SEA 2024 Standards for Global Control of Vascular Risk. / Estándares de la Sociedad Española de Arteriosclerosis 2024 para el control global del riesgo vascular.

One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to the knowledge, prevention and treatment of vascular diseases, which are the leading cause of death in Spain and entail a high degree of disability and health expenditure. Atherosclerosis is a multifactorial disease and its prevention requires a global approach that takes into account the associated risk factors. This document summarises the current evidence and includes recommendations for patients with established vascular disease or at high vascular risk: it reviews the symptoms and signs to evaluate, the laboratory and imaging procedures to request routinely or in special situations, and includes the estimation of vascular risk, diagnostic criteria for entities that are vascular risk factors, and general and specific recommendations for their treatment. Finally, it presents aspects that are not usually referenced in the literature, such as the organisation of a vascular risk consultation.

Actualización sobre las nuevas formas de consumo de tabaco / Update on new forms of tobacco use

El tabaquismo sigue siendo la principal causa de morbimortalidad a nivel mundial. Por su clara influencia en las enfermedades cardiovasculares y respiratorias, es un factor importante en la consulta de medicina interna. Aunque la tasa de abandono del hábito tabáquico está ascendiendo en los últimos años, existe un porcentaje de pacientes que continúan fumando porque no pueden o no quieren cesar el hábito, a pesar de haber probado las terapias farmacológicas y no farmacológicas existentes. Para este grupo de paciente existen unas estrategias que se basan en intervenciones destinadas a reducir los efectos negativos del tabaco sin la necesidad de extinguir por completo su consumo. En esta revisión se contempla como gracias a la ausencia de combustión de la materia orgánica que se da en el cigarrillo convencional, en snus, cigarrillo electrónico y productos de tabaco calentado se genera un nivel significativamente inferior de sustancias tóxicas.(AU)

Smoking remains the leading cause of morbidity and mortality worldwide. Because of its clear influence on cardiovascular and respiratory diseases, it is an important factor in internal medicine consultations. Although the rate of smoking cessation has been increasing in recent years, there is a percentage of patients who continue to smoke because they are unable or unwilling to quit, despite having tried existing pharmacological and non-pharmacological therapies. For this group of patients there are strategies based on interventions aimed at reducing the negative effects of smoking without the need for complete cessation. In this review it is shown that due to the absence of combustion of organic matter in conventional cigarettes, snus, e-cigarettes and heated tobacco products generate significantly lower levels of toxic substances.(AU)

Update on new forms of tobacco use. / Actualización sobre las nuevas formas de consumo de tabaco.

Smoking remains the leading cause of morbidity and mortality worldwide. Because of its clear influence on cardiovascular and respiratory diseases, it is an important factor in internal medicine consultations. Although the rate of smoking cessation has been increasing in recent years, there is a percentage of patients who continue to smoke because they are unable or unwilling to quit, despite having tried existing pharmacological and non-pharmacological therapies. For this group of patients there are strategies based on interventions aimed at reducing the negative effects of smoking without the need for complete cessation. In this review it is shown that due to the absence of combustion of organic matter in conventional cigarettes, snus, e-cigarettes and heated tobacco products generate significantly lower levels of toxic substances.

Perception of Medical Professionalism among Medical Residents in Spain.

BACKGROUND: Medical professionalism, defined as commitment to the primacy of patient welfare, is the basis for doctor-patient-society relationships, but previous research with medical students has shown that professionalism and social commitment to medicine may be waning. To determine if this trend also appears in recently qualified practicing doctors, we surveyed 90 newly graduated doctors currently working as medical residents in two university hospitals in Murcia, Spain. A previously validated questionnaire that studies the perception of six categories (responsibility, altruism, service, excellence, honesty and integrity, and respect) defining medical professionalism was used. RESULTS: A good perception of professionalism was found among medical residents, with more than 70% positive responses in all these six categories. There is an increasing trend in the number of negative responses as the residency goes on. Altruism was the category with the greatest percentage of negative answers (22.3%) and Respect was the category with the lowest percentage (12.9%). CONCLUSIONS: The results show a good professionalism perception in medical residents, but also a slight decline in positive answers that began during medical school. A significant trend was found when including both students and residents. Although there were some differences between students and residents, these were not statistically significant. Educational interventions are needed both at the level of medical school and postgraduate medical residency.

