Disseminated fusariosis in immunocompromised children: a case series and review of literature.

In the era of antifungal prophylaxis for cancer patients, Fusarium genus has become the second leading cause of invasive fungal infections and mortality in this group of patients. The intrinsic resistance to antifungal agents and the patient's risk factors are the most important variables for prognosis and survival. Currently, the use of monotherapy in comparison to combined antifungal treatment information is scarce. In this report, we present a series of three cases of children with acute lymphoblastic leukemia and disseminated fusariosis categorized according to the European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG). Furthermore, we present a current literature review focused on treatment using monotherapy or combined antifungal treatment.

Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice. / Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica.

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.

[Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. / Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica.

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.

[Control of anticoagulation in patients with non-valvular atrial fibrillation in a primary care clinical practice setting in the different autonomous communities. PAULA study]. / Control de la anticoagulación en pacientes con fibrilación auricular no valvular en práctica clínica de atención primaria en las diferentes comunidades autónomas. Estudio PAULA.

AIMS: To determine the differences between regions in the level of control of patients with non-valvular atrial fibrillation treated with vitamin K antagonists, included in the PAULA study. METHODS: Observational, and coss-sectional/retrospective study, including 139 Primary Care physicians from 99 Health Care centres in all autonomous communities (except La Rioja). Anticoagulation control was defined as the time in therapeutic range assessed by either the direct method (poor control <60%), or the Rosendaal method (poor control <65%). RESULTS: A total of 1,524 patients were included. Small differences in baseline characteristics of the patients were observed. Differences in the percentage of time in therapeutic range were observed, according to the Rosendaal method (mean 69.0±17.7%), from 78.1%±16.6 (Basque Country) to 61.5±14% (Balearic Islands), by the direct method (mean 63.2±17.9%) from 73.6%±16.6 (Basque Country) to 57.5±15.7% (Extremadura). When comparing regions, in those where the Primary Care physicians assumed full control without restrictions on prescription, the percentage of time in therapeutic range by the direct method was 63.89 vs. 60.95% in those with restrictions (p=.006), by Rosendaal method, 69.39% compared with 67.68% (p=.1036). CONCLUSIONS: There are significant differences in the level of control between some regions are still inadequate. Regions in which the Primary Care physicians assumed the management of anticoagulation and without restrictions, time in therapeutic range was somewhat higher, and showed a favourable trend for better control. These findings may have clinical implications, and deserve consideration and specific analysis.

Statement of the Spanish Interdisciplinary Cardiovascular Prevention Committee (CEIPC for its Spanish acronym) on the 2012 European Cardiovascular Prevention Guidelines.

Based on the two main frameworks for evaluating scientific evidence (SEC and GRADE) European cardiovascular prevention guidelines recommend interventions across all life stages using a combination of population-based and high-risk strategies with diet as the cornerstone of prevention. The evaluation of cardiovascular risk (CVR) incorporates HDL levels and psychosocial factors, a very high risk category, and the concept of age-risk. They also recommend cognitive-behavioural methods (e.g., motivational interviewing, psychological interventions) led by health professionals and with the participation of the patient's family, to counterbalance psychosocial stress and reduce CVR through the institution of positive habits such as a healthy diet, physical activity, smoking cessation, and adherence to treatment. Additionally, public health interventions - such as smoking ban in public areas or the elimination of trans fatty acids from the food chain - are also essential. Other innovations include abandoning antiplatelet therapy in primary prevention and the recommendation of maintaining blood pressure within the 130-139/80-85 mmHg range in diabetic patients and individuals with high CVR. Finally, due to the significant impact on patient progress and medical costs, special emphasis is given to the low therapeutic adherence levels observed. In sum, improving cardiovascular prevention requires a true partnership among the political class, public administrations, scientific and professional associations, health foundations, consumer associations, patients and their families. Such partnership would promote population-based and individual strategies by taking advantage of the broad spectrum of scientific evidence available, from clinical trials to observational studies and mathematical models to evaluate population-based interventions, including cost-effectiveness analyses.

