Registro Argentino de Medición de la Presión Arterial en Consultorio. Estudio RAMPAC / Argentine registry of office blood pressure monitoring. RAMPAC study

Introducción: La hipertensión es el factor de riesgo más importante para la muerte cardiovascular a nivel mundial. En Argentina cerca del 44% de las personas desconocen ser hipertensos, y posiblemente sea debido a que no se les mide de la presión arterial (PA) en la consulta médica. Nuestra hipótesis es que la medición y el registro de la PA (MRPA) es omitida durante la consulta médica en Argentina. Objetivo: Determinar la frecuencia de MRPA en la consulta médica en Argentina. Métodos: Estudio multicéntrico, retrospectivo de punto de prevalencia. Se analizaron todas las consultas externas realizadas el 19/09/2019 en mayores de 18 años, en 9 instituciones sanitarias de Argentina y se evaluó la MRPA. Resultados: Se analizaron 2.982 consultas. La edad promedio fue de 52,1 años (18-103), 1.780 (59,7%) eran mujeres y 702 (36,1%) tenían antecedentes de hipertensión arterial (HTA). La PA se midió y registró en 420 consultas (14,1%; IC 95%: 12,8-15,4). En un modelo de regresión logística multivariado el antecedente de HTA (OR: 1,91; p<0,001) y de enfermedad cardiovascular (OR: 1,76; p<0,001) fueron las variables que más se asociaron a la MRPA. La presencia de cáncer se asoció un descenso de MRPA (OR: 0,51; p<0,01). Cardiología fue la especialidad que más midió la PA 49,5% (144/291 consultas), seguida por clínica médica 30% (152/507 consultas). Conclusión: La MRPA en la consulta médica ambulatoria es deficitaria y constituye una oportunidad perdida en salud. Se necesitan estrategias que mejoren la detección y el control de la HTA.

Introduction: Hypertension (HTN) is the leading cause of mortality and disability in the world. In Argentina, almost 44% of hypertensives do not know about their condition and this may be due to the low rate of blood pressure (BP) measurements during the office visit. Our hypothesis is that the measurement and electronic recording of BP (BPMR) is not a routine practice in Argentina. Objective: To describe the rate of office BP measurement in Argentina. Methods: This is a retrospective, multicentre, point prevalence study. We analysed all office visits on 9/19/2019 at 9 medical institutions in 6 provinces of Argentina. Results: Two thousand and eighty-two office visits were analysed. The patients’ mean age was 52.1 years (18-103), 1790 (59.7%) were female, and 702 (36.1%) were hypertensives. BP was measured in 420 visits (14.1%; 95% CI 12.8-15.4). In a multivariate logistic regression model, history of HTN (OR 1.91, P<.001) and previous cardiovascular event (OR 1.76, P<.001) were associated with more odds of BPMR. The presence of cancer was associated with fewer odds of BPMR (OR .51, P<.01). Cardiology measured BP up to 49.5% (144/291 visits), followed by internal medicine 30% (152/507 visits). Conclusion: BPMR during office visits is deficient in Argentina and represents a missed healthcare opportunity. Different strategies are needed to detect hypertensive patients and reduce cardiovascular events.

[Argentine registry of office blood pressure monitoring. RAMPAC study]. / Registro Argentino de Medición de la Presión Arterial en Consultorio. Estudio RAMPAC.

INTRODUCTION: Hypertension (HTN) is the leading cause of mortality and disability in the world. In Argentina, almost 44% of hypertensives do not know about their condition and this may be due to the low rate of blood pressure (BP) measurements during the office visit. Our hypothesis is that the measurement and electronic recording of BP (BPMR) is not a routine practice in Argentina. OBJECTIVE: To describe the rate of office BP measurement in Argentina. METHODS: This is a retrospective, multicentre, point prevalence study. We analysed all office visits on 9/19/2019 at 9 medical institutions in 6 provinces of Argentina. RESULTS: Two thousand and eighty-two office visits were analysed. The patients' mean age was 52.1 years (18-103), 1790 (59.7%) were female, and 702 (36.1%) were hypertensives. BP was measured in 420 visits (14.1%; 95% CI 12.8-15.4). In a multivariate logistic regression model, history of HTN (OR 1.91, P<.001) and previous cardiovascular event (OR 1.76, P<.001) were associated with more odds of BPMR. The presence of cancer was associated with fewer odds of BPMR (OR .51, P<.01). Cardiology measured BP up to 49.5% (144/291 visits), followed by internal medicine 30% (152/507 visits). CONCLUSION: BPMR during office visits is deficient in Argentina and represents a missed healthcare opportunity. Different strategies are needed to detect hypertensive patients and reduce cardiovascular events.

