Determinación del límite de normalidad de la presión arterial mediante la automedida domiciliaria / Determination of normality limit of blood pressure by home self-measurement

Objetivos. Dada la gran utilización de este nuevo método diagnóstico que es la AMPA, y la escasa clarificación sobre los valores de normalidad se realizó este estudio. Método. Se seleccionó una muestra de 1.136 personas, de forma aleatoria y estratificada por edad y sexo, de 25 a 64 años. Se excluyeron a los diagnosticados de HTA. En consulta (C) se determinó la PA mediante el esfigmomanómetro de mercurio (Hg) y el aparato automático Omron 705 CP (ap. autom.). Se registró la frecuencia cardíaca (FC), la talla y el peso. En el domicilio (D) se les pidió que obtuviesen 9 mediciones de PA, tres por la mañana (M), tres por la tarde (T) y tres por la noche (N). Se aplicó la «t» de Student de medias pareadas, ANOVA y regresión lineal. Resultados. Las mediciones de PA (mmHg) en C y D se obtuvieron en 734 participantes. Las medias de presión sistólica (PS)/presión diastólica (PD) en C con el esfigmomanómetro Hg fueron 123,5 ± 15,1/76,4 ± 10,4 y 122,4 ± 14,4/75,6 ± 10,0 y con el ap. autom. 123,4 ± 16,1/73,7 ± 10,4. La media de PS/PD en el D de toda la muestra fue 115,0 ± 14,3/69,2 ± 9,0. Al compararla PA de la C y del D existieron diferencias significativas entre las determinaciones en C en relación con las del D (p < 0,05). La media de FC en la C fue 70,3 ± 10,4 (pulsaciones/ minuto). La media de FC en el D de toda la muestra fue 67,9 ± 9,7 siendo superior en C que en el D. Al determinar el límite superior de normalidad en el D mediante la media +2 DE en el grupo seleccionado con una PA en C < 140/90 fue 135/82; mediante el percentil 95 correspondió a 131/80 en el total de la muestra. Al aplicar la regresión a la muestra de participantes con PA < 140/90 se obtuvieron unos valores del límite de normalidad en el D de 125/78; en el grupo de personas seleccionadas con PA ≥ 140/90 fue 130/81 y en la muestra total fue de 128/81

Objectives. Home blood pressure (HBP) is frequently used in clinical evaluation; however the interpretation of the data collected is lacked of a precide definition of normal HBP, so we did this study. Methods. A random sample of 1,136 was selected, stratified by gender and age (25 up to 64 years old). Those receiving antihypertensive therapy were excluded. Clinical blood pressure (CBP) consisted of three measurements, with the mercury sphygmomanometer (MS) and with the automatic blood pressure device (Omron 705 CP) (AD). Heart rate (HR), body weight and height were registered. HBP: each participant was asked to obtain 9 home measurements, three in the morning (M), three in the afternoon (A) and three at night (N). Statistical methods included Student's t test for paired comparisons, ANOVA and regression analysis. Results. CBP and HBP measurements (mmHg) were obtained in 734 participants. The means of S-CBP/D-CBP with the MS were 123.5 ± 15.1/ 76.4 ± 10.4 and 122.4 ± 14.4/75.6 ± 10.0 and with the AD, 123.4 ± 16.1/73.7 ± 10.4. The average of S-HBP/D-HBP in the total sample was 115.0 ± 14.3/69.2 ± 9.0. The HBP measurements were significantly lower than CBP (p < 0.05). The mean of clinic HR was 70.3 ± 10.4. The average of home HR in the whole sample was 67.9 ± 9.7. The clinic HR and the home HR were significantly different (p < 0.05). The upper limit of normality for HBP obtained from the values that correspond on the mean +2 SD to the CBP value of 140/90 was 135/82. The 95th percentile value of the HBP in the whole sample was 131/80. The upper limit of normality for HBP obtained from the values that correspond on the regression lines in the group with CBP < 140/90 was 125/78, in the group with CBP ≥ 140/90 was 130/81 and in the total sample was 128/81. Conclusions. We consider that the upper limit of normality of home blood pressure is 130/81. Clinic heart rate is higher than home heart rate, which demonstrates a phenomenon of alerting reaction

Características clinicoanalíticas y complicaciones de pacientes con mononucleosis infecciosa derivados desde atención primaria a atención especializada / Clinical and analytic characteristics and complications in patients with infectious mononucleosis referred from primary care to specialists

No disponible

Nociones sobre la farmacoterapia en el paciente de edad / Concepts about the pharmacotherapie in the elderly

La farmacocinética de los antimicrobianos o fármacos en general se pueden ver afectados por los cambios psicológicos que se producen por la edad. Estos cambios farmacocinéticos actuan a nivel de la absorción, distribución, metabolismo y excreción de drogas y sus metabolitos (AU)

[Prevalence of smoking among adolescent students in Navarra]. / Prevalencia del tabaquismo en la población escolar adolescente de Navarra.

This paper reports the prevalence of smoking among adolescent students in Navarra, analyzing the data by sex and geographic area. A sample representative of Navarran adolescent school children between 12 and 18 years old was identified. The prevalence of smoking was measured by way of an anonymous self-administered questionnaire filled out at school. A chi 2 test and analysis of variance were performed. Three hundred students (180 girls, 51.43%; 170 boys, 48.57%) were surveyed. Mean ages were 14.35 +/- 1.82 and 14.15 +/- 1.93 years, respectively. Smoking prevalence was 35% among girls in the Foral Community of Navarra and 28.82% among the boys. The age of initiation to smoking and frequency of smoking are analyzed for the five geographic areas of the Navarra province. The prevalence of smoking is higher among girls. Children are tending to start smoking at earlier ages (primary school). No differences in smoking frequency were observed for rural and urban areas.

