Factores asociados al control óptimo simultáneo de la diabetes, hipertensión arterial e hipercolesterolemia en la población diabética. Estudio BPC diabetes / Factors associated with the optimum simultaneous control of diabetes, arterial hypertension and hypercholesterolemia in the diabetic population. BPC Diabetes study

Objetivos: Conocer el grado de control óptimo simultáneo de la diabetes (DM), hipertensión arterial (HTA) e hipercolesterolemia y determinar los factores asociados. Material y métodos: Estudio descriptivo transversal en pacientes diabéticos de 18 o más de edad, seleccionados consecutivamente en consultas de medicina de familia (MF). Los datos de los pacientes se obtuvieron mediante acceso a la historia informatizada, registrándose variables clínicas y analíticas de interés. Se consideró buen control metabólico una HbA1c < 7%, buen control de la presión arterial (PA) valores < 140/80 mmHg y buen control de colesterol LDL (c-LDL) valores < 100 mg/dL. Se realizó análisis bivariante y se calcularon odds ratio (OD) en un modelo de regresión logística. El estudio fue aprobado por el CEIm del Hospital Clínico San Carlos (Madrid). Resultados: Se incluyó a 1.420 pacientes (55,8% varones), con una edad media (DE) de 70,6 (10,8) años. El 75,9% eran hipertensos y el 69,1% dislipémicos. Los valores de HbA1c fueron de 6,9 (1,2) %, PA sistólica 135,0 (16,8) mmHg, PA diastólica 75,9 (10,6) mmHg y LDL-colesterol 93,7 (32,8) mg/dL. El buen control metabólico de la DM se alcanzó en el 63% (intervalo de confianza [IC] 95%: 60,4-65,5), el buen control de la HTA en el 42,6% (IC 95%: 40,0-45,2) y el buen control de colesterol LDL en el 61,1% (IC 95%: 58,4-63,7) de los pacientes. El buen control de los tres factores de riesgo cardiovascular (FRCV) simultáneamente se alcanzó en el 16,1% (IC 95%: 14,2-18,1). Se observó una asociación positiva e independiente (p < 0,05) entre el buen control simultáneo de los FRCV con la edad (OR: 1.017) y los antecedentes personales de enfermedad cardiovascular (OR: 1.596). Conclusiones: Los resultados de nuestro estudio indican que una proporción pequeña, menos de dos de cada 10 pacientes cumplen los objetivos de buen control recomendados por las guías de práctica clínica (AU)

Objectives: To know the degree of simultaneous optimal control of diabetes (DM), high blood pressure (BP) and hypercholesterolemia and determine the associated factors. Material and method: Cross-sectional descriptive study in diabetic patients 18 years aged or older selected consecutively in primary care centers (PC). Patient data were obtained through access to electronical clinical history. Clinical and analytical variables of interest were registered. Good metabolic control was considered as HbA1c < 7%, good blood pressure control (PA) as values < 140/80 mmHg and good LDL cholesterol control (c-LDL) as values < 100 mg/dL. Bivariate analysis was performed and odds ratio were calculated in a logistic regression model. The study was approved by the San Carlos Clinical Hospital's Clinical Research Ethics Committee (CREC), in Madrid. Results: 1420 patients (55.8% male), with an average (SD) age of 70.6 (10.8) years were included. 75.9% were hypertensive patients, and 69.1% dyslipemic. HbA1c values were 6.9 (1.2) %, sistolic BP 135.0 (16.8) mmHg, diastolic BP 75.9 (10.6) mmHg and LDL-cholesterol 93.7 (32.8) mg/dL. Good metabolic control of DM was achieved at 63.0% (95% CI: 60.4–65.5), good control of HTA at 42.6% (95% CI: 40.0–45.2) and good LDL cholesterol control in 61.1% (95% IC: 58.4–63.7) of patients. Good simultaneous control of the three cardiovascular risk factors (CVRF) was reached at 16.1% (95% CI: 14.2–18.1). A positive and independent association (p<0.05) was observed between good simultaneous control of CVRF with age (OR: 1.017) and with personal history of cardiovascular disease (OR: 1.596). Conclusions: The results of our study indicate that a small proportion, less than two out of 10 patients, meet the good control goals recommended by clinical practice guidelines. We found important differences between patients with and without cardiovascular disease (AU)

[Factors associated with the optimum simultaneous control of diabetes, arterial hypertension and hypercholesterolemia in the diabetic population. BPC Diabetes study]. / Factores asociados al control óptimo simultáneo de la diabetes, hipertensión arterial e hipercolesterolemia en la población diabética. Estudio BPC diabetes.