Glycerol kinase deficiency in adults: Description of 4 novel cases, systematic review and development of a clinical diagnostic score.

BACKGROUND AND AIMS: Glycerol kinase deficiency (GKD) is a rare genetic disorder characterized by hyperglycerolemia and glyceroluria, which could be misdiagnosed as a moderate to severe hypertriglyceridemia (HTG). We aimed to describe four novel cases of GKD, to complete a systematic review of all cases of isolated GKD published so far, and to develop a suspicion clinical diagnostic score for GKD. METHODS: We reported four cases with suspicion of GKD and compared their phenotype with 584 males with triglycerides (TG) > 300 mg/dL, selected as control group (HTG non-GKD). The GK gene was sequenced in all cases. Lipoprotein particle concentrations were measured in all cases with GKD. The systematic review involved a PubMed, Cochrane and Scopus databases search to identify anthropometric and biochemical characteristics of all described cases with GKD. RESULTS: The systematic review retrieved a total of 15 articles involving 39 subjects with GKD. GKD cases reported a history of high TG levels resistant to lipid-lowering therapy. Compared to GKD subjects (n = 43), HTG non-GKD subjects (n = 584) showed significantly higher BMI, total cholesterol, non-HDL cholesterol and gamma-glutamyltransferase, significantly lower HDL cholesterol and TG, and higher prevalence of diabetes. The proposed diagnostic score was significantly higher in GKD than in HTG non-GKD subjects. CONCLUSIONS: This is the first systematic review that compiles all GKD cases reported to date including 4 novel cases, and examine the differential GKD phenotype compared to other types of HTG. The proposed score would have a broad utility in clinical practice to avoid unwarranted lipid lowering treatment in GKD patients.

Protocolos de supervisión de residentes

Contiene: por qué elaborar protocolos de supervisión, plantilla de protocolo de supervisión de residentes, y protocolos de supervisión de residentes en las diferentes unidades docentes del hospital. Cada protocolo incluye información sobre objeto y campo de aplicación, departamentos involucrados, documentación de referencia, definiciones, desarrollo, registros, histórico de ediciones, etc.

Papel de la troncalidad en la formación especializada / Role of the core curriculum system (troncalidad) in the specialized training

La implantación en 1978 del sistema de formación sanitaria especializada (FSE) mediante residencia supuso un gran avance en el terreno de la educación médica en nuestro país. Años después, se inició su reforma con la Ley 44/2003, de Ordenación de las Profesiones Sanitarias, y, finalmente, después de casi una década de debates y enfrentamientos en diferentes foros, se ha publicado el Real Decreto 639/2014, que regula la troncalidad, la reespecialización y otros aspectos de la formación especializada y representa el cambio más importante desde que comenzó el sistema de residencia. El nuevo sistema distingue dos periodos en la formación especializada: uno en el que los residentes desarrollan las competencias que son comunes a varias especialidades, es decir, aquellas que conforman el bloque de base (o tronco), y otro en el que se adquieren las competencias específicas de la propia especialidad. En este nuevo modelo de troncalidad hay tres tipos bien definidos de competencias que debe lograr el futuro especialista: transversales (comunes a todos los profesionales de la salud), nucleares o troncales (comunes a un conjunto de especialidades de un bloque o tronco) y específicas de cada especialidad. Sin embargo, toda esta extensa regulación contrasta con la falta de adaptación a la realidad y la ausencia de una estructura educativa mínimamente profesionalizada en el sistema de salud en que se basa

