Aumento de microorganismos no habituales en la neumonía adquirida en la comunidad / Increasing incidence of community-acquired pneumonia caused by atypical microorganisms

Introducción. Conocer los microorganismos más frecuentes en nuestro medio nos puede ayudar a tomar decisiones terapéuticas empíricas. El objetivo del estudio fue evaluar la etiología microbiológica de las neumonías adquiridas en la comunidad. Pacientes y métodos. Estudio observacional descriptivo prospectivo. Se incluyeron sujetos≥14 años con diagnóstico clínico-radiográfico de neumonía adquirida en la comunidad durante 383 días consecutivos. Se recogieron variables sociodemográficas, antecedentes personales, escalas pronósticas de gravedad, evolución y agentes patógenos. Para obtener un diagnóstico etiológico se realizaron hemocultivos, detección de antígenos urinarios de Streptococcus pneumoniae y Legionella pneumophila, cultivo de esputo, virus influenza y detección de Streptococcus pyogenes. Se describieron las variables categóricas como valor absoluto y porcentaje y las variables continuas por sus medias y desviaciones estándar. Resultados. Fueron incluidos en el estudio 287 pacientes (42% mujeres; edad media 66±22 años). Falleció el 10,45%, ingresando el 70%. Se consiguió un diagnóstico etiológico en 43 pacientes (14,98%), determinándose 16 microorganismos en 59 muestras positivas. El patógeno más frecuentemente aislado fue Streptococcus pneumoniae (24/59, 41%), seguido de bacilos entéricos gramnegativos, Klebsiella pneumoniae, Escherichia coli, Serratia marcescens y Enterobacter cloacae, aislados en un 20% de las muestras (12/59), virus influenza (5/59, 9%), Staphylococcus aureus, todos resistentes a meticilina (3/59, 5%), Pseudomonas aeruginosa (2/59, 3%), Moraxella catarrhalis (2/59, 3%), Legionella pneumophila (2/59, 3%) y Haemophilus influenzae (2/59, 3%). Las infecciones polimicrobianas supusieron el 14% (8/59). Conclusión. Encontramos un alto porcentaje de microorganismos no habituales en neumonías adquiridas en la comunidad (AU)

Introduction. Knowing the most common microorganisms in our environment can help us to make proper empirical treatment decisions. The aim is to identify those microorganisms causing community-acquired pneumonia. Patients and methods. An observational, descriptive and prospective study was conducted, including patients over 14 years with a clinical and radiographic diagnosis of community-acquired pneumonia during a 383 consecutive day period. A record was made of sociodemographic variables, personal history, prognostic severity scales, progress, and pathogenic agents. The aetiological diagnosis was made using blood cultures, detection of Streptococcus pneumoniae and Legionella pneumophila urinary antigens, sputum culture, influenza virus and Streptococcus pyogenes detection. Categorical variables are presented as absolute values and percentages, and continuous variables as their means and standard deviations. Results. Of the 287 patients included in the study (42% women, mean age 66±22 years), 10.45% died and 70% required hospital admission. An aetiological diagnosis was achieved in 43 patients (14.98%), with 16 microorganisms found in 59 positive samples. The most frequently isolated pathogen was Streptococcus pneumonia (24/59, 41%), followed by gram-negative enteric bacilli, Klebsiella pneumonia, Escherichia coli, Serratia marcescens and Enterobacter cloacae isolated in 20% of the samples (12/59), influenza virus (5/59, 9%), methicillin-resistant Staphylococcus aureus (3/59, 5%), Pseudomonas aeruginosa (2/59, 3%), Moraxella catarrhalis (2/59, 3%), Legionella pneumophila (2/59, 3%), and Haemophilus influenza (2/59, 3%). Polymicrobial infections accounted for 14% (8/59). Conclusion. A high percentage of atypical microorganisms causing community-acquired pneumonia were found (AU)

[Increasing incidence of community-acquired pneumonia caused by atypical microorganisms]. / Aumento de microorganismos no habituales en la neumonía adquirida en la comunidad.