Monolayer of silica nanospheres assembled onto ITO-coated glass substrates by spin-coating.

In this work, we synthesized colloidal silica nanospheres with an average size of 400 nm through the modified Stöber method and successfully fabricated an ordered close-packed silica nanosphere monolayer onto ITO-coated glass substrates using a three-step spin-coating method. ITO films showed resistivity comparable to that of commercial ITO and the silica nanosphere monolayer-coated ITO/glass substrate exhibited good optical transmittance in the visible (550 nm) and near-infrared (900 nm) regions of 62% and 82%, respectively. The results suggest that this monolayer can be used in optoelectronic devices to enhance efficiency in photovoltaic cells.

Impacto de los sesgos cognitivos en la inercia terapéutica en hipertensión arterial: no todo es lo que parece / Impact of cognitive biases in therapeutic inertia in arterial hypertension: Not everything is as it seems

La inercia terapéutica se define como la omisión de tomar una conducta terapéutica, tal como iniciar, adicionar un fármaco o incrementar su dosis durante el seguimiento del paciente, a pesar de tener indicación para ello. En hipertensión arterial, actualmente se considera que la inercia terapéutica es un notable impedimento para lograr un adecuado control y esto tiene implicaciones en el pronóstico de la enfermedad. La inercia terapéutica puede deberse a distintos factores que involucran al médico, al paciente y al sistema sanitario. Gran número de estudios han intentado encontrar determinantes que condicionen la presentación de inercia terapéutica en hipertensión arterial y explicar las causas por las que el profesional sanitario responsable del tratamiento no realiza las modificaciones terapéuticas adecuadas. Entre las múltiples causas que podrían motivar la aparición de inercia terapéutica por parte del médico, se describen la presencia de diversos sesgos cognitivos y afectivos que influyen en el razonamiento clínico y en la toma de decisiones durante la actividad asistencial en el consultorio. Identificar y reconocer estos sesgos cognitivos y afectivos podría ser importante para plantear estrategias educativas en los profesionales de la salud. Para esto se requiere un abordaje multidimensional, incluyendo otros conocimientos más allá de lo observado hasta ahora en relación con el déficit de información y actualización en la patología, abriendo el análisis a la consideración de otras causas. Evitar la inercia terapéutica debería considerarse una prioridad junto a otras importantes medidas, para lograr el control de la hipertensión arterial y minimizar sus consecuencias

Therapeutic inertia is defined as the failure to take therapeutic decisions, such as initiating, adding or increasing the dose of a drug during patient follow-up, despite there being an indication to do so. It is currently considered that therapeutic inertia is a considerable impediment to achieving adequate control of hypertension, and this has implications for the prognosis of the disease. Therapeutic inertia might be due to various factors involving physicians, patients and the health system. Many studies have attempted to find determinants for therapeutic inertia in hypertension and to explain the reasons why health professionals in charge of treatment are failing to make the appropriate modifications to therapy. The many reasons for therapeutic inertia on the part of physicians include the various cognitive and affective biases that influence clinical reasoning and decision-making during healthcare activity in doctors' surgeries. Identifying and recognising these cognitive and affective biases could be important for planning educational strategies for health professionals. This requires a multi-dimensional approach, including knowledge beyond that observed in terms of insufficient information and updating on the disease, and starting to analyse and consider other reasons. Preventing therapeutic inertia should be made a priority along with other important measures to control hypertension and minimise its consequences

[Impact of cognitive biases in therapeutic inertia in arterial hypertension: Not everything is as it seems]. / Impacto de los sesgos cognitivos en la inercia terapéutica en hipertensión arterial: no todo es lo que parece.