OBJECTIVES: To know the degree of simultaneous optimal control of diabetes (DM), high blood pressure (BP) and hypercholesterolemia and determine the associated factors. MATERIAL AND METHOD: Cross-sectional descriptive study in diabetic patients 18 years aged or older selected consecutively in primary care centers (PC). Patient data were obtained through access to electronical clinical history. Clinical and analytical variables of interest were registered. Good metabolic control was considered as HbA1c < 7%, good blood pressure control (PA) as values < 140/80 mmHg and good LDL cholesterol control (c-LDL) as values < 100 mg/dL. Bivariate analysis was performed and odds ratio were calculated in a logistic regression model. The study was approved by the San Carlos Clinical Hospital's Clinical Research Ethics Committee (CREC), in Madrid. RESULTS: 1420 patients (55.8% male), with an average (SD) age of 70.6 (10.8) years were included. 75.9% were hypertensive patients, and 69.1% dyslipemic. HbA1c values were 6.9 (1.2) %, sistolic BP 135.0 (16.8) mmHg, diastolic BP 75.9 (10.6) mmHg and LDL-cholesterol 93.7 (32.8) mg/dL. Good metabolic control of DM was achieved at 63.0% (95% CI: 60.4-65.5), good control of HTA at 42.6% (95% CI: 40.0-45.2) and good LDL cholesterol control in 61.1% (95% IC: 58.4-63.7) of patients. Good simultaneous control of the three cardiovascular risk factors (CVRF) was reached at 16.1% (95% CI: 14.2-18.1). A positive and independent association (p<0.05) was observed between good simultaneous control of CVRF with age (OR: 1.017) and with personal history of cardiovascular disease (OR: 1.596). CONCLUSIONS: The results of our study indicate that a small proportion, less than two out of 10 patients, meet the good control goals recommended by clinical practice guidelines. We found important differences between patients with and without cardiovascular disease.

Análisis del grado de cumplimiento de las recomendaciones de las guías de práctica clínica para el diagnóstico y seguimiento de las complicaciones crónicas vasculares en la diabetes tipo 2 en atención primaria / Analysis of the level of compliance to the clinical practice guidelines recommendations for the diagnosis and monitoring of chronic vascular complications in type 2 diabetes in Primary Care

OBJETIVOS: Evaluar el grado de cumplimiento de las recomendaciones de las guías de práctica clínica (GPC) en el diagnóstico y seguimiento de las principales complicaciones crónicas vasculares de los pacientes con diabetes tipo2 (DM2) en atención primaria (AP). MATERIAL Y MÉTODOS: Estudio descriptivo transversal retrospectivo en pacientes de 18 o más años de edad seleccionados consecutivamente a medida que acudieron a la consulta en AP. Los datos de los pacientes se obtuvieron mediante acceso a la historia informatizada, registrándose variables clínicas y analíticas de interés. Se consideró adecuada la determinación y el registro de microalbuminuria (MALB), filtrado glomerular (FG), exploración pies (palpación pulsos, monofilamento o diapasón) y electrocardiograma (ECG) si habían sido realizados de manera anual, y del fondo de ojo (FO) cada dos años. RESULTADOS: Se incluyó a 1.420 pacientes (55,8% varones), con una edad media (DE) de 70,6 (10,8) años y una media de 9,3 (6,2) años de evolución de su diabetes. El índice de masa corporal (IMC) medio (kg/m2) fue de 30,1 (5,4) en mujeres y de 29,5 (4,7) en varones (p = 0,023) y la HbA1c (%), de 6,9 (1,2). El buen control metabólico de la DM se alcanzó en el 63,0% (IC95%: 60,4-65,5). Tenían realizado FO en los dos últimos años 976 pacientes (68,7%; IC95%: 66,2-71,1). La MALB se había realizado a 1.228 pacientes (86,5%; IC95%: 84,6-88,2), el FG estimado a 1.391 (98,0%; IC95%: 97,1-98,6), la exploración de los pulsos del pie a 626 (44,1%; IC95%: 41,5-46,7) y la exploración neurológica a 473 (33,3%; IC95%: 30,8-35,8). CONCLUSIONES: Los resultados de nuestro estudio indican que en una proporción importante de los pacientes con DM2 no se explora la presencia de retinopatía ni de neuropatía. A siete de cada diez pacientes se les ha cribado de retinopatía, uno de cada tres tiene realizada exploración neurológica y uno de cada cuatro tiene realizadas todas las exploraciones recomendadas por las GPC