INTRODUCTION: Knowing the most common microorganisms in our environment can help us to make proper empirical treatment decisions. The aim is to identify those microorganisms causing community-acquired pneumonia. PATIENTS AND METHODS: An observational, descriptive and prospective study was conducted, including patients over 14 years with a clinical and radiographic diagnosis of community-acquired pneumonia during a 383 consecutive day period. A record was made of sociodemographic variables, personal history, prognostic severity scales, progress, and pathogenic agents. The aetiological diagnosis was made using blood cultures, detection of Streptococcus pneumoniae and Legionella pneumophila urinary antigens, sputum culture, influenza virus and Streptococcus pyogenes detection. Categorical variables are presented as absolute values and percentages, and continuous variables as their means and standard deviations. RESULTS: Of the 287 patients included in the study (42% women, mean age 66±22 years), 10.45% died and 70% required hospital admission. An aetiological diagnosis was achieved in 43 patients (14.98%), with 16 microorganisms found in 59 positive samples. The most frequently isolated pathogen was Streptococcus pneumonia (24/59, 41%), followed by gram-negative enteric bacilli, Klebsiella pneumonia, Escherichia coli, Serratia marcescens and Enterobacter cloacae isolated in 20% of the samples (12/59), influenza virus (5/59, 9%), methicillin-resistant Staphylococcus aureus (3/59, 5%), Pseudomonas aeruginosa (2/59, 3%), Moraxella catarrhalis (2/59, 3%), Legionella pneumophila (2/59, 3%), and Haemophilus influenza (2/59, 3%). Polymicrobial infections accounted for 14% (8/59). CONCLUSION: A high percentage of atypical microorganisms causing community-acquired pneumonia were found.

Concentración del fragmento aminoterminal del NT-proBNPen plasma: ¿un nuevo marcador biológico predictivo en las neumonías adquiridas en la comunidad? / N-terminal fragment of pro-brain natriuretic peptide plasma concentration: a new predictive biomarker for community acquired pneumonia?

Objetivo: Evaluar la relación entre la concentración plasmática del fragmento aminoterminal del pro-péptido natriurético cerebral (NT-ProBNP) en el momento del diagnóstico de neumonía adquiridad en la comunidad (NAC) en urgencias y su gravedad determinada como mortalidad a los 30 días. Método: Estudio observacional prospectivo tipo cohortes en el que se determina NTProBNP (medido en ng/l) como factor exposición, se realiza seguimiento durante 30 días y se analiza la frecuencia de mortalidad. Incluimos a los pacientes con diagnóstico clínico-radiográfico de NAC atendidos consecutivamente en el servicio de urgencias desde el 1 de febrero al 30 de abril de 2012. Resultados: Se valoraron 110 pacientes, y 96 fueron incluidos en el estudio (87%), 44% mujeres. La edad media fue 66 (DE 22) años. Los valores medios en sangre de NT-Pro BNP extraídos fueron de 3.747 ng/l (DE 10.732) y mediana 506 ng/l (RIC2.490). Fallecieron 13 pacientes en los primeros 30 días (14%). Los valores de NTproBNP medios en los pacientes fallecidos fueron 17.805 ng/l (DE 24.952) comparados con 1.545 ng/l (DE 2.467) en los pacientes supervivientes (p = 0,003). Conclusiones: Los valores de NT-ProBNP en el momento del diagnóstico de NAC en elSU son un buen predictor de mortalidad precoz a los 30 días (AU)

Objective: To assess the association between plasma concentration of the N-terminal fragment of the precursor to brain type natriuretic peptide (NT-proBNP) and severity of community-acquired pneumonia (CAP) (30-day mortality) at the moment of emergency department diagnosis. Methods: Prospective observational cohort study of NT-proBNP plasma concentration as the potential indicator of risk of 30-day mortality. Emergency department patients with a clinical-radiographic diagnosis of CAP were enrolled consecutively from February 1 to April 30, 2012. Results: A total of 110 patients were recruited; 96 (87%) were included. Women comprised 44% of the cohort. The mean (SD) age was 66 (22) years. The mean NT-proBNP concentration was 3747 (10 732) ng/L; the median concentration was 506 ng/L (interquartile range, 2490 ng/L). Thirteen patients (14%) died within 30 days. The mean NT-proBNP concentration was 17 804.85 (24 952) ng/L in patients who died and 1545 (2467) ng/L in survivors (P=.003). Conclusions: NT-proBNP concentration at the time of CAP diagnosis in the emergency department provides a good predictor of early (30-day) mortality (AU)

Diferencia de presión entre brazos y riesgo cardiovascular / Pressure differences between arms and cardiovascular risk

