Dislipemia del síndrome metabólico. Documento sumario del Foro HDL / Dyslipidemia of the metabolic syndrome. Summary document of the HDL-Forum

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Diagnóstico de síndrome metabólico. Adecuación de los criterios diagnósticos en nuestro medio. Recomendaciones del foro HDL. Resumen ejecutivo / Diagnosis of Metabolic Syndrome. Adaptation of Diagnostic Criteria in Our Setting. Recommendations of the Hdl Forum

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Fiebre del humo de los metales. A propósito de un caso asociado al manganeso / Metallic fumes fever. With regard to a case related to manganese

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Leishmaniasis visceral en paciente inmunocompetente: una entidad a considerar en el diagnóstico diferencial de la fiebre de origen desconocido / Visceral leishmaniasys in an immunocompetent patient: an entity to be considered in the differential diagnosis of fever of unknown origin

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[Comparison of two models of education for asthmatic patients]. / Comparación de dos modelos de educación para pacientes asmáticos.

BACKGROUND: The education programs have demonstrated to be an important point in the management of asthmatic patients. The aim of the present study was to assess if an intensive group asthma education program was able to improve a simplified and individual asthma education program, both with a self-management plan included. PATIENTS AND METHOD: A prospective randomised controlled trial was conducted over 12 months and 73 moderate-severe asthmatic patients were included. Patients were randomly assigned to control or study group. Patients in control group received individual and simplified education with a self-management plan and patients in study group attended an <> in small groups where they received a three hours education program in three weeks.The outcome measures were: number of hospital admissions, observation unit admissions, emergency visits and unscheduled general practice consultations. Knowledge, adherence to treatment, ability with inhaler devices, airway function, environmental control measures and quality of life. They were assessed at the beginning and the end of the study. RESULTS: At the end of the study period the outcome of morbidity had improved in both groups but the number of observation unit admissions (p = 0.028) and unscheduled general practice consultations (p = 0.022) was substantially lower in study group. This group also demonstrated improvement in environmental control measures and better inhaler technique and knowledge (p = 0.007). In adherence, lung function or quality of life there were no differences between groups. CONCLUSIONS: In patients with asthma better results can be obtained with an intensive group asthma education program than with the individual and simplified program.

Risk factors for hepatocellular carcinoma in patients with liver cirrhosis.

OBJECTIVE: Although cirrhosis is known to predispose toward hepatocellular carcinoma (HCC), there is no agreement on the factors that can influence the risk for HCC in patients with cirrhosis. This study was designed to identify differences in cirrhosis-related risk factors for developing HCC in relation to epidemiological characteristics, stage of the disease and etiology. METHODS: 512 patients from southwestern Spain with Child-Pugh stage A or B cirrhosis were examined periodically by ultrasonography, and alpha-fetoprotein (AFP) concentration was measured. RESULTS: The average length of follow-up was 37 months. A total of 52 cases of HCC were detected, which represented a risk of 17% after 5 years of follow-up. The Cox model showed that the risk of HCC increased by 8% per year of increasing age. Male sex (relative risk: 3.4), hepatitis C virus infection (relative risk: 4.6), hepatitis B virus infection (relative risk: 2.9) and AFP levels higher than 15 ng/ml (relative risk: 2.5) were also shown to be risk factors. Among alcoholic patients, only age (risk increased by 15% per year), and hepatitis C virus infection (relative risk: 5.4) were risk factors for HCC. However, in patients infected by hepatitis C virus, the main risk factors were age (relative risk increased by 8% per year), male sex (relative risk: 3.9), co-infection with hepatitis B virus (relative risk: 4.9), and increased AFP (relative risk: 2.8). Of the patients with HCC, 71% were infected with hepatitis C virus. Alcoholism, Child-Pugh stage and duration of cirrhosis did not increase the risk of the appearance of HCC. CONCLUSIONS: The risk of HCC increased to 17% after 5 years of follow-up in patients with Child-Pugh stage A or B cirrhosis. Hepatitis C virus infection was the main risk factor in patients with cirrhosis. Other risk factors were age, male sex, hepatitis B virus infection and altered AFP level.

