Función eréctil y calidad de vida en pacientes hipertensos tratados con nebivolol en Atención Primaria / Erectile function and quality of life in hypertensive patients treated with nebivolol in Primary Health Care

Objetivo. El objetivo es evaluar la función eréctil en pacientes hipertensos tratados con nebivolol. Método. Se trata de una investigación cuasi-experimental de cohortes prospectiva, de pacientes hipertensos con disfunción eréctil (DE) tratados con nebivolol, con dos grupos control: el primer grupo estaba compuesto de pacientes hipertensos con DE tratados con un medicamento distinto al nebivolol y el segundo de pacientes no hipertensos pero con DE. Resultados. Durante 24 semanas 53 pacientes han participado en el grupo del nebivolol, 51 en el grupo control (con DE e hipertensión [HTA]) y 52 en el grupo 2 (con DE sin HTA). La media de edad de los pacientes es de 55,21 años y el 92,32 % de ellos estaba casado o tenía una pareja estable. Al finalizar la investigación se observaron diferencias entre la media inicial y final de la presión arterial sistólica (PAS) (d = 7,8; t = 4,8; p < 0,001) y la presión arterial diastólica (PAD) (d = 6,16; t = 1,87; p < 0,05) en el grupo del nebivolol. En el grupo control 1 (DE + HTA) se observaron diferencias entre la media inicial y final de la PAS (d = 4,8; t = 5,11; p < 0,001), pero no en la PAD. En el grupo del nebivolol se observaron diferencias entre la puntuación media del total inicial y la puntuación media del total final del índice internacional de función eréctil (d = 19,81; t = 20,830; p < 0,001). También se observaron diferencias de menor intensidad en el grupo control 1 (DE + HTA; d = 5,95; t = 9,192; p < 0,01) y en el grupo control 2 (DE sin HTA; d = 9,30; t = 14,068; p < 0,001). Conclusiones. Los cambios mostrados en la función sexual de los pacientes que pertenecen al grupo de los tratados con nebivolol y el de los no hipertensos con trastorno eréctil (grupo 2) han demostrado ser similares y son más acusados en los pacientes hipertensos con DE tratados con otro antihipertensivo. De ahí que podamos concluir que el tratamiento con nebivolol no interfiere en la función sexual de los pacientes que lo toman, pudiendo incluso mejorarla

Objective. The objective is to evaluate erectile function in hypertensive patients treated with nebivolol. Method. Quasi-experimental research of prospective cohorts of hypertense patients (HBP) with erectile dysfunction (ED) treated with nebivolol, with two control groups: the first one made up of hypertense patients with ED treated with a medication other than nebivolol and the second of non-hypertense patients but with ED. Results. During a period of 24 weeks, 53 patients participated in the nebivolol group, 51 in the control group (with ED and HBP) and 52 in group 2 (with ED without HBP). Mean age is 55.21 years and 92.32 % of them were married or had a stable partner. When the research ended, differences were observed between the initial and final mean of the systolic blood pressure, SBP (d = 7.8; t = 4.8; p < 0.001) and diastolic blood pressure (d = 6.16; t = 1.87; p < 0.05) in the nebivolol group. In control group 1 (ED + HBP), differences were found between the initial and final mean of the SBP (d = 4.8; t = 5.11; p < 0.001), but not in the DBP. In the nebivolol group, differences were observed between the mean score of the initial total and mean score of the final total of the International Index of Erectile Function (d = 19.81; t = 20.830; p < 0.001). Differences having less intensity were also observed in control group 1 (ED + HBP; d = 5.95; t = 9.192; p < 0.01) and control 2 (ED without HBP; d = 9.30; t = 14.068; p < 0.001). Conclusions. The changes demonstrated in the sexual function of the patients who belong to the group treated with nebivolol and that of the non-hypertensive with erectile disorder (group 2) have been demonstrated to be similar and are greater in the hypertense patients with erectile dysfunction treated with another antihypertensive drug. Thus, we can conclude that treatment with nebivolol does not interfere in the sexual function of the patients who take it and can even improve it

SyDSF-AP: un cuestionario de 21 ítems para aproximarnos a la salud sexual y detectar las disfunciones sexuales femeninas en Atención Primaria / SyDSF-AP: a 21-item questionnaire to approach sexual health and detectfeminine sexual dysfunctions in Primary Health Care