Posicionamiento del Comité Español Interdisciplinario de Prevención Cardiovascular y la Sociedad Española de Cardiología en el tratamiento de las dislipemias: divergencia entre las guías europea y estadounidense / Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology Position Statement on Dyslipidemia Management. Differences Between the European and American Guidelines

La publicación en EE. UU. de la guía de 2013 de American College of Cardiology/American Heart Association para el tratamiento del colesterol elevado ha tenido gran impacto por el cambio de paradigma que supone. El Comité Español Interdisciplinario de Prevención Cardiovascular y la Sociedad Española de Cardiología han revisado esa guía, en comparación con la vigente guía europea de prevención cardiovascular y de dislipemias. El aspecto más destacable de la guía estadounidense es el abandono de los objetivos de colesterol unido a lipoproteínas de baja densidad, de modo que proponen el tratamiento con estatinas en cuatro grupos de riesgo aumentado. En pacientes con enfermedad cardiovascular establecida, ambas guías conducen a una estrategia terapéutica similar (estatinas potentes, dosis altas). Sin embargo, en prevención primaria, la aplicación de la guía estadounidense supondría tratar con estatinas a un número de personas excesivo, particularmente de edades avanzadas. Abandonar la estrategia según objetivos de colesterol, fuertemente arraigada en la comunidad científica, podría tener un impacto negativo en la práctica clínica y crear cierta confusión e inseguridad entre los profesionales y quizá menos seguimiento y adherencia de los pacientes. Por todo ello, el presente documento reafirma las recomendaciones de la guía europea. Ambas guías tienen aspectos positivos pero, en general y mientras no se resuelvan las dudas planteadas, la guía europea, además de utilizar tablas basadas en la población autóctona, ofrece mensajes más apropiados para el entorno español y previene del posible riesgo de sobretratamiento con estatinas en prevención primaria (AU)

The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention (AU)

Perfil de los pacientes con claudicación intermitente en España. Estudio VITAL / Profile of patients with intermittent claudication in Spain. The VITAL Study

Introducción: La claudicación intermitente ( CI ) es frecuente entre la población occidental, incluida la española; sin embargo, sus características no son bien conocidas. El objetivo del estudio es conocer el perfil de los pacientes españoles con CI. Material y métodos: Estudio prospectivo, observacional, transversal, multicéntrico y no aleatorizado sobre 1.641 claudicantes, divididos en 2 grupos: a) angiología y cirugía vascular (ACV) (n = 920), y b) atención primaria (MAP) (n = 721). Los pacientes fueron sometidos a un cuaderno de recogida de datos (CRD), analítica, índice tobillo/brazo (ITB), cuestionario Walking Impairment Questionaire (WIQ) y cuestionario europeo de calidad de vida (EQ-5D). Resultados: Fueron varones el 75,3%, de 68,3 ± 9,4 años, destacando sobremanera el elevado número de factores de riesgo cardiovascular y enfermedades asociadas (fundamentalmente cardiacas), más frecuente en el grupo ACV. El ITB de la serie 0,66 ± 0,19, inferior en grupo ACV (p = 0,001). Los porcentajes WIQ fueron: daños motores (48,57 ± 20,12), distancia (35,09 ± 25,73), velocidad (36,18 ± 22,83) y escaleras (41,76 ± 27,62), peores en lo relativo a los daños motores (p < 0,001) y distancia (p = 0,007) en el grupo ACV. La puntuación EQ-5D fue 0,57 ± 0,21, sin diferencias entre grupos. Conclusiones: Los pacientes españoles con CI presentan 3 características: alto riesgo cardiovascular, limitada capacidad para el ejercicio e importante reducción de la calidad de vida. Existen diferencias entre grupos, dado que los ACV tratan pacientes con enfermedad más avanzada (AU)

