[NT-proBNP in chronic obstructive pulmonary disease patients]. / NT-proBNP en pacientes con enfermedad pulmonar obstructiva crónica.

BACKGROUND: Brain natriuretic peptide (BNP) is produced and released mainly from ventricles. It has several physiological actions. BNP has been shown to be useful for diagnosis and prognosis in heart failure. The aim of this study is to analyse NT-proBNP levels in chronic obstructive pulmonary disease (COPD) patients and to distinguish factors which could modify these levels. PATIENTS AND METHODS: A descriptive and prospective study was made. COPD patients admitted due to acute exacerbation of this disease at the Hospital Universitario Lozano Blesa (Zaragoza, Spain) were included from November 1st 2004 to May 1st 2007. We included 99 patients; they had not suffered heart failure and they did not present any exclusion criteria. Blood samples were taken to determine NT-proBNP concentrations. RESULTS: Mean age was 74 years and 79% of patients were men. Medium value of NT-proBNP was 1289 pg/ml. Mean body mass index (BMI) was 27.19. There were significant differences between NT-proBNP in patients with or without atrial fibrillation and depending on their age, but there were no differences between men and women nor between patients with or without renal insufficiency. CONCLUSION: COPD patients present high serum levels of NT-proBNP during acute exacerbations and these are modified with age and atrial fibrillation. NT-proBNP could be a prognostic factor identifying COPD patients at special risk, or with a worsening clinical evolution.

NT-proBNP en pacientes con enfermedad pulmonar obstructiva crónica / NT-proBNP in chronic obstructive pulmonary disease patients

Introducción. El péptido natriurético cerebral (BNP) esun péptido de producción fundamentalmente ventricular,con múltiples acciones fisiológicas, cuyo principaluso clínico es el diagnóstico y estratificación pronósticade la insuficiencia cardiaca. El presente trabajo tienepor objeto analizar las concentraciones de NT-proBNPen una población con enfermedad pulmonar obstructivacrónica (EPOC) y su correlación con algunos parámetrosque las modifican en condiciones normales.Material y métodos. Estudio descriptivo, prospectivo, enel que se incluyeron de forma consecutiva pacientes conEPOC ingresados en el servicio de Medicina Interna delH.C.U. “Lozano Blesa” de Zaragoza, del 1 de noviembre de2004 al 1 de mayo de 2007, por una reagudización de su enfermedad,sin insuficiencia cardiaca y sin criterios de exclusión.Se incluyeron 99 pacientes, a los que se les extrajosangre en las primeras 72 horas para analizar NT-proBNP.Resultados. La edad media fue de 74 años, el 79% fueronhombres. El valor medio del NT-proBNP fue de 1.289 pg/ml. El índice de masa corporal (IMC) medio fue de 27,19.Se encontraron diferencias estadísticamente significativasen las concentraciones de NT-proBNP en relacióncon la presencia o ausencia de fibrilación auricular yla edad, pero no hubo modificaciones con relación alsexo, IMC o la presencia de insuficiencia renal.Conclusiones. Los pacientes con EPOC presentan concentracioneselevadas de NT-proBNP durante las reagudizaciones,que se modifican en función de la edad y de lacoexistencia o no de fibrilación auricular. Ello podría tenerun valor pronóstico, constituyendo una herramienta deselección de los pacientes de riesgo o con peor evolución(AU)

Background. Brain natriuretic peptide (BNP) is producedand released mainly from ventricles. It has severalphysiological actions. BNP has been shown to be usefulfor diagnosis and prognosis in heart failure. The aimof this study is to analyse NT-proBNP levels in chronicobstructive pulmonary disease (COPD) patients and todistinguish factors which could modify these levels.Patients and methods. A descriptive and prospectivestudy was made. COPD patients admitted due to acuteexacerbation of this disease at the Hospital UniversitarioLozano Blesa (Zaragoza, Spain) were included fromNovember 1st 2004 to May 1st 2007. We included 99 patients;they had not suffered heart failure and they didnot present any exclusion criteria. Blood samples weretaken to determine NT-proBNP concentrations.Results. Mean age was 74 years and 79% of patientswere men. Medium value of NT-proBNP was 1289 pg/ml. Mean body mass index (BMI) was 27.19. There weresignificant differences between NT-proBNP in patientswith or without atrial fibrillation and depending ontheir age, but there were no differences between menand women nor between patients with or without renalinsufficiency.Conclusion. COPD patients present high serum levelsof NT-proBNP during acute exacerbations and theseare modified with age and atrial fibrillation. NT-proBNPcould be a prognostic factor identifying COPD patientsat special risk, or with a worsening clinical evolution(AU)

Assessment of an after-school physical activity program to prevent obesity among 9- to 10-year-old children: a cluster randomized trial.