OBJECTIVE: To evaluate the level of compliance to the clinical practice guidelines (CPG) recommendations for the diagnosis and monitoring of the main chronic vascular complications of patients with type2 diabetes (DM2) in Primary Care (PC). MATERIAL AND METHODS: A retrospective cross-sectional descriptive study was conducted on patients aged 18years and over and consecutively selected in PC. Patient data were obtained by direct interview and access to the computerised history, and recording the clinical and analytical variables of interest. The determination and recording of urine microalbumin (MALB), glomerular filtration rate (GFR), foot examination (pulse palpation, monofilament or tuning fork), and electrocardiogram (ECG), if performed annually, and the eye fundus (FO) every two years. RESULTS: A total of 1,420 patients were included, of which 55.8% were male. The mean age (SD) was 70.6 (10.8) years and the mean onset of the diabetes was 9.3 (6.2) years. The mean BMI (kg /m2) was 30.1 (5.4) in females and 29.5 (4.7) in males (P=.023), and a mean HbA1c (%) of 6.9 (1.2). Good metabolic control of DM was achieved in 63.0% (95%CI: 60.4-65.5). In the last two years, 976 (68.7%; 95%CI: 66.2-71.1) patients had an eye fundus examination. The urine microalbumin had been performed on 1,228 patients (86.5%; 95%CI: 84.6-88.2). The mean glomerular filtration rate was performed on 1,391 patients (98.0%; 95%CI: 97.1-98.6), the foot pulses examination on 626 (44.1%; 95%CI: 41.5-46.7), and the neurological examination on 473 patients (33.3%; 95%CI: 30.8-35.8). CONCLUSIONS: The results of the present study indicate that the presence of retinopathy or neuropathy is not explored in a significant percentage of patients with DM2. Only seven out of ten patients have been screened for retinopathy, one in three had a neurological examination, and only one in four have all the scans recommended by the CPG

[Analysis of the level of compliance to the clinical practice guidelines recommendations for the diagnosis and monitoring of chronic vascular complications in type2 diabetes in Primary Care]. / Análisis del grado de cumplimiento de las recomendaciones de las guías de práctica clínica para el diagnóstico y seguimiento de las complicaciones crónicas vasculares en la diabetes tipo 2 en atención primaria.

OBJECTIVE: To evaluate the level of compliance to the clinical practice guidelines (CPG) recommendations for the diagnosis and monitoring of the main chronic vascular complications of patients with type2 diabetes (DM2) in Primary Care (PC). MATERIAL AND METHODS: A retrospective cross-sectional descriptive study was conducted on patients aged 18years and over and consecutively selected in PC. Patient data were obtained by direct interview and access to the computerised history, and recording the clinical and analytical variables of interest. The determination and recording of urine microalbumin (MALB), glomerular filtration rate (GFR), foot examination (pulse palpation, monofilament or tuning fork), and electrocardiogram (ECG), if performed annually, and the eye fundus (FO) every two years. RESULTS: A total of 1,420 patients were included, of which 55.8% were male. The mean age (SD) was 70.6 (10.8) years and the mean onset of the diabetes was 9.3 (6.2) years. The mean BMI (kg /m2) was 30.1 (5.4) in females and 29.5 (4.7) in males (P=.023), and a mean HbA1c (%) of 6.9 (1.2). Good metabolic control of DM was achieved in 63.0% (95%CI: 60.4-65.5). In the last two years, 976 (68.7%; 95%CI: 66.2-71.1) patients had an eye fundus examination. The urine microalbumin had been performed on 1,228 patients (86.5%; 95%CI: 84.6-88.2). The mean glomerular filtration rate was performed on 1,391 patients (98.0%; 95%CI: 97.1-98.6), the foot pulses examination on 626 (44.1%; 95%CI: 41.5-46.7), and the neurological examination on 473 patients (33.3%; 95%CI: 30.8-35.8). CONCLUSIONS: The results of the present study indicate that the presence of retinopathy or neuropathy is not explored in a significant percentage of patients with DM2. Only seven out of ten patients have been screened for retinopathy, one in three had a neurological examination, and only one in four have all the scans recommended by the CPG.