[Thyroglossal duct cyst with anomalous localization]. / Quiste del conducto tirogloso de localización anómala.

The cyst of thyroglossal duct (CTD) are the more frequent congenital mass of the neck, so you must consider them in the differential diagnosis of the neck's tumours. We present one case of CTD with certain clinical peculiarities.

[Adverse drug reactions: Naranjo's and Venulet's algorithms]. / Reacciones adversas medicamentosas: algoritmos de Naranjo y Venulet.

Prospective evaluation of adverse drug experiences (ADE) in patients admitted in the Respiratory Section of a General Hospital. 32 ADE's were collected (14.6%). Mean age and stay-length were longer in ADE group but with no statistical significance. Theophyllines, beta-mimetics and antibiotics were the more frequent responsibilities of ADE's. ADE's class more frequently reported was epigastralgia-nausea in 40.6%, followed by dermic disorders in 18.75%. No deaths were attributed to ADE's ans only 9 required an specific treatment. Using Naranjo's and Venulet's algorithms we have found them as non-comparable tests.

[Cognitive deterioration and dementias in an urban geriatric population]. / Deterioro cognitivo y demencias en una población geriátrica urbana.

OBJECTIVE: To find the extent of cognitive deterioration and dementias and their approximate etiology, in Pamplona's geriatric population. DESIGN: Crossover study. SITE. Pamplona's geriatric population. PATIENTS AND OTHERS PARTICIPANTS: Sample of 393 people over 64, drawn in random fashion from among the population of this age Pamplona. Ordered according to sex and age group. MAIN MEASUREMENTS AND RESULTS: The diagnostic sequence followed for the evaluation of the level of cognitive deterioration was that of Folstein's Minimental test; then the DSM-111 criteria for diagnosing dementia; and the attempt to define dementias by means of the Hachinski scale. Scores lower than 24 were observed in 24.9% of old people, reaching 82.8% in those over 84. Dementia affected 8.9% of people older than 64, and as many as 55.2% of those over 84. The aetiology of these dementias is, according to the Hachinski scale, parenchymatous in 42.8% of cases, mixed or doubtful in another 42.8% and vascular in 14.4%. Both the low educational level of those patients suffering dementia and their serious functional deterioration were notable. CONCLUSIONS: A high level of dementias exists in our elderly population. A big percentage of these are overlooked as concrete clinical phenomena, although their formal diagnosis at the Primary Care stage is relatively simple and extremely useful in order to tackle the earliest and most treatable cases.

[Epidemiology of community-acquired pneumonia in the Health Area I of Navarra]. / Epidemiología de las neumonías adquiridas en la comunidad del Area de Salud I de Navarra.

BACKGROUND: During one year (1988), a protocol study of the community-acquired pneumonias was carried out in patients referred to the Hospital Virgen del Camino in Pamplona (Health Area I or Northern Navarra), so as to have an epidemiological and microbiological knowledge of this disease in this geographic area. METHODS: A clinical protocol, microbiological investigation, 3 blood cultures, Gram stain and sputum culture and serological tests at admission and 20 days later (complement fixing antibodies and indirect immunofluorescence) were carried out. Chest radiographs were carried out on admission, on the third and seventh hospital days and subsequently depending on the evolution. RESULTS: The causative organism was found in 141 of the 225 included patients (62%). Two or more organisms were identified in 19 (8%). In 84 (38%) no microorganism was found. The results for the causative organisms and their frequency were: Pneumococcus 12%, mycoplasma 12%, other bacteria (including Legionella) 11%, Q fever 8%, viruses 7%, and psitaccosis 4%. In 59% of patients there was an underlying disease and 39% developed complications. 4% of patients died. CONCLUSIONS: 22% of the community acquired pneumonias were cared for in the hospital, representing 6% of the admissions to the Internal Medicine Service. The etiologic diagnosis was made in 62% of the community-acquired pneumonias. 23% were of bacterial origin (including Legionella) and 31% were nonbacterial. There was a high incidence of pneumonias caused by Mycoplasma pneumoniae and Coxiella burnetii.

[Community-acquired pneumonia: 573 cases]. / Neumonías de la comunidad: 573 casos.

To evaluate the epidemiology and incidence of community-acquired pneumonia (CAP) a retrospective study of 573 cases which had been diagnosed during a 3 1/2 year period was carried out. There was a male predominance (2.09/1) with mean age of 53.33 years. The diagnostic delay (days) was 1.5. The mean hospital stay was 13.39 days. The most common underlying disease was COLD (27%). 34% of patients had received previous therapy. The most common clinical features were cough, fever, and mucous sputum. The most common radiological pattern was alveolar (81%). There was increased ESR and moderately high GOT and GPT. The microbiological diagnosis was achieved in 35.4%, with positive sputum culture (mostly pneumococcus) in 26.8% an positive blood culture in 5.9%. Ten patients died (1.7%). The following factors predicted a poor prognosis: age 75 years, underlying disease, bilateral radiological involvement and leukocytosis with neutrophilia.