Introduction: Intermittent claudication (IC) is a very prevalent condition in Western countries including the population of Spain. However, little is known about the medical profile and quality of life (QoL) of the IC in Spain. Aim: To determine the clinical characteristics and QoL in a large sample of Spanish patients with IC. Material and methods: An observational, prospective, cross sectional and multicentre study was performed between October 2010 and January 2011, with 625 investigators recruiting 1,641 consecutive patients with claudication. The sample was divided into two groups: a) patients evaluated by vascular surgeons (VS) (n = 920), and b) patients evaluated by general practitioners (GP) (n = 721). Demographical and clinical characteristics, analytical findings (glucose levels and lipid metabolism) and the Ankle-Brachial Index (ABI) were recorded. Each patient included in the study also filled in two questionnaires: the Walking impairment Questionnaire (WIQ) and the European Quality of Life-5 Dimensions (EQ-5D). Results: The population mean age was 68.3 ± 9.4 years; in 75.3% of the cases the patients were males. The presence of risk cardiovascular factors (49.5% of diabetes; 76.9% of hypertension and 65.3% of dyslipemia) and comorbid conditions (in particular, cardiovascular diseases) were high. The mean ABI of the series was 0.66 ± 0.19. Patients in the VS group had more severe IC than patients from GP Group (ABI = 0.63 vs ABI = 0.71, P<0.001). WIQ scores obtained were: a) walking distance = 35.09 ± 25.73; b) walking speed = 36.18 ± 22.83, and c) stair-climbing capacity = 41.76 ± 27.62. We only found significant statistical differences in walking distance between the VS Group and GP Group. The global EQ-5D score was 0,57 ± 0,21. No significant differences were observed between the VS and GP groups (AU)

Conclusions: Spanish patients with IC showed three characteristics: high cardiovascular risk, limited ability to tolerate exercise, and reduction in the quality of their life. There are differences between groups; compared to general practitioners, vascular surgeons treated patients with more advanced disease (AU)

[Spanish version of the CAM-ICU (Confusion Assessment Method for the Intensive Care Unit). Pilot study of validation]. / Versión en español del método para la evaluación de la confusión en cuidados intensivos, estudio piloto de validación.

OBJECTIVE: To validate the Spanish version of the CAM-ICU. DESIGN: Validation study. The inter-rater reliability and validity were evaluated using a blind comparison with the DSM-IVTR criteria (reference standard) in a group of patients hospitalized in an Intensive Care Unit (ICU). SETTING: Medical-surgical ICU. PATIENTS: 129 adults with RASS >-4 score, within the 24-48 h of ICU admission. Independent application of the CAM-ICU by two intensive care specialists and evaluation by a psychiatrist using the DSM-IVTR criteria for delirium. RESULTS: Prevalence of delirium in the sample was 26.4%, this being and 48.3% in the 29 patients who received mechanical ventilation. Inter-rater reliability in the whole sample according to the Kappa index was 0.792 (95% CI 0.662-0.922, p<0.001) and in those who received mechanical ventilation was 0.726 (95% CI 0.487-0.965, p<0.001). The sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (-LR) were 79.4% (95% CI 63.2-89.7%); 97.9% (95% CI 92.6-99.4%); 93.1% (95% CI 78.0-98.1%); 93.0% (95% CI 86.3-96.6%); 37.72 (95% CI 9.47-150.20) and 0.21(95% CI 0.11-0.41), respectively, in the whole sample. In mechanically-ventilated patients, sensitivity, specificity, PPV, NPV, +LR and -LR were 92.9% (95% CI 68.5-98.7%); 86.7% (95% CI 62.1-96.3%); 86.7% (95% CI 62.1-96.3%); 92.9% (95% CI 68.5-98.7%); 6.96(95% CI 1.90-25.51) and 0.08 (95% CI 0.01-0.55), respectively. CONCLUSION: The Spanish version of the CAM-ICU is reliable. Its sensitivity, specificity and predictive values should be considered good.

Versión en español del método para la evaluación de la confusión en cuidados intensivos, estudio piloto de validación / Spanish version of the method for evaluation of confusion in intensive cares, pilot study of validation