Resumen La diferencia de presión arterial entre brazos (DPIB) se ha asociado a aumento del riesgo cardiovascular. Objetivo Determinar la prevalencia de DPIB en hipertensos, utilizando una técnica de medida simultánea en ambos brazos, y su relación con el índice tobillo-brazo (ITB).Metodología Se utilizó un dispositivo automático que también realiza el ITB. Resultados Se estudió a 288 hipertensos, 28,2% diabéticos. Encontramos DPIB sistólica > 5 mmHg en el 23,6% de los pacientes (p = 0,005) (25,9% en diabéticos) y DPIB diastólica > 5 mmHg en el 13,9% (p = 0,023). Con DPIB ≥ 10 mmHg, la mayoría eran diabéticos. Encontramos relación entre ITB patológico, diabetes mal controlada, obesidad y DPIB. Conclusiones Las DPIB tienen alta prevalencia, más acusadas en los diabéticos con ITB patológico. Cuanto mayores DPIB tiene un paciente, mayor riesgo cardiovascular presenta (AU)

Abstract Inter-arm blood pressure differences (IABPD) are related to greater cardiovascular risk. Objectives To determine IABPD in hypertensive patients, measuring BP in both arms and correlating it with the ankle-brachial index (ABI).Methods A device which also measures ABI was used. Results A total of 288 hypertensive patients, 28.2% of whom were diabetic, were studied. Systolic IABPD was > 5 mmHg in 23.6% and diastolic IABPD > 5 mmHg in 13.9%. Most patients were diabetics when the IABPD ≥ 10mmHgm. A relation was found between pathological ABI, poor diabetes control, obesity and IABPD. Conclusions IABPDs have high prevalence, this being greater in diabetics with pathological IABPD. The higher the IABPD in a patient, the greater is the cardiovascular risk (AU)

Impact of a CAD system in a screen-film mammography screening program: a prospective study.

OBJECTIVE: The purpose of our study was to perform a prospective assessment of the impact of a CAD system in a screen-film mammography screening program during a period of 3 years. MATERIALS AND METHODS: Our study was carried out on a population of 21,855 asymptomatic women (45-65 years). Mammograms were processed in a CAD system and independently interpreted by one of six radiologists. We analyzed the following parameters: sensitivity of radiologist's interpretation (without and with CAD), detection increase, recall rate and positive predictive value of biopsy, CAD's marks, radiologist's false negatives and comparative analysis of carcinomas detected and non-detected by CAD. RESULTS: Detection rate was 4.3‰. CAD supposed an increase of 0.1‰ in detection rate and 1% in the total number of cases (p<0.005). The impact on recall rate was not significant (0.4%) and PPV of percutaneous biopsy was unchanged by CAD (20.23%). CAD's marks were 2.7 per case and 0.7 per view. Radiologist's false negatives were 13 lesions which were initially considered as CAD's false positives. CONCLUSIONS: CAD supposed a significant increase in detection, without modifications in recall rates and PPV of biopsy. However, better results could have been achieved if radiologists had considered actionable those cases marked by CAD but initially misinterpreted.

[Gender differences in the hospitalization and reperfusion delays in the acute coronary syndrome]. / Diferencias de género en los retrasos de ingreso y reperfusión en el síndrome coronario agudo.

OBJECTIVE: To study delay times in women with acute coronary syndrome (ACS) and ST segment elevation (STSEACS) until administration of possible reperfusion therapy as well as its possible differences in relationship to the men. MATERIAL AND METHODS: A study was conducted in 1,849 patients consecutively hospitalized in a Coronary Unit from January 2000 to December 2005 who had been diagnosed of ACS. Different delay times were studied from the beginning of the symptoms, comparing them between genders and correcting this by variable age. RESULTS: The percentage of women was 24.4% with a mean age of 71.5 years. Medium delay time from the beginning of the symptoms to contact with the first health care agent was significantly (p < 0.001), longer for women than for men, 164 min. vs 120 min. Reperfusion treatments were used in 57.6% of the subjects, with a significant difference (p < 0.01) of 7.6% between men (59.5%) and women (51.9%). CONCLUSIONS: Delay times are greater in women than men, above all regarding the beginning of the symptoms until arrival to the first health care agent. Currently, reperfusion treatments are performed more in men than in women, the differences are minimum when adjusted by age.