Therapeutic inertia is defined as the failure to take therapeutic decisions, such as initiating, adding or increasing the dose of a drug during patient follow-up, despite there being an indication to do so. It is currently considered that therapeutic inertia is a considerable impediment to achieving adequate control of hypertension, and this has implications for the prognosis of the disease. Therapeutic inertia might be due to various factors involving physicians, patients and the health system. Many studies have attempted to find determinants for therapeutic inertia in hypertension and to explain the reasons why health professionals in charge of treatment are failing to make the appropriate modifications to therapy. The many reasons for therapeutic inertia on the part of physicians include the various cognitive and affective biases that influence clinical reasoning and decision-making during healthcare activity in doctors' surgeries. Identifying and recognising these cognitive and affective biases could be important for planning educational strategies for health professionals. This requires a multi-dimensional approach, including knowledge beyond that observed in terms of insufficient information and updating on the disease, and starting to analyse and consider other reasons. Preventing therapeutic inertia should be made a priority along with other important measures to control hypertension and minimise its consequences.

Point-of-care ultrasound in internal medicine: A position paper by the ultrasound working group of the European federation of internal medicine.

Point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. It has many uses in daily clinical practice, including improved diagnostic timeliness and accuracy, and providing information about a patient's prognosis and follow-up. It has been integrated into numerous specialities, but remains relatively undefined in internal medicine training programs. Ultrasonography is a useful tool in the standard clinical practice of internists in numerous clinical scenarios (Emergency Department, hospital ward, general and specific consultations, and home care). Although POCUS has been recently included in the European curriculum of internal medicine, there are differences between European internists in its use, ranging from not at all to well structured educational programs. The use of POCUS needs to be widespread in internal medicine departments, and to accomplish this we must encourage structured training. This document details the consensus-based recommendations by the European Federation of Internal Medicine (EFIM) Ultrasound working group. We establish POCUS core competencies and clinical settings for internists in a symptom-based approach. We also propose training requirements, providing a framework for training programs at a national level.

Prevalencia del síndrome metabólico en Argentina en los últimos 25 años: revisión sistemática de estudios observacionales poblacionales / Prevalence of metabolic syndrome in Argentina in the last 25 years: systematic review of population observational studies

Introducción y objetivo: El síndrome metabólico (SM) comprende un conjunto de factores de riesgo para las enfermedades cardiovasculares y la diabetes. Argentina cuenta con numerosos estudios epidemiológicos sobre SM y, sin embargo, no se ha realizado un análisis sistemático de la prevalencia de SM en nuestra población. Con el fin de estimar la prevalencia de SM en la República Argentina se realizó una revisión sistemática de los estudios observacionales publicados durante el período 1988-2014. Estrategia de búsqueda: Se realizó una búsqueda bibliográfica en las bases de datos MEDLINE (National Library of Medicine), SciELO (Scientific Electronic Library Online) y LILACS (Latin American and Caribbean Health Sciences Literature) sobre estudios realizados en Argentina entre enero de 1988 y diciembre de 2014. Se utilizaron los siguientes términos de búsqueda combinados en los idiomas inglés, castellano y portugués: «síndrome metabólico», «insulinorresistencia», «síndrome dismetabólico», «prevalencia», «epidemiología», «Argentina». Selección de estudios: Fueron incluidos en el análisis los estudios epidemiológicos basados en población adulta de la República Argentina con reporte de la prevalencia de SM (de acuerdo con los criterios de la OMS, ATPIII o IDF). Síntesis de resultados: En la búsqueda bibliográfica inicial se identificaron 400publicaciones. En la segunda fase de búsqueda, 296títulos y resúmenes fueron excluidos. En la tercera fase, se analizó el texto completo de 104estudios. Finalmente, se incluyeron 6 publicaciones en el análisis que reportaron la prevalencia de SM sobre un total de 10.191sujetos (39,6% varones). La edad media de la población fue de 45,2años. La prevalencia de SM (modelo de efectos aleatorios) fue del 27,5% (IC 95%: 21,3-34,1%). La prevalencia de SM fue más elevada en varones que en mujeres (29,4% vs. 27,4%, respectivamente; p=0,02). En orden de frecuencia, los componentes de SM más comunes fueron la dislipidemia (38,3%), la presión arterial elevada (33,4%), la obesidad (32,1%) y la diabetes (7,5%). Conclusiones: Nuestros datos muestran que la prevalencia de SM es alta, lo que representa un problema de salud pública muy importante en Argentina (AU)

