Evaluation of the position of the permanent maxillary canine and its relationship to dental anomaly patterns in the paediatric patient.

AIM: To evaluate the prevalence of ectopic eruption of the permanent maxillary canine in patients 6 to 10 years of age and its relationship to other dental anomalies, age and sex of the patient. MATERIALS: Study design: Descriptive, cross-sectional, observational, and retrospective study METHODS: A total of 260 panoramic radiographs were collected from patients who had their first visit at the Paediatric Dentistry Department of the Hospital HM Nens, HM Hospitals in Barcelona from January to May 2021. The prevalence of ectopic eruption was evaluated based on the following variables: age, sex, inclination angle and mesiodistal position of the crown of the permanent maxillary canine. Additionally, the presence of other dental anomalies was recorded. The statistical analysis to evaluate the relationship between two categorical variables was carried out using the Chi-square (or Fisher) test with unrelated samples and the Mann-Whitney test with related samples. A p-value of 0.05 and a 95% reliability level were considered statistically significant. CONCLUSION: The prevalence of ectopic eruption of the permanent maxillary canine was 9.23%. In this sample, no relationship was found between patients with maxillary canine with abnormal position and inclination and the presence of other dental anomalies.

Dilatación de la aurícula izquierda en deportistas de alta competición y electrofisiología auricular / Left atrial enlargement in competitive athletes and atrial electrophysiology

Introducción y objetivos: Existe poca información sobre la dilatación de la aurícula izquierda (AI) y los parámetros electrocardiográficos en deportistas. Métodos: Estudio observacional multicéntrico en deportistas de competición y controles. La dilatación de la AI se definió como un volumen indexado por área de superficie corporal ≥ 34ml/m2. Se estudió su relación con parámetros electrocardiográficos auriculares. Resultados: Se incluyó en total a 356 sujetos: 308 deportistas de competición (media de edad, 36,4±11,6 años) y 48 controles (49,3±16,1 años). Los deportistas de competición tenían un mayor volumen medio indexado de la AI (29,8±8,6 frente a 25,6±8,0ml/m2; p=0,006) y una mayor prevalencia de dilatación de la AI (113 [36,7%] frente a 5 [10,4%]; p <0,001), sin diferencias relevantes en cuanto a la duración de la onda P (106,3±12,5 frente a 108,2±7,7 ms; p=0,31), la prevalencia de bloqueo interauricular (40 [13,0%] frente a 4 [8,3%]; p=0,36) ni la puntuación Morphology-Voltage-P-wave duration (1,8±0,84 frente a 1,5±0,8; p=0,71). El entrenamiento competitivo se asoció de manera independiente con la dilatación de la AI (OR=14,7; IC95%, 4,7-44,0; p < 0,001), pero no con la duración de la onda P (OR=1,02; IC95%, 0,99-1,04), el bloqueo interauricular (OR=1,4; IC95%, 0,7-3,1) o la puntuación Morphology-Voltage-P-wave duration (OR=1,4; IC95%, 0,9-2,2). Conclusiones: La dilatación de la AI es frecuente en deportistas de competición, pero no se acompaña de una modificación relevante en los parámetros electrocardiográficos (AU)

Introduction and objectives: There are scarce data on left atrial (LA) enlargement and electrophysiological features in athletes. Methods: Multicenter observational study in competitive athletes and controls. LA enlargement was defined as LA volume indexed to body surface area ≥ 34mL/m2. We analyzed its relationship with atrial electrocardiography parameters. Results: We included 356 participants, 308 athletes (mean age: 36.4±11.6 years) and 48 controls (mean age: 49.3±16.1 years). Compared with controls, athletes had a higher mean LA volume index (29.8±8.6 vs 25.6±8.0mL/m2, P=.006) and a higher prevalence of LA enlargement (113 [36.7%] vs 5 [10.4%], P <.001), but there were no relevant differences in P-wave duration (106.3±12.5ms vs 108.2±7.7ms; P=.31), the prevalence of interatrial block (40 [13.0%] vs 4 [8.3%]; P=.36), or morphology-voltage-P-wave duration score (1.8±0.84 vs 1.5±0.8; P=.71). Competitive training was independently associated with LA enlargement (OR, 14.7; 95%CI, 4.7-44.0; P <.001) but not with P-wave duration (OR, 1.02; 95%CI, 0.99-1.04), IAB (OR, 1.4; 95%CI, 0.7-3.1), or with morphology-voltage-P-wave duration score (OR, 1.4; 95%CI, 0.9-2.2). Conclusions: LA enlargement is common in adult competitive athletes but is not accompanied by a significant modification in electrocardiographic parameters (AU)