Diferencias de género en los retrasos de ingreso y reperfusión en el síndrome coronario agudo / Gender differences in the hospitalization and reperfusion delays in the acute coronary syndrome

Objetivo. Estudiar los tiempos de retraso hasta una eventual terapéutica de reperfusiónen las mujeres con síndrome coronario agudo (SCA) y elevación del segmento ST, así comolas posibles diferencias en relación con los varones.Material y métodos. Se ha llevado a cabo un estudio con 1.849 pacientes con diagnósticode SCA ingresados consecutivamente en una Unidad Coronaria, desde enero de 2000 a diciembrede 2005. Se estudian diversos tiempos de retraso desde el inicio de los síntomas,se comparan entre sexos y se corrigen por la variable edad.Resultados. Fueron mujeres el 24,4%, con una media de edad de 71,5 años. La medianaen el tiempo de retraso desde el inicio de los síntomas hasta el contacto con el primerescalón sanitario fue significativamente (p < 0,001) más prolongada en las mujeres queen los hombres, 164 minutos frente a 120 minutos. Los tratamientos de reperfusión seemplearon en el 57,6% de los sujetos, con una diferencia significativa (p < 0,01) del 7,6%entre hombres (59,5%) y mujeres (51,9%).Conclusiones. Los tiempos de retraso son mayores en las mujeres que en los hombres,sobre todo desde el inicio de los síntomas hasta la llegada al primer escalón sanitario.Los tratamientos de reperfusión se realizan más en hombres que en mujeres, aunque,ajustando por edad, las diferencias son mínimas(AU)

Objective. To study delay times in women with acute coronary syndrome (ACS) and STsegment elevation (STSEACS) until administration of possible reperfusion therapy as wellas its possible differences in relationship to the men.Material and methods. A study was conducted in 1,849 patients consecutively hospitalizedin a Coronary Unit from January 2000 to December 2005 who had been diagnosed of ACS.Different delay times were studied from the beginning of the symptoms, comparing thembetween genders and correcting this by variable age.Results. The percentage of women was 24.4% with a mean age of 71.5 years. Mediumdelay time from the beginning of the symptoms to contact with the first health careagent was significantly (p < 0.001), longer for women than for men, 164 min. vs 120 min.Reperfusion treatments were used in 57.6% of the subjects, with a significant difference(p < 0.01) of 7.6% between men (59.5%) and women (51.9%).Conclusions. Delay times are greater in women than men, above all regarding thebeginning of the symptoms until arrival to the first health care agent.Currently, reperfusion treatments are performed more in men than in women, thedifferences are minimum when adjusted by age(AU)

Patrón de abuso de analgésicos en la cefalea crónica diaria: un estudio en población general / Abuse pattern of analgesics in chronic daily headache: a study in the general population

Fundamento y objetivo. El patrón de abuso de analgésicos no es bien conocido en personas con «cefalea crónica diaria y abuso de analgésicos» (CAA) en la población general. El objetivo de este estudio ha sido conocer el tipo de analgésicos consumidos por grupo farmacológico y principio activo en sujetos con CAA en una amplia muestra de la población general. Pacientes y método. Se distribuyó un cuestionario que investigaba la frecuencia de cefalea y el consumo de analgésicos entre las personas mayores de 14 años (9.984 habitantes) de la población semiurbana de Santoña (Cantabria). Un total de 4.855 sujetos rellenaron el cuestionario. Si bien los criterios de CAA exigen cefalea mayor o igual a 15 días al mes, aquellos individuos (n = 332) que referían consumo subjetivo de analgésicos por cefalea mayor o igual a 10 días en este período cumplimentaron un diario de cefaleas durante un mes. Un total de 72 individuos cumplían criterios de CAA (1,48% de la población general). Las variedades de CAA se clasificaron de acuerdo con los criterios de Silberstein et al. Resultados. El mayor consumo correspondió al grupo de analgésicos simples con un 34,7% del total de sujetos, seguido por el de analgésicos combinados y ergotamínicos consumidos por el 27,8% y 22,2%, respectivamente. El 12,5% tomaba opioides solos o asociados y en quinto lugar los triptanes, que eran consumidos por el 2,8% del total de sujetos. Los principios activos más utilizados fueron: paracetamol (54%), cafeína (49%), derivados ergóticos (38%) y propifenazona (35%). Los sujetos detectados consumieron una media de 2,5 principios activos simultáneamente. La media de unidades consumidas en sus diversas presentaciones por los sujetos con CAA fue de 50 unidades/mes.Conclusiones. Este estudio muestra que la CAA es un problema sanitario importante. En nuestro medio, el 85% de las personas con CAA de la población utilizan analgésicos y/o ergóticos. Estas medicaciones se dispensan sin receta, por lo que debería regularse su obtención en las oficinas de farmacia