Introduction and aim: Metabolic syndrome (MS) comprises a set of risk factors for cardiovascular disease and diabetes. Argentina has numerous epidemiological studies on MS, however, there has been no systematic analysis of the prevalence of MS in our population. To estimate the prevalence of MS in the Argentine Republic, a systematic review of observational studies published during the period 1988-2014 was carried out. Search strategy: A bibliographic search was conducted in the MEDLINE (National Library of Medicine), SciELO (Scientific Electronic Library Online) and LILACS (Latin American and Caribbean Health Sciences Literature) databases on studies conducted in Argentina between January 1989 and December 2014. The following search terms were combined in English, Spanish and Portuguese: 'metabolic syndrome', 'insulin resistance', 'dysmetabolic syndrome', 'prevalence', 'epidemiology', and 'Argentina'. Selection of studies: Epidemiological studies based on the adult population of Argentina with specific report of the prevalence of MS (according to the WHO, ATP III or IDF criteria) were included in the analysis. Synthesis results: In the initial bibliographic search, 400 publications were identified. In the second phase of search, 296 titles and abstracts were excluded. In the third phase, the full text of 104 studies was analyzed. Finally, 6 publications were included in the analysis that reported the prevalence of MS in a total of 10,191 subjects (39.6% male). The average age of the population was 45.2 years. The prevalence of MS (random effects model) was 27.5% (95% CI: 21.3%-34.1%). The prevalence of MS was higher in men than in women (29.4% vs. 27.4%, respectively, P=.02). In order of frequency, the most common components of MS were dyslipidaemia (38.3%), hypertension (33.4%), obesity (32.1%) and diabetes (7.5%). Conclusions: Our data show that the prevalence of MS is high, which represents a very important public health problem in Argentina (AU)

[Prevalence of metabolic syndrome in Argentina in the last 25 years: systematic review of population observational studies]. / Prevalencia del síndrome metabólico en Argentina en los últimos 25 años: revisión sistemática de estudios observacionales poblacionales.

INTRODUCTION AND AIM: Metabolic syndrome (MS) comprises a set of risk factors for cardiovascular disease and diabetes. Argentina has numerous epidemiological studies on MS, however, there has been no systematic analysis of the prevalence of MS in our population. To estimate the prevalence of MS in the Argentine Republic, a systematic review of observational studies published during the period 1988-2014 was carried out. SEARCH STRATEGY: A bibliographic search was conducted in the MEDLINE (National Library of Medicine), SciELO (Scientific Electronic Library Online) and LILACS (Latin American and Caribbean Health Sciences Literature) databases on studies conducted in Argentina between January 1989 and December 2014. The following search terms were combined in English, Spanish and Portuguese: 'metabolic syndrome', 'insulin resistance', 'dysmetabolic syndrome', 'prevalence', 'epidemiology', and 'Argentina'. SELECTION OF STUDIES: Epidemiological studies based on the adult population of Argentina with specific report of the prevalence of MS (according to the WHO, ATP III or IDF criteria) were included in the analysis. SYNTHESIS RESULTS: In the initial bibliographic search, 400 publications were identified. In the second phase of search, 296 titles and abstracts were excluded. In the third phase, the full text of 104 studies was analyzed. Finally, 6 publications were included in the analysis that reported the prevalence of MS in a total of 10,191 subjects (39.6% male). The average age of the population was 45.2 years. The prevalence of MS (random effects model) was 27.5% (95% CI: 21.3%-34.1%). The prevalence of MS was higher in men than in women (29.4% vs. 27.4%, respectively, P=.02). In order of frequency, the most common components of MS were dyslipidaemia (38.3%), hypertension (33.4%), obesity (32.1%) and diabetes (7.5%). CONCLUSIONS: Our data show that the prevalence of MS is high, which represents a very important public health problem in Argentina.