score was used. CONCLUSIONS: Blood pressure control as well as main cardiovascular risk factors is poor in this population. Considering this fact plus the number of target organ damage, the global risk is high in many patients according to the European guidelines. Guidelines that do not consider target organ damage do not estimate adequately the risk of this uncontrolled population. This conclusion could explain the clinical tendency of many doctors when attending uncontrolled patients.

Alto riesgo cardiovascular por el inadecuado control de los factores de riesgo de hipertensos españoles en Atención Primaria en España / High cardiovascular risk due to inadequate control of risk factors in spanish hypertensive patients seen in the spanish Primary Care

Introducción. Las enfermedades cardiovasculares constituyen la causa principal de muerte en España. En su génesis son importantes la hipertensión y otros factores de riesgo. En este estudio se ha valorado el control de los principales componentes de riesgo en hipertensos tratados. Pacientes y métodos. Estudio multicéntrico en hipertensos de Atención Primaria. Se determinaron presiones arteriales, factores de riesgo cardiovascular, lesiones de órganos diana y patologías asociadas calculándose el riesgo cardiovascular global. Resultados. El 17,3% de los hipertensos (3,9% en diabéticos) tenían la presión arterial controlada. El control del colesterol ligado a lipoproteínas de baja densidad empeoró a medida que aumentaba el riesgo (90,4% en riesgo bajo y 19,94% en pacientes de alto/muy alto). El 8,3% tenían creatinina elevada, 15,6% microalbuminuria positiva, 20,8% hipertrofia ventricular. El 31% tenía diabetes y un 59,8% de ellos HbA1c ≥ 6,5%. Según la guía European Society of Hypertension-European Society of Cardiology (ESH-ESC) el riesgo cardiovascular era alto/muy alto en el 65,4%. Según las tablas de Framingham adaptadas a España este porcentaje era 3,6%. Conclusiones. El grado de control de presiones y otros factores de riesgo cardiovascular fue bajo. La elevada prevalencia de lesión de órgano diana determinó que el riesgo cardiovascular fuera elevado/muy elevado en la mayoría de sujetos según la guía europea, que tiene en cuenta todos estos factores. Las guías que no consideran la lesión orgánica infraestiman el riesgo de estos hipertensos deficientemente controlados y ello podría contribuir a la inercia médica ante la falta de control de los factores de riesgo

Introduction. Cardiovascular diseases are the main cause of morbidity-mortality in Spain. Hypertension and the other cardiovascular factors are important in the pathophysiological basis of this fact. Control of the main risk factors in treated hypertensives was evaluated in this study. Patients and methods. Multicenter study in hypertensive patients treated in Primary Care. Blood pressure, cardiovascular risk factors as well as registered target organ damage and clinical diseases were measured. Finally, global cardiovascular risk was calculated. Results. Only 17.3% of pharmacologically treated hypertensives were controlled (3.9% of diabetic patients). LDL-cholesterol control deteriorated as the patient's cardiovascular risk pattern increased (90.4% in low risk and 19.9% in high-very high risk). High levels of serum creatinine were detected in 8.3%, microalbuminuria being positive in 15.6%, with 20.8% ventricular hypertrophy. A total of 31% of the patients were diabetic, 59.8% of them having HbA1c ≥ 6.5%. Global CV risk was high very high in many subjects (65.4%) when European Society of Hypertension-European Society of Cardiology (ESH-ESC) guidelines were used. This percentage was 3.6% when the Spanish-validated Framingham score was used. Conclusions. Blood pressure control as well as main cardiovascular risk factors is poor in this population. Considering this fact plus the number of target organ damage, the global risk is high in many patients according to the European guidelines. Guidelines that do not consider target organ damage do not estimate adequately the risk of this uncontrolled population. This conclusion could explain the clinical tendency of many doctors when attending uncontrolled patients

Gammapatía monoclonal de significado incierto. A propósito de un caso / Monoclonal gammopathy with uncertain meaning. A case report

Las gammapatías monoclonales constituyen un grupo heterogéneo de trastornos que se caracterizan por la proliferación estable o progresiva de células plasmáticas, produciendo inmunoglobulinas (Ig) iguales entre sí que reciben el nombre de Ig monoclonales o componente M. El interés clínico de la detección de una proteína anómala viene determinado tanto por el hecho de que dicha alteración puede ser indicativa de procesos patológicos tan dispares como una infección o una neoplasia, como por la circunstancia de que a nivel evolutivo pueda presentar comportamientos radicalmente distintos, desapareciendo en algunos casos, permaneciendo estable en otros o, por último, presentando una evolución progresiva hacia una patología maligna. El papel del médico de Atención Primaria se centra en la derivación del paciente al hematólogo para la realización de las pruebas complementarias necesarias para el correcto diagnóstico diferencial entre las distintas gammapatías y, sobre todo, una vez realizado el diagnóstico, en la colaboración con el nivel especializado en el seguimiento de estos pacientes

Monoclonal gammopathies are a heterogeneous group of disorders that are characterized by the stable or progressive proliferation of plasma cells, producing immunoglobulins (Ig) that are equal and receive the name of monoclonal Ig or M component. The clinical interest of the detection of an abnormal protein is determined both by the fact that this alteration may be indicative of such different diseases as an infection or neoplasm, as by the circumstance that there may be radically different behaviors on the evolutive level that disappear in some cases, remain stable in others or finally present a progressive evolution towards a malignant disease. The role of the primary care doctor is focused on referring the patient to the hematologist for the necessary complementary tests for a correct differential diagnosis between the different gammopathies and, above all, once the diagnosis is made, for the collaboration with the specialized level in the follow-up of these patients

¿Son los servicios de urgencias hospitalarios un lugar adecuado para morir? / Are hospital emergency services an adequate place to die?