Background and objective. The abuse pattern of analgesics is not well known in persons with «chronic daily headache and analgesic abuse» (CHA) in the general population. The objective of this study was to know the type of analgesics used by pharmacological group and the active ingredient in subjects with CHA in a large sample of the general population. Patients and methods. A questionnaire was distributed that investigated the frequency of headache and analgesic consumption among persons over 14 years (9,984 inhabitants) of the semiurban population of Santoña (Cantabria). A total of 4,855 subjects filled out the questionnaire. Although the CHA criteria require headache ≥ 15 days a month, those individuals (n = 332) that report subjective consumption of analgesics for headache ≥ 10 days in this period filled out a headache diary for one month. A total of 72 individuals fulfilled CHA criteria (1.48% of the general population). The varieties of CHA were classified according to the Silberstein et al criteria. Results. The greatest consumption corresponded to the simple analgesic group with 34.7% of all the subjects followed by those of combined analgesics and ergotaminics consumed by 27.8% and 22.2% respectively. A total of 12.5% took opioids alone or associated and triptans were in the fifth place. The latter were consumed by 2.8% of all the subjects. The active ingredients used most were: paracetamol (54%), caffeine (49%), ergotic derivatives (38%) and propyphenazone (35%). The subjects detected consumed a mean of 2.5 active ingredients simultaneously. The mean units consumed in their different presentation by the subjects with CHA was 50 units/month. Conclusions. This study shows that CHA is a significant health care problem. In our setting, 85% of the persons with CHA of the population used analgesics and/or ergotics. These medications were given without prescription so that their obtention should be regulated in the pharmacy offices

[Abuse pattern of analgesics in chronic daily headache: a study in the general population]. / Patrón de abuso de analgésicos en la cefalea crónica diaria: un estudio en población general.

BACKGROUND AND OBJECTIVE: The abuse pattern of analgesics is not well known in persons with "chronic daily headache and analgesic abuse" (CHA) in the general population. The objective of this study was to know the type of analgesics used by pharmacological group and the active ingredient in subjects with CHA in a large sample of the general population. PATIENTS AND METHODS: A questionnaire was distributed that investigated the frequency of headache and analgesic consumption among persons over 14 years (9,984 inhabitants) of the semiurban population of Santoña (Cantabria). A total of 4,855 subjects filled out the questionnaire. Although the CHA criteria require headache > or = 15 days a month, those individuals (n = 332) that report subjective consumption of analgesics for headache > or = 10 days in this period filled out a headache diary for one month. A total of 72 individuals fulfilled CHA criteria (1.48% of the general population). The varieties of CHA were classified according to the Silberstein et al criteria. RESULTS: The greatest consumption corresponded to the simple analgesic group with 34.7% of all the subjects followed by those of combined analgesics and ergotaminics consumed by 27.8% and 22.2% respectively. A total of 12.5% took opioids alone or associated and triptans were in the fifth place. The latter were consumed by 2.8% of all the subjects. The active ingredients used most were: paracetamol (54%), caffeine (49%), ergotic derivatives (38%) and propyphenazone (35%). The subjects detected consumed a mean of 2.5 active ingredients simultaneously. The mean units consumed in their different presentation by the subjects with CHA was 50 units/month. CONCLUSIONS: This study shows that CHA is a significant health care problem. In our setting, 85% of the persons with CHA of the population used analgesics and/or ergotics. These medications were given without prescription so that their obtention should be regulated in the pharmacy offices.

Sonographically guided 11-G directional vacuum-assisted breast biopsy as an alternative to surgical excision: utility and cost study in probably benign lesions.

PURPOSE: To evaluate the utility and economic costs of the 11-G vacuum-assisted biopsy probe under ultrasound (US) guidance as an alternative to surgical excision in patients with probably benign lesions. MATERIAL AND METHODS: US-guided 11-G vacuum-assisted biopsy was performed in 102 probably benign breast lesions in 97 women who refused radiological follow-up. Complete removal of the lesion was intended in all cases. Open biopsy was done if questionable pathologic findings were present. Treatment was indicated if the diagnosis was malignant. Economic costs were estimated taking into consideration monetary expenses generated to the public health system, as well as expenses for the patients receiving percutaneous and open surgical biopsy. RESULTS: Median patient age was 42 years (range 18-77). Median lesion size was 14.7 mm (range 6-30 mm). Complete removal of the lesion seen at imaging was achieved in 72.5% of cases. Adequate tissue samples for histopathological evaluation were obtained in all cases. Surgical biopsy was recommended in nine cases. One patient diagnosed with mucinous carcinoma underwent immediate surgical treatment. The remaining 87 women with 92 lesions were included in a follow-up program. Economic cost of the 11-G vacuum-assisted percutaneous biopsy was 82% lower than the surgical biopsy (total savings in this series: 136,402.84 euros). Time spent for the patient was 71% less in percutaneous biopsy than in surgery. CONCLUSION: Ultrasound-guided 11-G directional vacuum-assisted breast biopsy is an accurate and less expensive procedure that can be used as an alternative to open surgical excision in a selected group of patients.