Objetivo: Validar la versión en español del CAM-ICU (confusion assessment method for the intensive care unit «método para la evaluación de la confusión en cuidados intensivos»). Diseño: Estudio de validación. Se valoran la concordancia interevaluador y la validez mediante comparación ciega con los criterios del Manual Diagnóstico y Estadístico de los Trastornos Mentales, cuarta edición, texto revisado (DSM-IV TR) (estándar de referencia) en un grupo de pacientes ingresados en una unidad de cuidados intensivos (UCI). Ámbito: UCI médico-quirúrgica. Pacientes: Ciento veintinueve adultos con puntuación >-4 en la Richmond Agitation Sedation Scale y entre las 24-48h de admisión en la UCI. Se tuvo en cuenta la aplicación independiente del CAM-ICU por 2 intensivistas y la valoración por psiquiatría con el uso de los criterios del DSM-IV TR para delírium. Resultados: La prevalencia de delírium en la muestra fue del 26,4% y fue del 48,3% en los 29 pacientes que recibieron ventilación mecánica. La concordancia interevaluador en toda la muestra, según el índice κ fue de 0,792 (intervalo de confianza [IC] del 95%: 0,662-0,922; p<0,001) y en los pacientes con ventilación mecánica fue de 0,726 (IC del 95%: 0,487-0,965; p<0,001). La sensibilidad fue del 79,4% (IC del 95%: 63,2-89,7%); la especificidad, del 97,9% (IC del 95% 92,6-99,4%); el valor predictivo positivo (VP+), del 93,1% (IC del 95%: 78,0-98,1%); el valor predictivo negativo (VP-), del 93,0% (IC del 95%: 86,3-96,6%); el cociente de probabilidades positivo (CP+), de 37,72 (IC del 95%: 9,47-150,20), y el cociente de probabilidades negativo (CP-), de 0,21(IC del 95%: 0,11-0,41) en toda la muestra. En los pacientes con ventilación mecánica, la sensibilidad fue del 92,9% (IC del 95%: 68,5-98,7%); la especificidad, del 86,7% (IC del 95%: 62,1-96,3%); el VP+, del 86,7% (IC del 95%: 62,1-96,3%); el VP-, del 92,9% (IC del 95%: 68,5-98,7%); el CP+, de 6,96 (IC del 95%: 1,90-25,51), y el CP-, de 0,08 (IC del 95%: 0,01-0,55). Conclusión: El CAM-ICU en español es reproducible. Su sensibilidad y especificidad así como sus valores predictivos son buenos (AU)

Objective: To validate the Spanish version of the CAM-ICU. Design: Validation study. The inter-rater reliability and validity were evaluated using a blind comparison with the DSM-IVTR criteria (reference standard) in a group of patients hospitalized in an Intensive Care Unit (ICU). Setting Medical-surgical ICU. Patients 129 adults with RASS >-4 score, within the 24-48h of ICU admission. Independent application of the CAM-ICU by two intensive care specialists and evaluation by a psychiatrist using the DSM-IVTR criteria for delirium. Results: Prevalence of delirium in the sample was 26.4%, this being and 48.3% in the 29 patients who received mechanical ventilation. Inter-rater reliability in the whole sample according to the Kappa index was 0.792 (95% CI 0.662-0.922, p<0.001) and in those who received mechanical ventilation was 0.726 (95% CI 0.487-0.965, p<0.001). The sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (-LR) were 79.4% (95% CI 63.2-89.7%); 97.9% (95% CI 92.6-99.4%); 93.1% (95% CI 78.0-98.1%); 93.0% (95% CI 86.3-96.6%); 37.72 (95% CI 9.47-150.20) and 0.21(95% CI 0.11-0.41), respectively, in the whole sample. In mechanically-ventilated patients, sensitivity, specificity, PPV, NPV, +LR and -LR were 92.9% (95% CI 68.5-98.7%); 86.7% (95% CI 62.1-96.3%); 86.7% (95% CI 62.1-96.3%); 92.9% (95% CI 68.5-98.7%); 6.96(95% CI 1.90-25.51) and 0.08 (95% CI 0.01-0.55), respectively. Conclusion: The Spanish version of the CAM-ICU is reliable. Its sensitivity, specificity and predictive values should be considered good (AU)

A narrow and highly significant linkage signal for severe bipolar disorder in the chromosome 5q33 region in Latin American pedigrees.