Prevalencia de EPOC entre la población fumadora de Colloto (Asturias) / Prevalence of COPD among the smoker population of Colloto (Asturias)

Objetivos. Conocer la prevalencia total y no conocida de EPOC en la población fumadora y ex-fumadora de 40 a 75 años en el área urbano-rural de Colloto, Asturias, y las diferencias según las distintas variables sociodemográficas. Pacientes y método. Estudio descriptivo transversal sobre 364 fumadores y ex-fumadores de ambos sexos de 40 a 75 años que acudían al consultorio de Colloto. Se realizó una historia clínica del hábito y examen físico detallados, y un estudio espirométrico completo para el diagnóstico y estadiaje. Resultados. La prevalencia de EPOC fue del 15,1% (IC 95% 11,7-19,4), sin diferencias entre sexos. Los factores asociados fueron la edad (pasando del 8,1 al 24,8% del primer al tercer terciles de edad) y el índice tabáquico (pasando del 8,4 al 24,8% del primer al tercer terciles del mismo), y como factor protector el índice de masa corporal. El hábito actual de consumo de tabaco no presentaba diferencias. El 48% de los diagnosticados por espirometría fueron nuevos diagnósticos. De los diagnosticados previamente de EPOC, en el 52% no se confirma el diagnóstico en la espirometría. El 14,8% de los EPOC se clasificaron como grave o muy grave. Conclusiones. La prevalencia obtenida es similar a la de otros estudios, siendo la mitad de los casos desconocidos. Deben estudiarse espirométricamente de rutina todos los fumadores, al menos desde 15 paquetesaño a partir de los 40 años, y en todos los pacientes que hayan sido fumadores a partir de los 65 años (AU)

Objectives. To know the total and unknown prevalence of COPD in the smoker and ex-smoker population of 40 to 75 years in the urban -rural area of Colloto, Asturias, and the differences according to the different sociodemographic variables. Patients and method. A descriptive cross-sectional study on 364 smokers and ex-smokers of both genders, 40 to 75 years old, who came to the medical facility of Colloto. A detailed clinical history on the habit and physical examination was obtained, as well as a complete spirometric study for the diagnosis and staging. Results. COPD prevalence was 15.1% (95% CI 11.7- 19.4), without differences between genders. Associated factors were age (going from 8.1 to 24.8% from its first to third terciles of age) and the smoking habit index (going from 8.4 to 24.8% from its first to the third terciles) and as protective factor, the body mass index. The current smoking consumption habit showed no differences. A total of 48% of those diagnosed by spirometry were new diagnoses. Of those previously diagnosed of COPD, the diagnosis was not confirmed in the spirometry in 52% and 14.8% of the COPD were classified as severe or very severe. Conclusions. The prevalence obtained is similar to that of other studies, half of the cases being unknown. All smokers should undergo routine spirometric studies, at least those smoking from 15 packs a year after the age of 40 and in all of those patients who have been smokers after the age of 65 (AU)

[Identification of individuals with insulin resistance by means of clinical measurements and routine biochemical markers. Construction of an individual risk index]. / Identificación de individuos con resistencia a la insulina mediante mediciones clínicas y marcadores bioquímicos de rutina. Construcción de un índice de riesgo individual.