Mortalidad materna en España en el período 1995-1997: resultados de una encuesta hospitalaria / Maternal mortality in Spain from 1995-1997. Results of a hospital survey

Objetivo: Se propuso a la SEGO la necesidad de conocer mejor la tasa y las causas de mortalidad materna en España. Sujetos y métodos: Se envió una encuesta según el certificado europeo de muerte materna a los hospitales españoles (directorio SEGO, 1995) para investigar en el período 1995-1997 la tasa y las causas de muerte materna. Resultados: Han respondido 69 hospitales, contabilizándose 363.589 nacidos vivos en 19951997. Hubo que lamentar 26 muertes maternas, por lo que la tasa de mortalidad materna es de 7,15/100.000 nacidos vivos. En el 50 per cent de los casos existió una causa obstétrica directa y en el 42 per cent se identificó una causa obstétrica indirecta, y sólo el 7,6 per cent se clasificaron como desconocidas. Según los datos comunicados al INE, este índice se calcula en 2,74/100.000 nacidos vivos. Conclusiones: Se estima que la tasa de muerte materna, que se obtiene a partir de los datos comunicados oficialmente, puede estar subestimada en el 38 per cent. Es preciso modificar los certificados de defunción y crear un Comité Nacional para el estudio de la muerte materna en colaboración con el INE (AU)

[Prevalence of orthostatic hypotension in elderly hypertensive patients in primary care]. / Prevalencia de hipotensión ortostática en ancianos hipertensos tratados en atención primaria.

OBJECTIVE: To find the prevalence of orthostatic hypotension (OH) and associated factors in elderly hypertensive patients in a primary care setting. DESIGN: Descriptive cross-sectional study. SETTING: La Marina Health Centre (an urban centre in Santander). PATIENTS: A random sample of 295 patients aged 65 years or older regularly assisted from hypertension. MEASUREMENTS AND MAIN RESULTS: Measurements of sitting and standing blood pressure were obtained. Orthostatic hypotension was defined as 20 mmHg or greater decrease in systolic or 10 mmHg or greater decrease in diastolic blood pressure after 1-minute or 5-minute standing. Associated diseases, symptoms upon standing, medication use, habits and other clinical assessments were also recorded. The prevalence of OH was 14.6%. The prevalence of systolic OH after 1-minute (OH-S1) and after 5-minute (OH-S5) standing was 5.8% in both, and the diastolic OH was 5.1% after 1-minute (OH-D1) and 4.1% after 5-minute (OH-D5) standing. By logistic regression analysis, association between higher level of systolic blood pressure and global OH was found, also with the presence of orthostatic intolerance symptoms (although only 25.6% of the patients with OH showed symptoms) and smoking. Beta-blockers and calcium channel blockers (different from dihydropyridines) use was associated with OH after 1-minute standing and smoking with OH after 5-minute standing. CONCLUSIONS: The detected prevalence is high and justifies the case finding of OH in elderly hypertensive patients in primary care. The symptoms of orthostatic intolerance are correlated with OH, but only 1 out of 4 patients showed symptoms. Smoking could be related with OH, so beta-blockers and calcium channel blockers (different from dihydropyridines) use.

Prevalencia de hipotensión ortostática en ancianos hipertensos tratados en atención primaria / Prevalence of orthostatic hypotension in elderly hypertensive patients in primary care