Factores de riesgo de aparición del carcinoma hepatocelular en pacientes con cirrosis hepática / Risk Factors for hepatocellular carcinoma in patients with liver cirrhosis

OBJETIVO: determinar la existencia de diferencias en el riesgo de presentar un carinoma hepatocelular (CHC) en pacientes con cirrosis en función de sus características epidemiológicas, evolución de la hepatopatía y su etiología. PACIENTES Y MÉTODOS: 512 pacientes cirróticos en grado A/13 de Child-Pugh menores de 70 años fueron valorados periódicamente mediante ecografía y determinaciones de alfa-fetoproteína (AFP). RESULTADOS: tras un seguimiento medio de 37 meses se detectaron 52 CHC (riesgo acumulado del 17 por ciento a los 5 años). El modelo de Cox demostró que por cada año de edad el riesgo de CHC se incrementó un 8 por ciento. El sexo varón (RR: 3,4), la infección por virus C (RR: 4,6), la infección por el virus B (RR: 2,9) y la alteración de la AFP (RR: 2,5) también se mostraron como factores de riesgo. Entre los pacientes etílicos, sólo la edad (incremento del 15 por ciento por cada año transcurrido) y la infección por el virus C (RR: 5,4) fueron factores de riesgo. En los pacientes infectados por el virus C supusieron un mayor riesgo: la edad (S por ciento por cada año), el sexo varón (RR: 3,9), la coinfección por el virus B (RR: 4,9) y la elevación de la AFP (RR: 2,8). El 71 por ciento de los pacientes con CHC tenían infección por el virus C. El etilismo y la duración de la cirrosis no incrementaron el riesgo de aparición del tumor, CONCLUSIONES: el riesgo de aparición del CHC asciende al 17 por ciento tras 5 años de seguimiento en pacientes con cirrosis en grado A/B de Child-Pugh. El virus C es el principal factor de riesgo en nuestro medio. Otros factores demostrados son la edad, el sexo varón, la infección por el virus B y la alteración de la AFP. El etilismo y la duración de la hepatopatía no influye en el riesgo de aparición del tumor (AU)

[Significance of apolipoproteins A and B and the remaining lipid fractions as indicators of protein-calorie malnutrition in the elderly]. / Importancia de las apolipoproteínas A y B y las restantes fracciones lipídicas como indicadoras de desnutrición proteico-calórica en el anciano.

Effects of calorie/protein malnourishment have been studied on plasma concentrations of cholesterol, triglycerides, HDL-C, LDL-C and apolipoproteins A and B, in institutionalized elderly people, 53 males and 62 females, of whom 19 females and 12 males were malnourished. In malnourished patients, total cholesterol and LDL-C were significantly lower both in males and in females, but HDL-C was lower only in females. No significant differences in plasma triglycerides were found between the control and the malnourished groups. Apolipoprotein A showed no significant changes on malnourished males, but did show a significant lowering in malnourished females. On the opposite, apolipoprotein B was lower in males than in females. The lowering in cholesterol in malnourished patients leads us to think that this could be a early predictor of nutritional risk in the elderly.

[The importance of a diet survey in the early detection of malnutrition in the elderly]. / Importancia de la encuesta dietética en la detección temprana de desnutrición en el anciano.