We previously reported linkage of bipolar disorder to 5q33-q34 in families from two closely related population isolates, the Central Valley of Costa Rica (CVCR) and Antioquia, Colombia (CO). Here we present follow up results from fine-scale mapping in large CVCR and CO families segregating severe bipolar disorder, BP-I, and in 343 population trios/duos from CVCR and CO. Employing densely spaced SNPs to fine map the prior linkage peak region increases linkage evidence and clarifies the position of the putative BP-I locus. We performed two-point linkage analysis with 1134 SNPs in an approximately 9 Mb region between markers D5S410 and D5S422. Combining pedigrees from CVCR and CO yields a LOD score of 4.9 at SNP rs10035961. Two other SNPs (rs7721142 and rs1422795) within the same 94 kb region also displayed LOD scores greater than 4. This linkage peak coincides with our prior microsatellite results and suggests a narrowed BP-I susceptibility regions in these families. To investigate if the locus implicated in the familial form of BP-I also contributes to disease risk in the population, we followed up the family results with association analysis in duo and trio samples, obtaining signals within 2 Mb of the peak linkage signal in the pedigrees; rs12523547 and rs267015 (P = 0.00004 and 0.00016, respectively) in the CO sample and rs244960 in the CVCR sample and the combined sample, with P = 0.00032 and 0.00016, respectively. It remains unclear whether these association results reflect the same locus contributing to BP susceptibility within the extended pedigrees.

[Non-invasive evaluation of pulmonary artery occlusion pressure in critically ill patients with mechanical ventilation]. / Evaluación no invasiva de la presión de oclusión de la arteria pulmonar en el paciente crítico mecánicamente ventilado.

OBJECTIVE: To compare the measurements of pulmonary artery occlusion pressure (PAOP) by means of the use a pulmonary artery catheter and those obtained through a formula that relates the systolic artery pressure before and after a Valsalva maneuver. DESIGN: Prospective observational study. SCOPE: Medical-surgical intensive care unit. PATIENTS: A total of 120 patients mechanically ventilated and with deep sedation who had pulmonary artery catheter and arterial line. INTERVENTIONS: Provocation of a Valsalva maneuver by maintaining airway pressure at 30 mmHg for 10 seconds that was subsequently released. MAIN VARIABLES OF INTEREST: PAOP measured at the end of expiration by means of the use of a pulmonary artery catheter, PAOP was calculated by means of the use of a formula that relates the systolic artery pressure before and after a Valsalva maneuver. RESULTS: There was a limited correlation between the measured PAOP and that calculated by means of the Valsalva maneuver in the total population (r=0.44, CI 95%: 0.28 to 0.57, p=0.0001). There was a better correlation in the post-surgical subgroup (r=0.518, CI 95%: 0.1055 to 0.7738, p=0.016) and in the sub-group of "Others diagnosis" (r=0.62, CI: 95%: 0.30 to 0.81, p=0.001). CONCLUSIONS: The prediction of the PAOP by means of the Valsalva maneuver showed a limited correlation with that obtained by means of the pulmonary artery catheter.

Evaluación no invasiva de la presión de oclusión de la arteria pulmonar en el paciente crítico mecánicamente ventilado / Non-invasive evaluation of pulmonary artery occlusion pressure in critically ill patients with mechanical ventilation

Objetivo. Comparar las mediciones de presión de oclusión de la arteria pulmonar (POAP) mediante la utilización de un catéter de arteria pulmonar y las obtenidas a través de una fórmula que relaciona la presión arterial sistólica antes y después de una maniobra de Valsalva. Diseño. Estudio prospectivo observacional. Ámbito. Unidad de Cuidados Intensivos medicoquirúrgicos. Pacientes. Ciento veinte pacientes en ventilación mecánica y con sedación profunda que tuvieran catéter de arteria pulmonar y catéter arterial. Intervenciones. Provocación de una maniobra de Valsalva mediante el mantenimiento de una presión en la vía aérea de 30 mmHg durante 10 segundos y la posterior liberación. Principales variables de interés. POAP al final de la espiración medida a través de un catéter de arteria pulmonar, valor calculado de POAP mediante la utilización de una fórmula que relaciona la presión arterial sistólica antes y después de una maniobra de Valsalva. Resultados. Se encontró una correlación limitada entre la POAP medida y la calculada en el total de la población (r = 0,44, IC 95%: 0,28 a 0,57; p = 0,0001). Se encontró una mejor correlación en el subgrupo de pacientes postquirúrgicos (r = 0,52, IC 95%: 0,10 a 0,77; p = 0,016) y en el subgrupo catalogado como «Otros diagnósticos» (r = 0,62, IC 95%: 0,30 a 0,81, p = 0,001). Conclusiones. La predicción de la POAP mediante la maniobra de Valsalva mostró una correlación limitada con la obtenida mediante el catéter de arteria pulmonar