OBJETIVO. Desarrollar un instrumento que valore la función sexual femenina y la correlacione con su ciclo vital, situación sociofamiliar y estado de salud. MÉTODO. Estudio longitudinal multicéntrico para evaluar la validez del cuestionario para la Salud y Disfunciones Sexuales Femeninas en Atención Primaria (SyDSF-AP). Se siguieron tres etapas para desarrollar el SyDSF-AP: de identificación de los ítems para las disfunciones sexuales, de desarrollo del cuestionario y de evolución de sus propiedades psicométricas. Se diseñó un cuestionario autoevaluativo de 21 ítems, con un dominio descriptivo sociodemográfico y del estado de salud y otro de función sexual. Su análisis ha consistido en: a) validez de contenidos: consenso del comité de la Asociación para la Investigación de las Disfunciones Sexuales en Atención Primaria (AIDSAP) y correlación intraobservadores (CCI); b) fiabilidad test-retest, con 2 semanas de diferencia, mediante el análisis de concordancia con índice kappa y análisis de coeficiente de correlación intraclase (CCI), y c) análisis de consistencia interna mediante * de Cronbach. RESULTADOS. Participaron 160 mujeres mayores de 18 años que acudieron consecutivamente a las consultas de 4 Centros de Salud por cualquier motivo. La consistencia interna, medida con el * de Cronbach, fue de 0,95. La reproducibilidad entre test y retest (CCI) fue de 0,93 (intervalo de confianza [IC] 99%). Respecto a la correlación intraobservadores, el CCI en el dominio sobre función sexual demostró un acuerdo muy alto con valor global de 0,941 (0,928-0,953, IC 95%). CONCLUSIONES. El cuestionario auto-administrado SyDSF-AP es adecuado para aproximarnos globalmente a la salud sexual de la mujer y detectar las disfunciones sexuales femeninas en Atención Primaria

OBJECTIVE. Develop an instrument that evaluates feminine sexual function and correlates it with their life cycle, social familiar situation, and health status. METHOD. Multicenter longitudinal study to evaluate the validity of the questionnaire for Health and Feminine Sexual Dysfunctions in Primary Care (SyDSF-AP). Three stages were followed-up to develop the SyDSF-AP: identification of the items for sexual dysfunctions, development of the questionnaire and evolution of their psychometric properties. A 21-item self-evaluation questionnaire, with descriptive sociodemographic and health status domain and another one of sexual function was designed. The analysis consisted in: a) validity of contents: consensus of AIDSAP committee and inter-observer correlation (CCI); b) test-retest reliability, with two week's difference, by concordance analysis with kappa index and intraclass correlation coefficient (CCI) analysis, and c) analysis of internal consistency by means of Cronbach's *. RESULTS. A total of 160 women over 18 years of age who came to the consultation of 4 Health Care Sites for any reason consecutively participated. Internal consistency, measured with Cronbach's *, was 0.95. Reproducibility between test and retest (CCI) was 0.93 (99% CI). Regarding intraobserver correlation, the CCI in the domain on sexual function had a very high at agreement with the global value of 0.941 (0.928-0.953, 95% CI). CONCLUSIONS. The self-administered SyDSF-AP questionnaire is adequate to make a global approach to the sexual health of the woman and to detect feminine sexual dysfunctions in Primary Health Care

El perfil de los pacientes con patrón hipertensivo no dipper y su implicación en la práctica clínica en Atención Primaria / Profile of patients with non-dipper hypertensive pattern and its implication in the primary care clinical practice

OBJETIVO. Analizar el perfil de los pacientes hipertensos con patrón circadiano no "reductor" (no dipper), valorando el riesgo añadido para eventos cardiovasculares. DISEÑO. Estudio naturalístico, longitudinal, con monitorización ambulatoria de la presión arterial. EMPLAZAMIENTO. Centros de Salud PARTICIPANTES. Cien pacientes en programa de hipertensión por sospecha de HTA de bata blanca, HTA límite/lábil, HTA de alto riesgo y HTA refractaria; seleccionados de forma consecutiva. MEDICIONES PRINCIPALES. Datos sociodemográficos, patrón circadiano de HTA y riesgo cardiovascular. RESULTADOS. Tres de cada 4 pacientes son varones de 61,88 años de promedio y de 5,64 años de evolución de su HTA. El índice de masa corporal es de 29,04 (IC: 27,62-31,02); el colesterol total de 236 (IC 95%: 213-254) y un 12% son fumadores. El 72% presentaba más de una patología asociada a la HTA: dislipemia 60%, síndrome metabólico 32%, diabetes mellitus tipo 2 el 32%, HPB 24%, y otras el 62%. La monitorización ambulatoria de la presión arterial no fue válida en 4 pacientes (4%); 46 presentaban patrón dipper (46%) y 50 diferente a dipper (50%), distribuidos en 38 no dipper (76%), 10 tenían un patrón riser (20%) y 2 presentaban un patrón extra dipper (4%). En cuanto al riesgo de los no dipper conforme al modelo SCORE fue: normal 4 (8%), ligero 10 (20%), moderado 8 (16%), elevado 24 (48%), y muy elevado 4 (8%). Por último un 36% de los varones presentaba disfunción eréctil (según IIEF). CONCLUSIONES. Los pacientes hipertensos con HTA de alto riesgo y refractarios al tratamiento son los que con más frecuencia presentan un patrón diferente a dipper, tienen un riesgo añadido elevado y más comorbilidad asociada

