Evaluation of the technique used by health-care workers for taking blood pressure.

The precise guidelines recommended by the American Heart Association for blood pressure measurement are commonly overlooked by health-care workers, who generally take blood pressure in an arbitrary way. To validate this observation we designed a descriptive and observational study to be carried out in a major hospital. One hundred and seventy-two health-care workers divided into four groups (63 general practitioners, 25 clinical and 25 surgical specialists, and 59 nurses) were evaluated in a two-part test. In the first part (practical), the examinee had to follow all the steps recommended by the American Heart Association to get a passing score. In the second part (theoretical, which came second to avoid influencing the practical), the examinee had to answer correctly 7 of 10 questions based on the American Heart Association's guidelines to obtain a passing score. The highest accepted variation in systolic and diastolic pressures between examinee and observer was +/- 4 mm Hg. None of the examinees followed the American Heart Association's recommendations. Sixty-three percent of systolic and 53% of diastolic readings were out of range. Surgical specialists obtained the best practical results (48% systolic and 64% diastolic within range), and nurses obtained the lowest values (29% and 39%, respectively; P = .03 versus surgical specialists). These two groups showed deficiencies in the theoretical test (nurses, 10% correct answers and surgical specialists, 16%). Clinical specialists obtained the best results on the theoretical test (60% correct; P < .05 versus the other groups) but were deficient in the practical test (32% systolic and 60% diastolic within range).(ABSTRACT TRUNCATED AT 250 WORDS)

[Social marketing applied to condom promotion: a proposal for intervention in groups at risk for sexually transmitted diseases]. / El marketing social aplicado a la promoción del condón: una propuesta de intervención sobre grupos en riesgo de enfermedades de transmisión sexual.

Sexually transmitted diseases (STDs) are an important worldwide health problem. Their association with AIDS an other insidious viral processes have brought them to the foreground of sanitary authorities and general population concern. Often, health services have to struggle with reinfections, which concentrate in pockets of risk that consume large amount of care and constitute an important link in the transmission of these diseases. General publicity have little impact among high risk groups. Thus, it becomes necessary to be more precise and divide into segments the target population we want to reach. Prevention of reinfection in these communities requires the implementation of healthy behaviours through the promotion of a tangible product (condom). Regarding these considerations, social marketing emerges as the right instrument to be used. Through individual focused interviews with prostitutes, homosexual and young promiscuous heterosexual patients from a STDs Prevention, Diagnosis and Treatment Centre, determining factors of the use condoms and related behaviour guidelines have been identified. Also, a social marketing strategy is suggested to prevent these diseases among groups at risk by means of condom promotion.

Regulación de líquidos y electrolitos por el riñón trasplantado / Fluid and electrolytes regulation by the transplnated kidney

Se hace una revision y actualizacion del comportamiento fisiologico del riñon trasplantado en relacion con el agua y los principales electrolitos. Son multiples los factores que afectan esta regulacion, principalmente las drogas inmunosupresoras y en especial la ciclosporina A (CyA). Sin embargo, con base en experimentacion con animales libres de influencias secundarias, se llega a la conclusion de que el riñon trasplantado, una vez superado el periodo inmediato que se manifiesta con poliuria, regula eficientemente el agua, el sodio y el potasio y continua concentrando y diluyendo adecuadamente. La duracion de la isquemia renal en frio se correlaciona positivamente con una disfuncion en la regulacion. La fraccion excretada de sodio (FENa) < 1 por ciento tiene un valor pronostico y diagnostico en el rechazo agudo, aun antes de que se produzcan aumentos en las cifras de creatinina. La hipercalcemia y la hipofosfatemia son de duración media y de grado leve y se relacionan con hiperparatiroidismo secundario, aunque hay fugas tubulares de ambos electrolitos. La CyA puede producir hipercalemia, hiperuricemia y contribuir al desarrollo de acidosis hipercloremica.

Sindrome hipereosinofilico idiopatico de 27 anos de evolucion / Idiopatic hypereosinophilic syndrome of 27 years of evolution

Se presenta el caso de una paciente de 53 anos con un sindrome hipereosinofilico de 27 anos de evolucion, con manifestaciones basicamente del sistema digestivo, como oclusion y pseudooclusion intestinales y ascitis. En los primeros anos fue sometida a varias intervenciones quirurgicas y se le prescribrieron esteroides, obteniendose buena respuesta. Este caso contrasta, por su larga evolucion, con lo descrito hasta ahora en la literatura.