The implementation in 1978 of the system of Specialized Healthcare Training (SHT) through residency in Spain has been a breakthrough in the field of medical education. Many years later, reform of the system of SHT came with the Law 44/2003, of planning of the health care professions, and, after a decade of debates and clashes in different forums, has been finally enacted Royal Decree 639/2014, which regulates the common core curricula of the specialties, the respecialisation and other aspects of specialized training, and represents the most significant change since the system of residency began. The new system distinguishes two periods in specialised training: one in which residents develop those competencies that are common across several specialties, that is to say, those that make up the core block (or trunk), and other one in which the competencies of the specialty itself are acquired. In this new model of core subjects there are three clearly defined types of competencies that the future health care specialist must accomplish: transversal (common to health care professionals), core (common to a set of specialties of a core block) and specific to each specialty. However, all this extensive regulation contrasts with the lack of adaptation to the reality and the lack of a minimally professionalized educational structure in the health care system on which it's based

Conclusiones del XII Encuentro Nacional de Jefes de Estudio y Tutores de Formación Sanitaria Especializada, AREDA 2015 (Bilbao, 23-25 de septiembre de 2015) / Conclusions of the 12th National Meeting of Specialised Health Training Heads of Studies and Tutors, AREDA 2015 (Bilbao 23-25 September 2015)

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Formación especializada en España: del internado rotatorio a la troncalidad / Specialized health training in Spain: from internship to the common core curricula of the specialities

La implantación en España del sistema de formación sanitaria especializada (FSE) mediante residencia ha supuesto un gran avance en el terreno de la educación médica. El Hospital General de Asturias, en 1963, y la Clínica Puerta de Hierro de Madrid, en 1964, iniciaron la formación de médicos internos y residentes (MIR), pese a que contravenía lo estipulado en la Ley de especialidades de 1955 y a que entraba en conflicto con el sistema de especialización a través de las escuelas universitarias, entonces vigente. El nuevo sistema recibió un fuerte impulso coincidiendo con la expansión de las residencias de la Seguridad Social, y los principales centros hospitalarios lo fueron implantando progresivamente. En 1968 se constituyó el denominado "seminario de hospitales con programas de posgraduados", que elaboró en 1970 el primer manual de acreditación de hospitales. Su influjo sobre el ministerio fue muy grande, y a partir de 1971 tienen lugar las primeras convocatorias de ámbito nacional, aunque por concurso de méritos y con entrevista local de los solicitantes. Recién creado el Ministerio de Sanidad y Seguridad Social, se publica el Real Decreto (RD) 2015/1978, primera norma que reconoce que las enseñanzas de especialización podrán cursarse por el sistema de residencia, que se convertirá en obligatorio para las especialidades que requieran formación hospitalaria a partir de 1984. La reforma del sistema de FSE viene de la mano de la Ley 44/2003, de ordenación de las profesiones sanitarias, y sus disposiciones de DESARROLLO: el RD 1146/2006, que regula los derechos y deberes del residente; el RD 183/2008, que clasifica las especialidades y regula importantes aspectos del sistema de FSE; los decretos autonómicos de ordenación de la FSE (solo cinco hasta ahora), y, finalmente, el RD 639/2014, que regula la troncalidad, la reespecialización, las áreas de capacitación específica, las pruebas de acceso y otros aspectos. Sin embargo, toda esta extensa normativa reguladora, muy formalizada y que pretende la excelencia del sistema, contrasta con los importantes incumplimientos existentes y los numerosos desarrollos pendientes, que ponen de manifiesto la evidente falta de adecuación de la normativa a la realidad del sistema formativo asistencial en el que se sustenta, que sigue careciendo de una estructura docente mínimamente profesionalizada