Objetivo. Conocer la prevalencia de hipotensión ortostática (HO) y los factores asociados en ancianos hipertensos tratados en atención primaria (AP).Diseño. Estudio descriptivo, transversal. Emplazamiento. Centro de Salud La Marina (centro urbano en Santander).Pacientes. Una muestra aleatoria de 295 pacientes de 65 o más años atendidos regularmente por presentar hipertensión arterial (HTA).Mediciones y resultados principales. Se han obtenido cifras de presión arterial (PA) en sedestación y en bipedestación. La definición de HO utilizada ha sido: disminución de 20 mmHg o más en la PA sistólica (PAS) o de 10 mmHg o más en la PA diastólica (PAD), tras 1 o 5 minutos de bipedestación. También se han recogido datos sobre enfermedades asociadas, síntomas en bipedestación, medicación utilizada, hábitos de los pacientes y resultados de otras exploraciones clínicas. La prevalencia global encontrada de HO fue del 14,6 por ciento. La prevalencia de HO sistólica tras un minuto (HO-S1) y tras 5 minutos (HO-S5) de bipedestación ha sido del 5,8 por ciento en ambas, y la de HO diastólica del 5,1 por ciento tras un minuto (HO-D1) y del 4,1 por ciento tras 5 minutos (HO-D5) de bipedestación. En el análisis de regresión logística se encontró una asociación entre la existencia de HO global y la mayor elevación de la PA sistólica inicial, la presencia de síntomas de intolerancia ortostática (aunque sólo un 25,6 por ciento de los pacientes con HO presentaba síntomas) y el hábito tabáquico. Asimismo, se encontró una asociación con el uso de bloqueadores beta y antagonistas del calcio (diferentes de las dihidropiridinas) y la existencia de HO al minuto de bipedestación, y entre el consumo de tabaco y la HO a los 5 minutos de bipedestación. Conclusiones. La prevalencia detectada es alta y justifica la búsqueda sistemática de HO en los pacientes ancianos que son tratados de HTA en AP. La existencia de síntomas con el ortostatismo se relaciona con una mayor prevalencia de HO, pero sólo los presentó uno de cada 4 pacientes con HO. El consumo de tabaco podría estar relacionado con la presencia de HO, así como el uso de bloqueadores beta y antagonistas del calcio (diferentes de las dihidropiridinas).. (AU)

La cardiopatía isquémica en los servicios de urgencia hospitalarios. Proyecto EVICURE / Coronary heart disease in the hospital emergency service. EVICURE Project

La Cardiopatía Isquémica (CI) supone una importante carga asistencial en los Servicios de Urgencias hospitalarios (SUH). La carga asistencial viene definida por el número de casos, las características de los mismos, las medidas asistenciales aplicadas y el tiempo de permanencia en el servicio de urgencias. Objetivo: La cuantificación de las variables que identifican la carga asistencial. Diseño: Estudio prospectivo multicéntrico de corte transversal. Métodos: Registro de todos los casos con diagnóstico final de CI atendidos en los servicios de urgencias de 35 hospitales españoles durante tres semanas. Se consideran variables de interés, clasificación y destino de los distintos tipos de CI atendidos; tiempo de permanencia en el servicio de urgencia. Maniobras terapéuticas y asistenciales realizadas. Se utiliza el Therapeutic Intervention Score (TISS) para cuantificar la carga asistencial. Resultados: Se registraron un total de 2216 casos de CI durante el estudio. La proporción de casos de CI sobre visitas a urgencia fue de 1,3 por ciento (1,1-1,5 IC al 95 por ciento). El 48,1 por ciento corresponde a Angina Inestable (AI) y el 27,1 por ciento a Infarto Agudo de Miocardio (IAM), de los cuales sólo el 49,7 por ciento ingresan directamente en las Unidades Coronarias (UCs); el resto lo hace tras un período de observación. La mortalidad del IAM en el SUH fue del 2,5 por ciento. Solamente ingresan el 19,8 por ciento de las AI en las UCs. El tiempo de permanencia en el servicio de urgencia de los IAM fue de 100 min. de media y 32 min. de mediana, para los que ingresan directamente en las UCs. De 540 min. de media y 305 min. de mediana para los que ingresan en UCs tras un período de observación en urgencias. El 35,2 por ciento de los pacientes tiene un TISS > de 9. Conclusiones: La CI constituye el 1,3 por ciento de las visitas a los SUH de nuestro país. Solamente el 49,7 por ciento de los IAM ingresan directamente en las UCs; el resto lo hace tras un período de observación produciendo una importante carga asistencial. La mortalidad del 2,5 por ciento para el IAM durante su estancia en el SU es muy elevada y es preciso tenerla en cuenta para no infraestimar la mortalidad hospitalaria del IAM. Los hospitales con más de 300 visitas día tendrán permanentemente un paciente con Síndrome Coronario Agudo (SCA) que requiera cuidados a nivel de UCs (AU)

[Prevalence of vaginal candidiasis in a low-risk obstetric population in Santander]. / Prevalencia de candidiasis vaginal en una población obstétrica de bajo riesgo en Santander.