OBJECTIVE. Analyze the profile of hypertensive patients with non-dipper circadian pattern, assessing the added risk for cardiovascular events. DESIGN. Naturalistic, longitudinal study with ambulatory blood pressure monitoring (ABPM). SITE. Health Center PARTICIPANTS. 100 patients in hypertension programs due to white coat HBP suspicion, borderline/labile HBP, high risk HBP and refractory HBP, consecutively enrolled. PRINCIPAL MEASUREMENTS. Sociodemographic data, circadian pattern of HBP and cardiovascular risk. RESULTS. Three out of every 4 patients are male with average age of 61.88 years and 5.64 years of evolution of their HBP. BMI is 29.04 (CI: 27.62-31.02); total cholesterol 236 (95% CI: 213-254) and 12% smoked. A total of 72% had a disease associated to the HBP: dyslipidemia 60%, metabolic S. 32%, type 2 diabetes mellitus 32%, HBP 24% and others 62%. ABPM was not valid in 4 patients (4%); 46 had dipper pattern (46%) and 50 different from dipper (50%), distributed in 38 non-dipper (76%), 10 had a riser pattern (20%) and 2 an "extra dipper" pattern (4%). Regarding the risk of the "non-dipper" according to the SCORE model, it was normal in 4 (8%), mild in 10 (20%), moderate in 8 (16%), elevated in 24 (48%) and very high in 4 (8%). Finally, 36% of the males had erectile dysfunction (according to IIEF). CONCLUSIONS. Hypertensive patients with high risk and refractory to treatment HBP are those who most frequently had a pattern different from dipper. They had an added elevate risk and more associated comorbidity

[Assessment of corticoid local injections at a health care center]. / Evaluación de las infiltraciones locales con corticoides en un centro de salud.

OBJECTIVE: To evaluate the effect of corticosteroid infiltrations in osteoarticular and tendinous pathology in Primary Care. DESIGN: Observational and descriptive study. SETTING: La Unión Health Center, a town of 14,000 inhabitants in Murcia. MEASUREMENTS AND MAIN RESULTS: All patients older than 14 years subjected to one or more infiltrations from 1-1-1997 to 1-5-1998 were included. The following variables were analysed using information obtained from the patient's medical records: age, sex, condition treated, evolution time, previous treatment, number of infiltrations, results and complications. Descriptive statistics including frequency and distribution tables were calculated. The 70.3% of the 138 cases are women, the mean age is 57.7 years. Most infiltrations were performed for shoulder conditions (60.1%). The mean time of evolution in these cases was 90.9 +/- 13.9 days. Only 10.9% of patients hadn't received any previous treatment. The mean number of infiltrations is 1.5 +/- 0.7 and the middle is 1. Symptoms improved in 82.62% of the cases, just completely (40.6%) or partially (42%). Only in 17.4% cases failed the intervention. Only a complication was registered, one case of residual pigmentation. CONCLUSIONS: The local corticosteroids infiltration is a useful technique in primary care because of a high effectivity, easy management, low cost and few complications.

[Staphylococcus aureus bacteremia at a general hospital]. / Bacteriemias por Staphylococcus aureus en un hospital general.

70 cases of bacteremia caused by Staphylococcus Aureus were studied. 49 (70%) males, and 21 (30%) females; 45 (64.5%) cases being nosocomial and 25 (35.4%) community acquired. The complications were significantly associated to the community acquired bacteremia (p less than 0.001), endocarditis and cutaneous abscesses being the most frequent (4). The group of cases with rapidly lethal prognosis was significantly associated to an increase of mortality (p less than 0.001), while lethal and non-lethal groups showed a decrease in mortality (p less than 0.001). We did not find a statistically significant association between nosocomial and community acquired bacteremias nor between antibiotic therapy and the mortality rate, chi 2 = 1.747.303 (N.S.), chi 2 = 1.323.806 (N.S.).

[Sepsis at an internal medicine department]. / Sepsis en un departamento de medicina interna.

185 cases of bacteremia admitted at the internal medicine department of "C.S. Virgen de la Arrixaga" in Murcia from 1977 to 1986, were studied retrospectively. The common infection was significantly associated to Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus A group and Neisseria meningitidis and the nosocomial infection was associated to Klebsiella Pneumoniae, Serratia Marcescens y Pseudomonas aeruginosa, Staphylococcus epidermidis and Enterobacter. We did not find significant differences between the common and nosocomial infection caused by E. Coli and Proteus mirabilis. These factors were associated to an increase of mortality: age greater than 40 years, nosocomial infection, Pseudomonas aeruginosa, other associated rapidly lethal diseases, acute clinical state at the beginning of bacteremia, shock and non-correct antibiotic therapy.