Objective. To compare the measurements of pulmonary artery occlusion pressure (PAOP) by means of the use a pulmonary artery catheter and those obtained through a formula that relates the systolic artery pressure before and after a Valsalva maneuver. Design. Prospective observational study. Scope. Medical-surgical intensive care unit. Patients. A total of 120 patients mechanically ventilated and with deep sedation who had pulmonary artery catheter and arterial line. Interventions. Provocation of a Valsalva maneuver by maintaining airway pressure at 30 mmHg for 10 seconds that was subsequently released. Main variables of interest. PAOP measured at the end of expiration by means of the use of a pulmonary artery catheter, PAOP was calculated by means of the use of a formula that relates the systolic artery pressure before and after a Valsalva maneuver. Results. There was a limited correlation between the measured PAOP and that calculated by means of the Valsalva maneuver in the total population (r = 0.44, CI 95%: 0.28 to 0.57, p = 0.0001). There was a better correlation in the post-surgical subgroup (r = 0.518, CI 95%: 0.1055 to 0.7738, p = 0.016) and in the sub-group of «Others diagnosis» (r = 0.62, CI: 95%: 0.30 to 0.81, p = 0.001). Conclusions. The prediction of the PAOP by means of the Valsalva maneuver showed a limited correlation with that obtained by means of the pulmonary artery catheter

[Brain natriuretic peptide in primary care: diagnostic value in heart failure]. / Péptido cerebral natriurético en atención primaria: valor diagnóstico en la insuficiencia cardíaca.

OBJECTIVE: To determine the validity and usefulness of brain natriuretic peptide (BNP) for diagnosing left ventricular dysfunction (LVD). DESIGN: Prospective, descriptive, multi-centred study to validate the diagnostic test. SETTING: Primary care centres in the Community of Madrid, Spain. PARTICIPANTS: Consecutive sample of patients at high risk of presenting with LVD. INTERVENTIONS: Data will be gathered from anamnesis, physical examination, ECG, and chest x-ray to find the risk factor(s) for LVD and the presence or absence of symptoms of congestive heart failure according to the Framingham scale. BNP will be determined at PC clinics in all patients who meet the inclusion criteria, using the "triage BNP test." All patients included in the study will be referred to an echocardiography service for an echocardiogram, which will be the gold standard test. Two independent cardiologists will evaluate the echocardiograph without knowing the BNP values. MAIN MEASUREMENTS: BNP concentrations will be compared against the kind and degree of LVD. ROC curves analysis will test the capacity of BNP to diagnose LVD. Optimal sensitivity and specificity value will be calculated by means of the position on the curve resulting from the minimum distance at the cut-off point for best sensitivity and specificity. Then, sensitivity, specificity, and positive and negative predictive values will be calculated. DISCUSSION: BNP can complement the information provided by other diagnostic tests. It should be included as an important factor in the taking of clinical-therapeutic decisions.

Religiosity and the earliest stages of adolescent drug involvement in seven countries of Latin America.

To investigate the role of religiosity in the earliest stages of drug involvement, the authors studied recent-onset occurrence of first chances to try a drug and first actual drug use, expressed as a function of religious practice behaviors, levels of religious devotion, and religious affiliation. Based upon standardized questionnaire assessments of nationally representative samples of school-attending youths drawn in Panama, the five Spanish heritage countries of Central America, and the Dominican Republic (n = 12,797), the 1999-2000 study estimates indicate that higher levels of religious practice are inversely associated with the earliest stages of tobacco and cannabis experiences (i.e., the first chance to try and the first actual use) but not so for alcohol. To illustrate, for each unit increase in levels of religious practice behaviors, there was an associated reduced occurrence of the first chance to try tobacco (odds ratio = 0.76, 95% confidence interval: 0.62, 0.94). Occurrence of first actual use of tobacco and cannabis was not associated with levels of religious practice behaviors among youths exposed to the opportunity to try these drugs. As such, these behaviors apparently have not strengthened resistance. Rather, autarcesis may be at work, functioning to shield youths from drug exposure opportunities.

Actividades preventivas cardiovasculares en atención primaria / Cardiovascular preventive activities in primary care

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