INTRODUCTION: This study aimed to know the markers and routine biochemical measures that are associated to the insulin resistance (IR) and to develop an index of individual IR risk from them. SUBJECTS AND METHODS: Cross-sectional study made in Primary Health Care population of both genders between 40 and 74 years (n = 2,143). A representative sample was obtained by simple random sampling of 305 patients after excluding the diabetic subjects. Sociodemographic variables, background, examinations, routine analyses as well as fasting insulin levels were obtained. IR was considered if HOMA was higher than 2.9. A step by step logistic regression was done to obtain the best variables to predict IR. A logistic equation, categorical scale and simple additive scale from the beta coefficients was then constructed and was compared with other instruments designed to predict IR. RESULTS: IR prevalence was 25.2%. There were no differences between genders or by age. The four variables that entered the model were fasting plasma glucose, BMI, HDL cholesterol and diastolic blood pressure. The logistic model had good adjustment. The logistic equation was: IR = 1/ 1 + exp (-[-21.011) - [0.119 * fasting plasma glucose] - [0.231 * BMI] - [-0.046 * HDL cholesterol] - [0.048 * diastolic blood pressure]). The scale constructed assesses each subject between -1 and 7 points; cutoff to predict IR was established at 3.5 points, obtaining a sensitivity and specificity similar to the McAuley index and better than the triglycerides/HDL cholesterol ratio, the first model of Stern and the diagnosis of metabolic syndrome according to ATP-III. DISCUSSION: A very easy-to-use instrument has been obtained to predict IR by means of exploratory measures and routine biochemical measures, which makes it possible to select the patients at the greatest risk in order to intensify preventive actions in them.

[Retinopathy of prematurity in the XXI century in a developing country: an emergency that should be resolved]. / La retinopatía del prematuro en el siglo XXI en un país en desarrollo: una urgencia que debe ser resuelta.

INTRODUCTION: Retinopathy of prematurity (ROP) is the first cause of childhood blindness in Argentina and is reaching epidemic proportions. To gain greater insight into the issues involved in this epidemic, we analyzed the characteristics of the infants referred for treatment of very severe ROP to the Dr. Juan P. Garrahan Pediatric Hospital, located in the city of Buenos Aires. METHODS: We performed a retrospective study of patients referred for ROP from 01/01/96 to 12/31/03. Very severe ROP was defined as threshold disease or worse in both eyes, plus disease in zones 1 or 2, or Rush disease. Unusual patients were defined as those with very severe ROP with a gestational age (GA) of > 31 weeks or birth weight (BW) > 1500 g. Patients were divided into two groups according to the distance between the referring center and our hospital: group A consisted of those from nearby areas ( 70 km from the hospital. RESULTS: During the study period, the number of cases progressively increased while the proportion of "unusual" patients slightly decreased. The total number of infants referred was 809 and 14 % were unusual patients; 55 % had very severe ROP, 89 % were treated, and 7 % were referred too late and lost the opportunity for treatment. Group B comprised 61 % of the infants referred. Very severe ROP was present in 53 % of patients in group A and in 56 % of those in group B. The mean GA was 29.5 +/- 3.1 weeks in group A and 30.8 +/- 2.6 in group B (p < 0.001); 90.5 % of the patients in group A and 64 % of those in group B required mechanical ventilation (p < 0.001). No predictors for very severe ROP were found in multifactorial analysis. CONCLUSIONS: We report a childhood epidemic of blindness in which the prevalence of very severe ROP increased during the study period and the disease occurred in large, fairly mature newborns. The differences found in relation to the referring center and the lack of correlation between very severe ROP and prematurity or the use of mechanical ventilation suggests substantial disparity in healthcare, which should be taken into account when planning prevention strategies.

La retinopatía del prematuro en el siglo XXI en un país en desarrollo: una urgencia que debe ser resuelta / Retinopathy of prematurity in the XXI century in a developing country: an emergency that should be resolved