BACKGROUND: The elevated incidence of malnutrition in the elderly and its close relation with the prevalence and evolution of determined diseases raises the need for early identification. Despite the existence of numerous indicators, specificity, sensitivity or occasionally both are lacking. METHODS: One hundred fifteen institutionalized elderly of which 19 females and 12 males had signs of malnutrition were studied. A dietetic survey was carried out on all of those studied by means of a 24 hour recollection-interview, during which triceps fold (TF) and muscular area of the arm (MAA) were measured and serum concentrations of prealbumin (PA) protein bound to retinol (PBR), albumin (ALB), trasferrin (TNF) and complement factor 3 (C3) were determined. RESULTS: Not only caloric but also proteic intake were significantly lower in the undernourished (p less than 0.001) as with ALB (p less than 0.001), TNF (p less than 0.001) and C3 (p less than 0.02 in males and p less than 0.05 in females). However, the sensitivity demonstrated by the dietetic survey (77% in males and 73% in females) was higher to that presented by ALB (44% in males and 53% in females), TNF (33% in males and 53% in females) and C3 (0 in both sexes). CONCLUSIONS: The results obtained demonstrate that the dietetic survey is a valid method for detecting not only the risk but also the subclinical presence of malnutrition, in contrast to ALB, TNF and C3 which, to that end, were of less use.

[Thrombogenic factors in the elderly. Evaluation of the plasma concentrations of thromboxane B2 and antithrombin III]. / Factores trombogénicos en el anciano. Valoración de las concentraciones plasmáticas de tromboxano B2 y antitrombina III.

The aim of this study is to prove the existence of a major tendency of platelet aggregation in elderly patients compared to medium-aged adults and, also, to detect whether it is affected by the presence of diabetes mellitus. Plasmatic concentrations of B2 thromboxane (TXB2) and antithrombin III (AT III) were determined in 73 elderly patients of both sexes; 56 without metabolic disease known (Group a) and 17 diabetic patients, 7 type I (Group bI) and 10 of type II (Group bII); and 12 healthy adults (control group). Medium plasmatic concentration of TXB2 was significantly higher (p less than 0.001) in Group a (55 +/- 14 ng/ml) compared to the control group (37 +/- 9 ng/ml) and there was no difference between Group bI (53 +/- 19 ng/ml) and bII (57 +/- 15 ng/ml). No variations were noted in ATIII concentration between the adults (27.4 +/- 2.3 mg/dl) and elderly patients (a = 29.6 +/- 4.4, bI = 29 +/- 2.6, bII = 31.2 +/- 5.9 mg/dl). In elderly patients, there appears to be a state of platelet pro-aggregation without influence of any risk factor, such as diabetes. This could explain the thrombogenic tendency of this age group.

[Clinical remission in Cushing's disease through treatment with sodium valproate and bromocriptine]. / Remisión clínica de una enfermedad de Cushing mediante tratamiento combinado con valproato sódico y bromocriptina.

A patient suffering Cushing disease is presented in whom the administration of ciproheptadine, bromocriptine and sodium valproate in a single dose did not manage to control the clinical-biologic manifestations of the process. Combined treatment with 1.200 mg/day of sodium valproate and 15 mg/day of bromocriptine induced a complete clinical-biological remission, being arterial pressure the last parameter to normalize. The patient who has always refused to undergo surgery has stayed with this treatment for three years, maintaining remission and without appearance of side effects. On two occasions (after one and a half years and after two and half years) the transitory interruption of treatment induced in a few weeks an increase in plasma cortisol levels which again normalized after treatment was re-established. There were no clinical-biological data, pharmacological tests which permitted the prediction of these therapeutic results and therefore, the therapeutic response obtained is not indicative of any specific etiological subtype of Cushing disease.

[Changes in the hypophyseal-thyroid axis and their prognostic value in sepsis]. / Modificaciones del eje hipofisotiroideo y su valor pronóstico en el curso de la sepsis.