The implementation in Spain of the system of Specialized Healthcare Training (SHT) through residency has been a breakthrough in the field of medical education. The Hospital General of Asturias, in 1963, and the Clínica Puerta de Hierro of Madrid, in 1964, initiated the education of intern and resident physicians, despite that it contravened provisions of the law of specialties of 1955 and was in conflict with specialization through the system of university professional schools, then existing. Coinciding with the expansion of the residences of the Social Security, the new system received a strong boost and the major hospital centres were progressively implementing it. In 1968, the so-called "seminario de hospitales con programas de posgraduados" was founded, and in 1970 drew up the first accreditation manual for hospitals. Their influence on the Ministry had a large impact, and in 1971 the first nationwide call took place, although by merit-based selection and with local interviews to applicants. Newly created the Ministry of Health and Social Security, is published Royal Decree (RD) 2015/1978, the first regulation that recognizes that the teachings of specialization may be performed by the residency system, that will become mandatory for specialties that require hospital training from 1984. Reform of the system of SHT comes with the Law 44/2003, of organization of the health professions, and its development provisions: RD 1146/2006, regulating the rights and duties of the residents; RD 183/2008, which classifies the specialties and regulates important issues of the system of SHT; regional decrees of organization of the SHT (only five currently); and finally RD 639/2014, that regulates the common core curricula of the specialties (troncalidad), the re-specialisation, the areas of specific training, the tests for the entrance and other aspects of specialized training. However, all this extensive regulation, very formalized and that aspires to excellency, contrasts with the lack of compliance of some important mandates and with several pending developments, which demonstrate the regulation's evident lack of adaptation to the reality of health care system on which it's based, that continues to lack a minimal professional teaching structure

[Ischaemic heart disease]. / Cardiopatía isquémica.

In the year 2011, cardiovascular diseases were responsible of 31.2% of total deaths in Spain. The absolute number of cases of acute coronary syndrome in this year will be approximately 115,752 cases (95%CI: 114,822-116,687). The prevalence of stable angina in the population aged 25-74 years is 2.6% in men and 3.5% in women. Cardiovascular diseases were in the year 2011 the first cause of hospitalizations representing 14.1% of the total hospitalizations. Diagnose of ischaemic heart disease and acute myocardial infarction were responsible of 110,950 and 50,064 hospitalizations, respectively. In the year 2003, the hospitalization rate was 314 while in the year 2011 was 237 per 100,000, a reduction of 24.4%. The average cost of hospitalization due to ischaemic heart disease in 1997 was 3,093.7euros while in the year 2011 was 7,028.71euros. Cardiovascular mortality rates have decreased from 2007 to 2011, showing a relative reduction of 7% in women and 8% in men. With regard to myocardial infarction, it was observed a relative reduction of 17% in men and 20% in women. According to EUROASPIREIII survey done in 8,966 patients with ischaemic heart disease in Europe, 17% of patients were still smokers, 35% were obese, 56% has uncontrolled blood pressure, 51% has raised blood cholesterol and 25% were diabetics. With regard to drugs utilisation, 91% were treated with antiplatelets agents, 80% with beta blockers, 71% with ACE inhibitors/ARBs.

Influence of birth weight on the apo E genetic determinants of plasma lipid levels in children.

To evaluate the influence of birth weight on apolipoprotein (apo) E genetic determinants of plasma lipids levels in prepubertal children we studied 933 healthy children (491 males and 442 females) 6 to 8 years old (mean age of 6.7 y), whose weight was recorded at birth. Plasma lipid and apolipoprotein concentrations and apo E genotypes were determined. We observed a greater effect of the apo E polymorphism on total cholesterol (TC), LDL-cholesterol (LDL-C) and especially apo B levels in children with birth weight in the lower tertile compared with those with birth weights in higher tertiles. Taking the epsilon3 allele homozygosity as reference, in boys with birth weights in the low tertile the overall lowering effect of the epsilon2 allele on TC, LDL-C and apo B was greater (10.5% (p < 0.01), 20.2% (p < 0.01) and 18.8% (p < 0.01), respectively) than in those in the highest tertile (5.6% on TC, 10.3% on LDL-C and 12.6% (p < 0.01) on apo B). A similar trend in this effect between tertiles of birth weight was also observed in girls. For both sexes, linear regression analysis demonstrates a positive and significant interaction between birth weight and epsilon2, which may explain the fact that the decrease in TC, LDL-C and apo B associated with the epsilon2 allele is more marked the lower the birth weight. Taking into account the prevalence of apo E polymorphism, and that appears to be the main genetic factor affecting plasma lipids, the interaction of apo E genotype and birth weight could be an important determinant of TC, LDL-C and apo B levels, and, as a consequence, of atherosclerosis.