Introducción: La retinopatía del prematuro (RdP) es la primera causa de ceguera infantil en Argentina, de alcances epidémicos. Con el objetivo de mejorar el conocimiento de factores involucrados en esta epidemia, analizamos las características de los niños derivados para tratamiento de RdP severa al Hospital de Pediatría Juan P. Garrahan, ubicado en la ciudad de Buenos Aires. Métodos: Revisión retrospectiva de pacientes admitidos por RdP entre el 1 de enero de 1996 y el 31 de diciembre de 2003. RdP severa = enfermedad umbral en ambos ojos o peor, enfermedad plus en zona 1 o 2, o enfermedad de Rush. Pacientes “inusuales” son definidos aquéllos con RdP grave y edad gestacional (EG) > 31 semanas o peso al nacer (PN) > 1.500 g. Los pacientes se dividieron en 2 grupos según distancia de procedencia en relación a nuestro hospital: grupo A de procedencia cercana (≤ 70 km) y grupo B amás de 70 km. Resultados: Durante el período de estudio hubo un aumento progresivo del número de casos, con escasa reducción de casos “inusuales”. El total de niños referidos fue de 809, con 14% de casos “inusuales”; 55 % presentó formas severas, 89% recibió tratamiento y 7% perdió oportunidad por derivación tardía. El 61 % perteneció al grupo B; la incidencia de RdP severa fue de 53 % en A y 56 % en B. La media de EG fue 29,5 +/- 3,1 semanas en el grupo A y de 30,8 +/- 2,6 en el B (p < 0,001); 90,5 % en A y 64 % en B requirió asistencia ventilatoria mecánica (p < 0,001). No se encontraron factores predictivos de RdP grave en el análisis multivariable. Conclusiones: En esta epidemia de ceguera durante la niñez, la prevalencia de formas severas de RdP aumentó durante los años del estudio y la enfermedad ocurre aún en prematuros cercanos al término. Las diferencias según el lugar de procedencia y la falta de asociación de RdP grave con inmadurez o uso de ventilación mecánica, sugieren una importante disparidad en los cuidados de salud que debería tomarse en cuenta al planificar estrategias de prevención

Introduction Retinopathy of prematurity (ROP) is the first cause of childhood blindness in Argentina and is reaching epidemic proportions. To gain greater insight into the issues involved in this epidemic, we analyzed the characteristics of the infants referred for treatment of very severe ROP to the Dr. Juan P. Garrahan Pediatric Hospital, located in the city of Buenos Aires. Methods We performed a retrospective study of patients referred for ROP from 01/01/96 to 12/31/03. Very severe ROP was defined as threshold disease or worse in both eyes, plus disease in zones 1 or 2, or Rush disease. Unusual patients were defined as those with very severe ROP with a gestational age (GA) of > 31 weeks or birth weight (BW) > 1500 g. Patients were divided into two groups according to the distance between the referring center and our hospital: group A consisted of those from nearby areas (≤ 70 km) and group B comprised those from areas > 70 km from the hospital. Results During the study period, the number of cases progressively increased while the proportion of “unusual” patients slightly decreased. The total number of infants referred was 809 and 14 % were unusual patients; 55 % had very severe ROP, 89% were treated, and 7% were referred too late and lost the opportunity for treatment. Group B comprised 61 % of the infants referred. Very severe ROP was present in 53 % of patients in group A and in 56 % of those in group B. The mean GA was 29.5 +/- 3.1 weeks in group A and 30.8 +/- 2.6 in group B (p < 0.001); 90.5% of the patients in group A and 64 % of those in group B required mechanical ventilation (p < 0.001). No predictors for very severe ROP were found in multifactorial analysis. Conclusions We report a childhood epidemic of blindness in which the prevalence of very severe ROP increased during the study period and the disease occurred in large, fairly mature newborns. The differences found in relation to the referring center and the lack of correlation between very severe ROP and prematurity or the use of mechanical ventilation suggests substantial disparity in healthcare, which should be taken into account when planning prevention strategies

Identificación de individuos con resistencia a la insulina mediante mediciones clínicas y marcadores bioquímicos de rutina. Construcción de un índice de riesgo individual / Identification of individuals with insulin resistance by means of clinical measurements and routine biochemical markers. Construction of an individual risk index