The alterations in serum concentration of thyroxine (T4), tri-iodine-thyronine (T3), reverse tri-iodinetiroinine (rT3), thyrotropine (TSH and free thyroxine index (IT4L), are studied in 37 patients diagnosed of sepsis who were divided into two groups according to their evolution: Group A: 22 patients who evolved favourably, and Group B: 15 patients who died, as well as in 14 healthy controls; this was carried out in order to establish, on one hand, its prognostic value, and, on the other, which of these parameters is most useful in the evaluation of thyroid function in these patients. A decrease in serum T3 levels was observed in patients from both groups (p less than 0.001) which was accompanied by an increase in rT3 levels (p less than 0.001) and a decrease in It4L (p less than 0.001); No significant modifications were observed in T4 and TSH. On follow up of 12 patients from group A and 14 from group B, an increase in mean T3 concentration was observed (p less than 0.02) only in the first patient from both groups. The greatest discriminative efficacy of thyroid hormones study with an unfavorable sepsis evolution corresponded to a T3 value below 35 ng/dl.

[The partial inhibition of the growth hormone response to growth hormone-releasing hormone after the administration of the calcium antagonist verapamil]. / Inhibición parcial de la respuesta de hormona de crecimiento a la hormona liberadora de hormona de crecimiento tras la administración del antagonista del calcio verapamil.

The changes produced by administering a calcium channel antagonist on the releasing of growth hormone (GH) induced by the growth hormone-releasing factor (GHRF), are studied. The study was performed on 7 healthy males between 25 and 35 years old, fasting and in bed. We measured the release of GH after the intravenous administration of 250 micrograms of GHRF on 2 successive occasions; one baseline and the second after 3 previous continuous days of 240 mg/day of verapamil. There were no statistically significant differences between the basal concentrations of GH before and after the administration of verapamil. However, the response of GH to GHRF, measured as maximum increase (before verapamil: 12.5 +/- 5.3; after verapamil: 9.5 +/- 3.9 ng/ml and total increase (before verapamil: 29.6 +/- 12.4; after verapamil: 21.6 +/- 11.9 ng/ml) was significantly lower after verapamil produces a partial blockade of GH release induced by GHRF.

[Tobacco and arterial pressure (II.). The acute effects on the angiotensin-converting enzyme]. / Tabaco y tensión arterial (IIo.). Efectos agudos sobre la enzima de conversión de la angiotensina.

The effects of the inhalation of 2.2 mg of nicotine in 20 persons with normal blood pressure and heavy smokers were studied. Blood pressure, heart rate, plasmatic renin activity, aldosterone and angiotensin-converting enzyme (ACE) changes were registered 10 and 20 minutes after the inhalation. Systolic and diastolic blood pressure increased significantly, as well as heart rate. Although the plasmatic renin activity did not alter during the study, aldosterone and the ACE activity increased significantly, being undoubtedly correlated. part from the adrenergic response and the possible effects of ACTH on aldosterone, secondary to nicotine, the results showed a possible modification of the renin-angiotensin-aldosterone, directly related to tobacco inhalation.

[Tobacco and arterial pressure (I.). The hormonal changes in a model of acute nicotine overload]. / Tabaco y tensión arterial (Io.). Modificaciones hormonales en un modelo de sobrecarga aguda de nicotina.

42 persons with normal blood pressure were studied. Only 31 of them were smokers. We did not find any differences in the basal blood pressure, heart rate, ACTH nor cortisol levels, but there were significant differences in the levels of biological markers of tobacco (cotinine and nicotine). When the smokers were induced to smoke 2 cigarettes which had 2.2 mg of nicotine, we observed an increase in the diastolic and systolic blood pressure as well as the heart rate, plasma levels of ACTH (basal: 21.61 +/- 12.52, 10 minutes: 28.06 +/- 21.01, p less than 0.05; 20 minutes: 26.06 +/- 18.56 ng/ml) and cortisol (basal: 14.56 +/- 3.84; 10 minutes: 14.60 +/- 4.7; 20 minutes: 16.55 +/- 6.61 ug/dl, p less than 0.01). At the same time, the nicotine and cotinine levels were significantly higher (p less than 0.0001) and correlated. Our results suggest that apart from the adrenergic response to tobacco exposure, nicotine can produce other hormonal changes which affect the regulating systems of blood pressure. Nicotine and cotinine are the election biological markers to monitor the response to passive or active tobacco smoke inhalation.