OBJECTIVES: To find the prevalence of vaginal candidiasis in pregnant women monitored through primary care and to see whether it is on the increase. DESIGN: Descriptive and retrospective study of pregnant women. SETTING: Cazoña Health District (34,783 inhabitants). SUBJECTS: The entire obstetric population monitored by our health centre between 1992 and 1997 inclusive. MEASUREMENTS AND RESULTS: Retrospective study of clinical histories of all the pregnant women seen at our health centre (878 pregnancies). After discounting those referred to obstetricians, abortions/miscarriages and premature births, 549 normal low-risk pregnancies (62.30% of the total) were monitored to completion in primary care. The women's age range was 16 to 40. The mean prevalence of candidiasis was 18% (CI, 15.0-21.6). Its frequency increased as the number of pregnancies increased and dropped as the age of the pregnant women increased. CONCLUSIONS: Prevalence found in our study was 18% and did not increase as the years passed.

Prevalencia de candidiasis vaginal en una población obstétrica de bajo riesgo en Santander / Prevalence of vaginal candidiasis in a low-risk obstetric population in Santander

Objetivo. Conocer la prevalencia de candidiasis vaginal en embarazadas controladas desde atención primaria y ver si está aumentando con el paso del tiempo. Diseño. Estudio descriptivo, retrospectivo del universo de mujeres embarazadas. Emplazamiento. Zona Básica de Salud Cazoña (34.783 habitantes). Sujetos. Toda la población obstétrica controlada en nuestro centro de salud desde 1992 a 1997, ambos inclusive. Mediciones y resultados. Estudio retrospectivo de las historias clínicas de todas las mujeres embarazadas captadas en nuestro centro de salud (878 embarazos). Descartados los derivados a tocólogo, abortos y partos prematuros, se han valorado 549 embarazos (62,30 por ciento del total) normales, de bajo riesgo, controlados hasta el final por atención primaria, con un rango de edad de 16-40 años. La prevalencia media de candidiasis es de un 18 por ciento (IC, 15,0-21,6). Su frecuencia aumenta a medida que se incrementa el número de gestaciones y disminuye a medida que aumenta la edad de la embarazada.Conclusiones. La prevalencia encontrada en nuestro estudio es de un 18 por ciento, y no está aumentando a medida que pasan los años (AU)

[Association between lipid profile and Apo E genotype in Spanish children (8-15 years old)]. / Asociación entre el perfil lipídico y genotipo de la apoproteína E en niños españoles (8-15 años).

OBJECTIVE: Different studies conclude that apoprotein E (Apo E) is a genetic determinant of lipid levels and cardiovascular risk, although these studies have been carried out principally in adults, with scarce and variable results available in children. The aim of our study was to analyze the association between lipid profile and the different Apo E isoforms (E2, E3 and E4) in a group of Spanish children. PATIENTS AND METHODS: In a transversal study, apo E genotypes and the lipid profile [total cholesterol (TC), LDL-c, HDL-c, triglycerides (TG), Apo A1, apo B and Lp(a)] were determined in 191 children (110 boys and 81 girls) between 8 and 15 years of age. Apo E genotyping was performed by means of polymerase chain reaction and subsequent digestion with the restriction enzyme HhaI. RESULTS: The relative frequency for the E3, E4 and E2 alleles were 0.87, 0.09 and 0.04, respectively. Total cholesterol, LDL-c and Apo B serum levels were highest in the group of individual with the genotypes E3/E4 and lowest in the group E2/E3, while E3/E3 individuals had intermediate levels. When analyzed according to gender, we only found statistical significance in the group of girls (p < 0.004). CONCLUSIONS: The apo E genotype was significantly associated with lipid differences observed in the childhood population and this is modulated by gender.

[Level of knowledge of patients with type II diabetes mellitus in primary care]. / Nivel de conocimientos de pacientes con diabetes tipo II de atención primaria.

A personal interview to 148 patients was carried out with the aim of getting to know the level of information of type II diabetic patients at an Urban Health Center in Santander. A validated questionnaire made up of 14 questions on general aspects of diabetis, dietetic habits and capability to handle complications was used. The Cronbach's alpha coefficient of questionnaire was 0.69. The correct answer average was 6.3 (IC = 5.9-6.5). Patients were best informed about general aspects and had much less information with regard to the handling of complications and to their diet. The differences among these three sections of questions were significative (p less than 0.001). The patients under diet treatment obtained worse results than those treated with oral hipoglucemiants and insulin. Our results are worse than those reported by other similar populations at a national level. Also, and due to the differences in knowledge within this group, we believe that the establishment of groups and subgroups when educating diabetic patients is possible and also highly recommended.