Documento de consenso para la formación de residentes en riesgo vascular / Consensus document for the training of residents in cardiovascular risk

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Consensus document for the training of residents in cardiovascular risk. / Documento de consenso para la formación de residentes en riesgo vascular.

Vascular disease is currently a major health problem, not only for its high prevalence but also for the considerable morbidity, mortality and disability that it entails. Medical internists play a central role in diagnosing and treating vascular disease and controlling the cardiovascular risk factors (CRFs) that cause it. In fact, the clinical care of patients in cardiovascular risk units is a specific characteristic of an internist's field of action. This article contains the consensus document for the training of residents in CRFs. This proposal by the Cardiovascular Risk Workgroup of the Spanish Society of Internal Medicine emerged as a response by our Society to the specific need for training in CRFs. Implementing this proposal would provide an important benefit, not only for medical internists in training but also for society as a whole.

Percheron artery syndrome: variability in presentation and differential diagnosis.

INTRODUCTION: Synchronous bilateral paramedian thalamic stroke (SBPTS), usually equated to Percheron artery infarction, is considered to be uncommon and difficult to diagnose clinically. Its characterization is based on the original description plus a few small series. AIM: To characterize SBPTS clinically by collecting cases and identifying the key difficulties for an early diagnosis. PATIENTS AND METHODS: Six cases at our centre plus another 115 located by systematic literature search and critical reading of articles fulfilled the criteria for SBPTS. An analysis was made of the variables age, gender, vascular risk factors, aetiology, alterations and fluctuations of consciousness, need for intubation, cognitive-behavioural disorders, pupillary changes, other neurological focal disorders and brainstem involvement on imaging studies. RESULTS: Of note in our series were disorders of consciousness (n=5), their fluctuations (n=3) and the diagnostic delay (seven days, with MRI in four patients). In only one case was a bilateral thalamic lesion seen on the initial CT. Joint analysis of all the cases showed a mean age of 61 years, a predominance of men (58%), the presence of vascular risk factors in 77%, a mainly cardioembolic aetiology (34% among those that were specified), sensory involvement in 75% (intubation in 7% and fluctuations in 16.5%), cognitive-behavioural disorders in 43%, oculomotor in 73%, pupillary in 31%, other in 67% and specified brainstem lesion in 37%. CONCLUSIONS: The SBPTS syndrome has a variable presentation with a low sensitivity on the initial CT, requiring brain MRI for typification. This explains the diagnostic difficulty and the fact that its frequency is probably underestimated.

Nuevas estrategias terapéuticas para elevar el colesterol unido a lipoproteínas de alta densidad / New therapeutic strategies to increase high-density lipoprotein cholesterol

Los marcados efectos antiaterogénicos y antioxidantes de las partículas de lipoproteínas de alta densidad (HDL) justifican la búsqueda de nuevas estrategias que mejoren no tanto los valores de colesterol unido a HDL (cHDL), sino que también promuevan un transporte reverso de colesterol más eficiente. Este capítulo revisa fármacos que han sido testados en investigación animal y que se han mostrado capaces de aumentar el eflujo de colesterol (agonistas LXR), promover la captación hepática de cHDL (inactivadores parciales de SRB1) o de incrementar la capacidad antioxidante (antiinflamatoria) de las HDL (D4F, miméticos de apo A-I). Sólo este último, junto con la perfusión de apo A-I Milano y la administración de un PPAR-α/γ (aleglitazar) han sido evaluados en humanos, mostrando resultados prometedores, lo que justifica la inversión en nuevos proyectos de investigación en este campo (AU)

The search for new strategies to improve not only HDL-cholesterol levels but also to promote more efficient reverse cholesterol transport is justified by the marked antiatherogenic and antioxidant effects of high-density lipoprotein (HDL) particles. The present article reviews the drugs tested in animal research that have been shown to be capable of increasing cholesterol efflux (LXR agonists), promoting HDL-cholesterol uptake by the liver (partial inactivators of SRB1 ) or increasing the antioxidant (antiinflammatory) capacity of HDL (D4F, apo A-I mimetics). Only the latter, together with apo A-I Milano infusion and administration of a PPARα/γ (aleglitazar) have been evaluated in humans and have shown promising results, thus justifying investment in further research in this field (AU)

[Anthropometric data on newborn infants: comparative study of two ethnic groups]. / Valores antropométricos en el recién nacido: estudio comparativo en dos grupos étnicos.

We have studied the birth weights, obstetrics data and anthropometrical data from 1.157 full-term newborns who were delivered in the Hospital del Insalud-Cruz Roja in Ceuta (Spain). Of these newborns, 489 were of arabic origin and 668 of hispanic origin. Arabic newborns were heavier (3.248 +/- 473 g versus 3.280 +/- 431 g, p < 0.001) and longer (50.2 +/- 1.8 cm versus 49.6 +/- 1.8 cm, p < 0.001) than their hispanic counterparts. These differences were not due to a disproportion in sex or gestational age between the groups. Furthermore, the differences were still present after adjustments were made for maternal age, parity and the mother's smoking habit. Thus, this difference in size at birth between arabic and hispanic newborns could be, at least in part, ethnically related.

[Effect of various levels of alcohol consumption on plasma lipoproteins and apoproteins]. / Influencia de diversos grados de consumo de alcohol sobre las lipoproteínas y apolipoproteínas plasmáticas.

To assess the abnormalities induced by alcohol on plasma lipids and lipoproteins and their possibly involved mechanisms three basis of the daily intake: social drinkers (less than or equal to 20 g/day; n = 10), moderate drinkers (greater than 20 to less than 70 g/day; n = 11), and severe drinkers (greater than or equal to 70 g/day; n = 15). Eleven nondrinkers were evaluated as control group. Very low density lipoproteins (VLDL), low density lipoproteins (LDL), high density lipoproteins (HDL)-2 and HDL-3 were isolated by preparative sequential isopicnic centrifugation, and their apolipoprotein and lipidic composition were measured. In the group of severe drinkers, a marked tendency of HDL-3 cholesterol to be higher than in the remaining groups was found. There was no correlation between this parameter and hepatic enzymes. The HDL-2 cholesterol of severe drinkers was significantly increased (p less than 0.005). The parallel enrichment in apolipoproteins C of the HDL-2 particle in all groups of alcohol users suggests a transfer phenomenon from VLDL. The apoA/C ratio of HDL-2 might be useful as a marker of alcohol intake.