Objetivos: Analizar el proceso asistencial de los fallecidos en un Servicio de Urgencias. Métodos: Estudio descriptivo retrospectivo de los fallecidos durante el año 2000 analizando las variables clínicas , los tiempos de triage, atención y estancia total, pruebas diagnósticas, tratamientos, así como el lugar de fallecimiento dentro del servicio y la presencia familiar. Resultados: Se incluyeron 146 pacientes. 80,6 por ciento fueron catalogados como urgencia vital (código rojo), condicionando tiempos de primera exploración significativamente menores que el resto. Al 87 por ciento se le realiza algún tipo de prueba diagnóstica. 40 por ciento recibe maniobras de resucitación y 75,6 por ciento algún tipo de medicación. La analgesia mayor y la sedación fue más empleada en enfermos con patología tumoral. 42,4 por ciento fallecen antes de la primera hora de su ingreso y 83 por ciento antes de seis horas. Los que mueren después de este tiempo lo hacen en el box de observación. 31 por ciento fallece acompañado por algún familiar. Conclusiones: Nuestro sistema actual de "triage" no parece ser el adecuado para la valoración inicial de los pacientes que fallecen en urgencias. Los que fallecen después de seis horas de su ingreso lo hacen prácticamente en su totalidad en el box de observación, cumpliendo una de las expectativas de funcionamiento del mismo. Observamos una escasa utilización de tratamientos paliativos. La mayoría de nuestros pacientes mueren solos (AU)

Objectives: To analyse the assistance procedure to the deceased in a Hospital Emergency Service. Methods: Descriptive retrospective study of the deceased during 2000 analysing the clinic variables, triage times, attention and total staying, diagnostic tests, treatments as well as the place of decease within the service and the family presence. Results: 146 patients were included, 80.6% of which were catalogued as life urgency (red code), conditioning significantly lower first exploration times than the rest. Diagnose tests were made to the 87%, 40% received resuscitation manoeuvres; finally 75.5% were given some medication. Major analgesia and sedative treatments were mostly employed with cancer patients. 42.2 % die within the first hour and 83% before six hours. Those who die after this time die in the observation box. 31% die accompanied by familiars. Conclusions: Our present "triage" system does not seem to be the adequate to initially evaluate the patients who die at the Emergency Service. Nearly all who die six hours after their entry die in the observation box, accomplishing one of its operation expectatives. We observe a scarce use of palliative treatments. Most of our patients die alone (AU)

Hipertensión arterial en la infancia y adolescencia. Importancia, patogenia, diagnóstico y tratamiento / Hypertension in children and adolescents. Importance, pathogenesis, diagnosis and treatment

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Mortalidad en un Servicio de Urgencias Hospitalarias. Características clínico epidemiológicas / Mortality in a hospital emergency department. Clinic-epidemiological characteristics

Objetivos: Determinar la incidencia de la mortalidad en un Servicio de Urgencias Hospitalario (SUH). Describir las características clínico-epidemiológicas de los fallecidos, las patologías más frecuentes que causan el fallecimiento y el porcentaje de muerte evitable. Método: Estudio descriptivo retrospectivo durante el año 2000. Se recogió información de las variables clínico-epidemiológicas, determinando si alguno de los fallecimientos era inesperado a su ingreso en el servicio. Resultados: Se incluyeron 146 pacientes. Suponen un 15,2 por ciento del total de fallecimientos ocurridos en el hospital. La edad media fue de 74,78 ñ 13,82 años. Un 50 por ciento fueron hombres, con una edad media significativamente menor que las mujeres. Un 30,1 por ciento había sido valorado previamente. El 84,2 por ciento fallecen por causa médica y el 30,1 por ciento pertenece al grupo de enfermedades cardiovasculares. Un 87,7 por ciento presentaban patología crónica previa y un 54,8 por ciento tenían un Karnofsky 50. En general no eran frecuentadores del servicio de urgencias. La muerte era esperada a su ingreso en el 97,7 por ciento. Conclusiones: El paciente tipo que fallece en el SUH es una persona de edad avanzada, con mala calidad de vida previa, poco frecuentadora, que acude sin haber sido valorada por Atención Primaria, presentando enfermedades crónicas en situación terminal. La causa de muerte más frecuente son las enfermedades del aparato circulatorio. La codificación de las altas de urgencias permitiría incluir estos fallecidos dentro del análisis de mortalidad hospitalaria (AU)

[Are hospital emergencies services an adequate place to die?]. / ¿Son los servicios de urgencias hospitalarios un lugar adecuado para morir?

OBJECTIVES: To analyse the assistance procedure to the deceased in a Hospital Emergency Service. METHODS: Descriptive retrospective study of the deceased during 2000 analysing the clinic variables, triage times, attention and total staying, diagnostic tests, treatments as well as the place of decease within the service and the family presence. RESULTS: 146 patients were included, 80.6% of which were catalogued as life urgency (red code), conditioning significantly lower first exploration times than the rest. Diagnose tests were made to the 87%, 40% received resuscitation manoeuvres; finally 75.5% were given some medication. Major analgesia and sedative treatments were mostly employed with cancer patients. 42.2 % die within the first hour and 83% before six hours. Those who die after this time die in the observation box. 31% die accompanied by familiars. CONCLUSIONS: Our present triage system does not seem to be the adequate to initially evaluate the patients who die at the Emergency Service. Nearly all who die six hours after their entry die in the observation box, accomplishing one of its operation expectatives. We observe a scarce use of palliative treatments. Most of our patients die alone.