Introducción. El objetivo del estudio fue conocer los marcadores bioquímicos y las medidas clínicas de rutina que se asocian a la resistencia a la insulina (RI), y desarrollar a partir de ellos un índice de riesgo individual de RI. Sujetos y métodos. Estudio transversal sobre población general de ambos sexos entre 40 y 70 años (n = 2.143); se obtuvo una muestra aleatoria simple de 305 pacientes tras excluir a los diabéticos. Se recogieron variables sociodemográficas, antecedentes, exploración y analítica de rutina más insulinemia. Se consideró RI un HOMA (homeostasis model assessment) ≥ 2,9. Se practicó una regresión logística por pasos hacia adelante para obtener las mejores variables para predecir la RI, posteriormente se construyó una ecuación logística, una escala categórica y una escala aditiva simple a partir de los coeficientes beta, y se comparó ésta con otros instrumentos diseñados para predecir la RI. Resultados. La prevalencia de RI fue del 25,2%. No hubo diferencias por sexos ni por edad. Las variables que entraron en el modelo fueron: glucemia, índice de masa corporal (IMC), colesterol ligado a lipoproteínas de alta densidad (c-HDL) y presión arterial diastólica (PAD). El modelo logístico presentó un buen ajuste. La ecuación logística fue: probabilidad de RI = 1/ 1 + exp (-[-21,011] ­ [0,119 * glucemia] ­ [0,231 * IMC] ­ [-0,046 * c-HDL] ­ [0,048 * PAD]. La escala construida valora a cada sujeto entre -1 y 7 puntos; el punto de corte para predecir la RI se estableció en > 3,5 puntos, obteniéndose una sensibilidad y especificidad similares al índice de McAuley y mejores que la razón triglicéridos/c-HDL, el modelo de Stern y el diagnóstico de síndrome metabólico (SM) según el Adult Treatment Panel III (ATP-III). Discusión. Se ha obtenido un instrumento de gran sencillez de uso para predecir la RI mediante la exploración y analítica de rutina, que permite seleccionar a los pacientes de mayor riesgo para intensificar intervenciones preventiva (AU)

Introduction. This study aimed to know the markers and routine biochemical measures that are associated to the insulin resistance (IR) and to develop an index of individual IR risk from them. Subjects and methods. Cross-sectional study made in Primary Health Care population of both genders between 40 and 74 years (n = 2,143). A representative sample was obtained by simple random sampling of 305 patients after excluding the diabetic subjects. Sociodemographic variables, background, examinations, routine analyses as well as fasting insulin levels were obtained. IR was considered if HOMA was higher than 2.9. A step by step logistic regression was done to obtain the best variables to predict IR. A logistic equation, categorical scale and simple additive scale from the beta coefficients was then constructed and was compared with other instruments designed to predict IR. Results. IR prevalence was 25.2%. There were no differences between genders or by age. The four variables that entered the model were fasting plasma glucose, BMI, HDL cholesterol and diastolic blood pressure. The logistic model had good adjustment. The logistic equation was: IR = 1/ 1 + exp (-[-21.011) ­ [0.119 * fasting plasma glucose] ­ [0.231 * BMI] ­ [-0.046 * HDL cholesterol] ­ [0.048 * diastolic blood pressure]). The scale constructed assesses each subject between -1 and 7 points; cutoff to predict IR was established at 3.5 points, obtaining a sensitivity and specificity similar to the McAuley index and better than the triglycerides/HDL cholesterol ratio, the first model of Stern and the diagnosis of metabolic syndrome according to ATP-III. Discussion. A very easy-to-use instrument has been obtained to predict IR by means of exploratory measures and routine biochemical measures, which makes it possible to select the patients at the greatest risk in order to intensify preventive actions in them (AU)

Prevalencia de tabaquismo en una población general y valoración de la actitud ante el cambio. ¿Están preparados nuestros pacientes para abandonar el hábito? / Prevalence of smoking in a general population and evaluation of patient attitude prior to stopping. Are our patients prepared to stop smoking?