Percepción de las puérperas y de los profesionales sanitarios sobre el embarazo y el parto como factores de riesgo de las disfunciones del suelo pélvico. Estudio cualitativo / Perception of postpartum women and health professionals on pregnancy and childbirth as risk factors for pelvic floor dysfunctions. A qualitative study

Objetivo: Conocer la percepción de puérperas y profesionales sanitarios sobre el embarazo y el parto como factores de riesgo de disfunciones del suelo pélvico (DSP). Sujetos y métodos: Estudio cualitativo con grupos focales, entrevistas semiestructuradas y análisis de documentos realizado entre marzo del 2014 y mayo del 2015 en el Hospital Universitario Príncipe de Asturias (HUPA) y en el centro de salud Juan de Austria, del distrito asistencial de Alcalá de Henares (Madrid). Participaron 19 puérperas ingresadas en el HUPA y 9 profesionales sanitarios relacionados con el embarazo, parto y puerperio. Se formaron 4 grupos focales, se realizaron 13 entrevistas semiestructuradas y se recogieron 4 cuestionarios. Mediante un proceso iterativo de análisis se identificaron las categorías emergentes. El rigor de la investigación se garantizó mediante diferentes procesos de triangulación. Resultados: Se identificaron 5 categorías: el embarazo, parto y puerperio; la información; el suelo pélvico (SP); la atención profesional y la intervención sanitaria. Las puérperas refirieron que precisaban más información de calidad y supervisada sobre el SP, sus funciones, sus problemas y los factores que pueden desencadenarlos, su prevención y su recuperación. Los profesionales refrendaron la opinión de las puérperas añadiendo la necesidad de protocolos y de equipos multidisciplinares que incluyan al fisioterapeuta. Conclusiones:Las puérperas desconocen los factores que desencadenan DSP. Son necesarios equipos multidisciplinares en Atención Primaria y especializada que incluyan al fisioterapeuta y que actúen según protocolos clínicos durante el embarazo, parto y puerperio

Objective: To know the perception of postpartum women and health professionals on pregnancy and childbirth as risk factors for pelvic floor dysfunctions (PFD). Subjects and methods: A qualitative study with focus groups, semi-structured interviews and document analysis conducted between March 2014 and May 2015 at the University Hospital Principe de Asturias (HUPA) and health centre Juan de Austria, from the healthcare district of Alcala de Henares (Madrid). The participants were 19 postpartum women admitted to HUPA and 9 healthcare professionals related to pregnancy, childbirth and postpartum. Four focus groups were formed, 13 semi-structured interviews were conducted, and 4 questionnaires were collected. Through an iterative process of analysis were identified emerging categories. Triangulation processes ensured the rigor of the research. Results: Five categories identified: pregnancy, childbirth and postpartum; information; pelvic floor (SP); professional care and health intervention. Puerperal women reported that they needed more quality information and supervised on the SP, its functions, its problems and the factors causing, prevention PFD and recovery. Professionals endorsed the views of puerperal women adding the need protocols and multidisciplinary teams including physiotherapists. Conclusions: Puerperal women are uniformed about factors causing PFD. Multidisciplinary teams are needed in primary and specialty care including physical therapist and they must act as clinical protocols for the monitoring and control of pregnancy, childbirth and postpartum

El vendaje en el tratamiento fisioterapéutico del linfedema secundario a cancer de mama: una serie de casos / Bandage in the physiotherapy treatment of breast cancer-related lymphedema: A series of cases