OBJECTIVE: To assess the impact of a physical activity program on obesity in primary school children. DESIGN: Cluster-randomized controlled trial with 10 intervention and 10 control schools. PARTICIPANTS: A total of 1044 children, mean age 9.4 years (s.d.=0.7) at baseline, of the Province of Cuenca, Spain. INTERVENTION: Recreational, non-competitive physical activity program conducted after school hours on school premises. The program consisted of three 90-min sessions per week, for 24 weeks. MAIN OUTCOME MEASURES: Body mass index (BMI), triceps skin-fold thickness (TST) and percentage body fat. Secondary measures were blood lipids and blood pressure. Measurements were made at the beginning (September 2004) and at the end of the program (June 2005). Since schools rather than children were randomized, mixed regression models were used to adjust for individual-level covariates under cluster randomization. RESULTS: There were no differences in BMI between the intervention and control groups. Compared with controls, intervention children showed a decrease in TST in both boys (-1.14 mm; 95% confidence interval (CI) -1.71 to -057; P<0.001) and girls (-1.55 mm; 95% CI -2.38 to -0.73; P<0.001), as well as a reduction in the percentage of body fat in girls (-0.58%; 95% CI -1.04 to -0.11; P=0.02). Furthermore, the intervention boys exhibited a decrease in apolipoprotein (apo) B levels (-4.59; 95% CI -8.81 to -0.37; P=0.03) and an increase in apo A-I levels (13.57; 95% CI 7.95-19.20; P<0.001). Blood lipid results in girls were very similar. No changes in total cholesterol, triglycerides or blood pressure were associated with the intervention in either sex, except for an increase in diastolic blood pressure (1.55 mm Hg; 95% CI 0.19-2.91; P=0.03) in the intervention versus control boys. CONCLUSION: An after-school program of recreational physical activity reduced adiposity, increased apo A-I and decreased apo B in primary school children.

Características del paludismo en el área 9 de Madrid. Implicación de Atención Primaria como escalón fundamental para su control / Characteristics of malaria in area 9 of Madrid. Involvement of primary case of fundamental step for its control

OBJETIVO. El objetivo de este estudio es conocer las características clínico epidemiológicas del paludismo en el Área 9 de Madrid. Estudio descriptivo, retrospectivo, con emplazamiento en el Hospital de Fuenlabrada, Madrid. Se han incluido en el estudio todos los pacientes diagnosticados de paludismo durante un periodo de 13 meses. MÉTODO. Se recogieron a partir de las historias clínicas los siguientes datos: sexo, edad, nacionalidad, visita reciente (en los 12 meses previos) a país endémico, sintomatología asociada, días de estancia hospitalaria, realización o no de profilaxis antipalúdica, tratamiento administrado y alteraciones hematológicas asociadas. El método diagnóstico utilizado fue el examen microscópico del parásito en extensiones y gota gruesa de sangre periférica. RESULTADOS. Se recogen los datos de 23 pacientes con diagnóstico de paludismo, 14 de ellos procedentes de Guinea. Se observa Plasmodium falciparum en 16 pacientes. En 21 pacientes no se realizó ninguna pauta de quimioprofilaxis y en 2 se realizó de manera incompleta. El síntoma más frecuente es la fiebre y la trombopenia es la alteración hematológica principal. Sólo 2 pacientes habían acudido previamente a su centro de Atención Primaria. CONCLUSIONES. El paludismo es una enfermedad emergente en nuestro medio. Resulta necesaria la información a los pacientes afectados, sobre todo en lo que se refiere a profilaxis para obtener un adecuado control de la enfermedad. Los programas de control y de prevención de la enfermedad deben ser desarrollados por los profesionales de Atención Primaria

OBJECTIVE. This study aims to know the epidemiological clinical characteristics of malaria in area 9 of Madrid. This is a descriptive, retrospective study located in the Hospital of Fuenlabrada, Madrid. All patients diagnosed of malaria during a 13 month period have been included in the study. METHOD. The following data are collected from the clinical histories: gender, age, nationality, recent visit (in last 12 months) to an endemic country, associated symptoms, days of hospital stay, if anti-malaria prophylaxis was performed, treatment administered and associated blood alterations. The diagnostic method used with microscopic examination of the parasite in thick and thin peripheral blood smears. RESULTS. A total of 23 patients were collected with a diagnosis of malaria, 14 of them from Guinea. Plasmodium falciparum was observed in 16 patients. No chemoprophylaxis regime was performed in 21 patients and was done incompletely in 2. The most frequent symptom is fever and thrombopenia is the main blood disorder. Only 2 patients had previously come to the primary care site. CONCLUSIONS. Malaria is a emerging disease in our setting. Giving information to the patients affected, above all in regards to prophylaxis, is necessary to obtain adequate control of the disease. The control and prevention programs of the disease should be developed by primary care professionals

[Acute-phase reactants and markers of inflammation in venous thromboembolic disease: correlation with clinical and evolution parameters]. / Reactantes de fase aguda y marcadores de inflamación en pacientes con enfermedad tromboembólica venosa: correlación con parámetros clínicos y evolutivos.