Antecedentes y objetivo: La fisioterapia compleja descongestiva, compuesta por drenaje linfático manual, ejercicios, educación terapéutica y vendaje compresivo, es el primer tratamiento de elección en pacientes con linfedema secundario a cáncer de mama. La literatura indica que la efectividad del tratamiento depende en gran medida de la técnica de vendaje. Así, existen distintos tipos de vendajes que pueden emplearse. El objetivo es evaluar la eficacia de diferentes vendajes en función del grado y el estadio del linfedema. Descripción de los casos: Tres mujeres con linfedema secundario a cáncer de mama. Dos de ellas fueron diagnosticadas de linfedema grado leve y una tercera de linfedema severo. Intervención: Se les aplicó el mismo tratamiento conservador, excepto el tipo de vendaje, que varió en relación con el grado de linfedema; en ambos linfedemas leves se aplicaron el vendaje neuromuscular y el vendaje multicapa, respectivamente; en el caso del linfedema severo, una combinación de ambos. Resultados y discusión: Todas las pacientes disminuyeron el volumen del miembro afectado. Los mejores resultados se obtuvieron en el caso de linfedema leve, en el que se empleó un vendaje multicapa, con una reducción del volumen del edema de un 80,2% y la total eliminación de los síntomas. El método de contención en el tratamiento del linfedema podría aplicarse en función del grado y el estadio del mismo para optimizar resultados. Son necesarios ensayos clínicos con un tamaño muestral apropiado que comparen los distintos tipos de vendaje en el mismo tipo de pacientes con el mismo grado de linfedema

Background and purpose: Complex Decongestive Physiotherapy, consisting of manual lymphatic drainage, exercises, therapeutic education and bandages, is the first treatment of choice in patients with lymphedema secondary to breast cancer. The literature indicates that the effectiveness of the treatment depends largely on the bandage technique employed. There are different types of bandages that can be used. The objective is to evaluate the effectiveness of different bandages depending on the lymphedema grade and stage. Case description: The cases of 3 women with lymphedema secondary to breast cancer are described. Two of them were diagnosed with mild lymphedema, and the third with severe lymphedema. Intervention: They received the same conservative treatment, except for the type of bandage. Bandage type varied in relation to the degree of lymphedema. For the mild lymphedema, kinesiotape and the multilayer bandage were applied, respectively. In the case of severe lymphedema, a combination of both was used. Results and discussion: The volume of the affected limb decreased in all of the patients. The best results were obtained in the patient with mild lymphedema in whom a multilayer bandage was used, with a reduction edema volume of 80.2% and total elimination of symptoms. The compression method of treatment of lymphedema used could be applied based on its grade to optimize results. Clinical trials with an appropriate sample size comparing various types of bandage in the same type of patient with the same degree of lymphedema are needed

La materia de investigación y documentación clínica tras la convergencia europea: una propuesta desde la experiencia en la UAH / Research and clinical documentation material after the European convergence: a proposal based on the Alcala de Henares University experience

Entre los cambios que se plantean en el Libro Blanco de Fisioterapia, se aconseja la incorporación de nuevas materias como obligatorias, entre ellas la Introducción a la investigación y la documentación clínica (IIDC). Actualmente y desde hace 3 años en el 2.º curso de la Diplomatura de Fisioterapia de la Universidad de Alcalá se imparte la asignatura Fisioterapia basada en la evidencia (FBE) que cumple con las recomendaciones propuestas en el Libro Blanco en relación a la materia IIDC. Se desarrolla en este artículo una comparación entre el programa de la asignatura FBE y las recomendaciones propuestas en el Libro Blanco. De ésta concluimos que: Esta asignatura cumple con las competencias específicas propuestas en el Libro Blanco para dicha materia. En cuanto a la carga lectiva, el Libro Blanco propone 6 créditos ECTS para la materia IIDC, que se equiparan con los 4,5 créditos actuales de la asignatura que se imparte en Alcalá. La distribución de los contenidos de la materia es similar a la de la asignatura en cuestión

Among the changes outline in the "Libro Blanco de Fisioterapia" , it is advisable to incorporate new compulsory subjects such as "Introduction to Clinic Investigation and Documentation" (IIDC). Nowadays and for 3 years in the 2nd Course of Physical Therapy Degree, the subject of "Physical Therapy based on evidence" (FBE) is taught at the Alcalá de Henares University. A comparison between FBE subject Programme and the recommendation proposed in the "Libro Blanco" is established. From this point the conclusions are: This subject complies with the specific competencies proposed in the White Paper for this subject. Regarding the academic charge, the White Paper proposed 6 ECTS credits for the IIDC subject, which will be put on a level with the current 4.5 credits of the subject taught in Alcalá. Content distribution of the subject is similar to the above mentioned subject

[Montelukast: new therapeutic option in patients with nasal polyps associated to respiratory allergic disease]. / Montelukast: nueva opción terapéutica en pacientes con poliposis nasal asociada a enfermedad alérgica respiratoria.

BACKGROUND: The physiopathogenic mechanism of nasal polyposis is unknown. Chemical mediators found in nasal polyposis are: histamine, serotonin, leukotrienes (LTC4, LTD4, LTE4, LTB4), norepinephrine and possibly prostaglandin D2. Leukotrienes that mediate bronchoconstriction as well as chemical mediators of inflammation are observed in the nasal disease associated to polyposis. HYPOTHESIS: Antileukotrienes might play a significant role in controlling polyposis and symptoms due to sinonasal disease. They represent an alternative to conventional treatments with oral steroids as well as to operations in the long-term control. OBJECTIVE: This study is a one year investigation that evaluates the important role of leukotriene receptor antagonists on nasal polyposis, with or without association to any allergic disease. Likewise, it compares its use with the conventional therapy used in the above mentioned disease. PATIENTS AND METHODS: We included 30 patients, 12 men (40%) and 18 women (60%), with ages between 16-45 years old. The mean age was of 20.7 years. Systematic assessments were made at the beginning of the study, as well as in the third, sixth, ninth, and twelfth month. Objective assessments, computed axial tomography of paranasal sinuses, allergological tests, nasal and bronchial symptoms evaluation, and interleukines, eosinophils, and immunoglobulin determinations were made. RESULTS: There was an improvement of nasal symptoms in the patients of group 1 (montelukast plus beclomethasone). They included the respiratory ones (p < 0.05), the nasal washing cells (p < 0.05), and the peak flow (p < 0.05) at the third, sixth, and twelfth months, respectively. There was no significant difference with the improvement obtained in the patients of group 3 (surgery-montelukast-beclomethasone) (p < 0.05). There was no significant change in group 2 regarding the baseline in the studied variables (p > 0.05).

Un caso de mielomeningocele, hipoplasia del sacro, amputación de miembro inferior por abscesos dérmicos en el que se detecta déficit de anticuerpos antipolisacáridos / A case of myelomeningocele, hypoplasia of the sacrum, amputation of lower limb due to dermal abscesses

El enfermo con mielomeningocele presenta entre otros síntomas, parálisis, tanto mayor cuanto más alto es el nivel, déficit sensitivos, deformidades en miembros inferiores, en parte producidas por el inicio de la carga, y trastornos urológicos. Describimos el caso de un paciente con mielomeningocele y múltiples infecciones dérmicas a lo largo de su crecimiento que conllevó la amputación del miembro inferior izquierdo. La frecuencia de abscesos y episodios de sepsis generalizadas, nos llevó a estudiar su sistema inmunológico, detectándose un déficit inmunológico de anticuerpos. Un tratamiento integral, tanto de los factores extrínsecos que podían producir los roces, mediante ayudas ortoprotésicas; de los factores locales mediante cirugía y de los factores intrínsecos mediante gammaglobulina, ha conseguido resolver los problemas que el paciente aquejaba. (AU)

[Allergic fungal sinusitis: recent developments]. / Sinusitis alérgica micótica: conceptos actuales.

Allergic fungal sinusitis is a recently reported disease of the nose and paranasal sinuses. Since the first reports by Lamb et al and Katzenstein there has been controversy about its diagnosis and treatment. Recently diagnostic criteria have been suggested. To our judgement they have a high degree of specificity. Allergy to fungi elements is essential. Currently surgical treatment consist in an adequate ventilation of the nose and paranasal sinuses followed by the use of oral and topical steroids. Immunotherapy is controversial and more prospective studies are needed to evaluate its possible use.

Bronchocentric granulomatosis as a first clinical manifestation in an adult patient with p67phox deficiency.

We report on a case of adult chronic granulomatous disease which first manifested as a pulmonary mass, and was histologically diagnosed as bronchocentric granulomatosis associated with aspergillosis in a patient with a deficiency of p67phox and a low oxidative response. Antifungal treatment was required for clinical resolution.