OBJECTIVE: To asses the association of acute reactants and interleukin 6 and 8 (IL-6 & IL-8) at diagnosis of venous thromboembolic disease (VTD) and clinical outcome. METHODS: 100 patients were diagnosed of VTD by image tests. Acute reactants (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen), D-dimer and IL-6 and IL-8 we measured at the moment of diagnosis. We made a 12 month follow-up of these patients to notice any clinical evolution outcomes (recurrences, bleeding, post-phlebitic syndrome, death). RESULTS: IL-6 was increased in 9 patients and IL-8 in 3. The risk factors, time to diagnosis and pulmonary embolism rate were similar in both interleukin groups (normal and high levels). Fibrinogen levels were significantly increased in high IL-6 group (585 +/- 179 vs. 485 +/- 154 mgr/dl; p = 0.05). During follow-up there were 5 deaths, 3 recurrences, 11 bleedings and 43 postphlebitic syndromes. Normal ESR level was associated to postphlebitic syndrome (17.8 +/- 14.5 vs. 31.4 +/- 27.4 mm/1st h; p = 0.016). Patients who had high levels of IL-6 had worse survival than these with normal levels (p = 0.015). CONCLUSION: IL-6, ESR, and CPR at diagnosis of VTD could be useful to identified patients with higher risks of death and postphlebitic syndrome during the first year after diagnosis.

Reactantes de fase aguda y marcadores de inflamación en pacientes con enfermedad tromboembólica venosa: correlación con parámetros clínicos y evolutivos / Acute reactives and markers of inflammation in venous thromboembolic disease: clinical and evolution outcomes

Objetivo: Determinar si los reactantes de fase aguda, dímero D y las interleucinas 6 y 8 (IL-6 e IL-8) en el momento de diagnóstico de la enfermedad tromboembólica venosa (ETEV) se relacionan con alguna variable clínica y evolutiva relevante. Material y métodos: Se estudiaron 100 pacientes con el diagnóstico de ETEV por pruebas de imagen. Se determinaron reactantes de fase aguda (proteína C reactiva (PCR), velocidad de sedimentación globular (VSG) y fibrinógeno), dímero D así como IL-6 e IL-8 en el momento del diagnóstico. Se recogieron los eventos clínicos más relevantes (recurrencia, hemorragia, síndrome postflebítico y mortalidad) durante un período de seguimiento de 12 meses. Resultados: La IL-6 estaba elevada en 9 pacientes y la IL-8 en 3. Los factores de riesgo, la duración de los síntomas y la forma de presentación como embolismo pulmonar fueron similares entre los dos grupos. Los niveles de fibrinógeno estaban significativamente aumentados (585 ±179 vs. 485 ± 154 mg/dl; p = 0,05) en el grupo de pacientes con IL-6 elevada. En los 12 meses de seguimiento la frecuencia de fallecimientos, recurrencias, hemorragias y síndrome postflebítico fueron 5, 3, 11 y 43, respectivamente. La VSG normal se asoció de forma significativa a la aparición de síndrome postflebítico (17,8 ± 14,5 vs. 31,4 ± 27,4 mm/1ª h;p = 0,016). La supervivencia de los pacientes con cifras elevadas de IL-6 fue significativamente peor que la del resto de los pacientes (p = 0,015). Conclusiones: Niveles elevados de IL-6 y los reactantes de fase aguda (VSG y PCR) en el momento del diagnóstico de la ETEV podrían servirpara identificar a los pacientes con mayor mortalidad y mayor probabilidad de desarrollar un síndrome postflebítico durante el primer año

Objective: To assess the association of acute reactants and interleukin 6 and 8 (IL-6 & IL-8) at diagnosis of venous thromboembolic disease (VTD) and clinical outcome. Methods: 100 patients were diagnosed of VTD by image tests. Acute reactants (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen), D-dimer and IL-6 and IL-8 we measured at the moment of diagnosis. We made a 12 month follow-up of these patients to notice any clinical evolution outcomes (recurrences, bledding, postphlebitic syndrome, death). Results: IL-6 was increased in 9 patients and IL-8 in 3. The risk factors, time to diagnosis and pulmonary embolism rate were similar in both interleukin groups (normal and high levels). Fibrinogen levels were significantly increased in high IL-6 group (585 ± 179 vs. 485 ± 154 mgr/dl; p=0.05). During follow-up there were 5 deaths, 3 recurrences, 11 bleedings and 43 postphlebitic syndromes. Normal ESR level was associated to postphlebitic syndrome (17.8 ± 14.5 vs. 31.4 ± 27.4 mm/1st ;;h; p=0.016). Patients who had high levels of IL-6 had worse survival than these with normal levels (p = 0.015). Conclusion: IL-6, ESR, and CPR at diagnosis of VTD could be useful to identified patients with higher risks of death and postphlebitic syndrome during the first year after diagnosis