Introducción y objetivos. El modelo teórico de los Estadios del Cambio permite entender los cambios en el grado de disposición del paciente ante un hipotético intento de abandono del tabaquismo. El objetivo del presente trabajo ha sido estudiar la prevalencia del tabaquismo, la dependencia del tabaco y los intentos del abandono del hábito, estudiar la asociación con la historia de tabaquismo en los padres, estudiar a los fumadores en función de la fase de abandono en que se encuentran y conocer si los afectados por enfermedades relacionadas con el tabaco son más proclives al abandono. Pacientes y métodos. Estudio descriptivo transversal en la población mayor de 14 años perteneciente al Consultorio de Colloto (Asturias). Se calculó una muestra de 415 personas, que se seleccionaron de forma aleatoria simple. Los datos se obtuvieron mediante encuesta. Para el análisis estadístico de los datos se utilizó el programa Epi Info (v. 6.04b). Resultados. Se evaluó a 402 individuos, un 51,7% mujeres. La prevalencia de fumadores actuales es del 29,9% (25,5-34,6%); son ex fumadores el 19,1% (15,5-23,4%) y nunca ha fumado el 51,0% (46,0-56,0%). Hay diferencias muy significativas entre sexos en el grupo de más de 64 años. De los que han sido fumadores, el 39,1% (32,3-46,3%) ha dejado el hábito. El abandono del tabaco se incrementa con la edad. Cuando los padres han sido fumadores los sujetos tienen 2 veces más posibilidades de serlo. Sólo el 13% de los fumadores tienen elevada dependencia. Se encuentra en la fase precontemplativa el 46,6% (37,5-55,0%), en la contemplativa el 40,7% (31,8-50,1%), y en la de preparación el 12,7% (7,5-20,4%). Aquellos que estaban en fase precontemplativa presentaban un grado de dependencia (índice de Fageström), una media de cigarrillos/día y de paquetes/año más altos que el resto. El 50,8% de los fumadores han intentado abandonar el tabaco. En los pacientes con enfermedades crónicas relacionadas con el tabaquismo o factores de riesgo vascular el abandono del hábito tabáquico ha sido mayor que en los que no presentaban ninguna enfermedad. Conclusiones. Se sugiere la existencia de un descenso en el número de consumidores activos. No obstante, en los más jóvenes el número de mujeres fumadoras se equipara al de varones. La distribución de los fumadores en función del modelo de los Estadios del Cambio revela un elevado número de pacientes en las fases donde es previsible una mayor eficacia de la intervención. Es notable el grado de abandono existente en pacientes con factores de riesgo cardiovascular y en aquéllos con enfermedad vascular ya presente (AU)

Introduction and objectives. The theoretical model of the Stages of Change allows us to understand changes in the degree of a patient's willingness in a hypothetical attempt to quit smoking. The aims of this study were to assess the prevalence of smoking, dependence and attempts to stop; study the link with a history of smoking by parents, classify smokers by the degree of desire to stop smoking and to ascertain whether those with smoking-related disesaes are more inclined to quit smoking. Patients and methods. Cross-sectional, descriptive study in the population aged 14 and over in Colloto (a primary care center in Asturias, Spain). The study was focused on a simple, random sample of 415 persons. Data were obtained by means of a survey. The epi-info 6.04b was used for statistical analysis. Results. A sample of 402 patients were evaluated; 51.7% were female. The prevalence of current smokers was 29.9% (25.5-34.6%); 19.1% (15.5-23.4%) had stopped smoking and 51.0% (46.0-56.0%) had never been smokers. Marked differences were observed between sexes in the over-64 age group. Among smokers, 39.1% (32.3-46.3%) had stopped. Quitting had increased with age. When parents had been smokers, the chance of their offspring also being smokers had doubled. Only 13% of smokers had high dependence. 46.6% (37.5-55.0%) were in the "precontemplative" stage, 40.7% (31.8-50.1%) in the contemplative stage and 12.7% (7.5-20.4%) in the readiness stage. Those in the precontemplative stage presented a Fageström score, a number of cigarettes-daily and packs per year consumption higher than the rest. The 50.8% of smokers had made attempts to stop. In patients with chronic tobacco-related illnesses and those at risk for vascular disease, stopping smoking was more prevalent than in those with no such symptoms. Conclusions. A decline in the number of active smokers is suggested; however, in the younger population the number of females approaches that of males. The distribution of smokers according to the Stages of Change model reveals a large number of patients in phases where there should be a high probability of intervention effectiveness. The degree of quitting in patients with higher cardiovascular risk and those who already have vascular diseases is noteworthy (AU)

PROCAM y Framingham por categorías: ¿miden igual riesgo? / PROCAM and Framinghan using risk factors categories: does it mesure the same risk?

Objetivo: comparar dos métodos de cálculo de riesgo cardiovascular, PROCAM y Framingham por categorías (eventos duros), en varones entre 45-65 años. Material y métodos: estudio descriptivo transversal. Ámbito del estudio: Atención Primaria. La población a estudio fueron todos los varones de 4565 años de cuatro cupos de Medicina General de tres Centros de Salud, sin enfermedad cardiovascular establecida (n=402). Las variables fueron : edad, diabetes mellitus, tabaquismo, antecedentes familiares de enfermedad coronaria precoz, presión arterial sistólica y diastólica, colesterol total, LDL - colesterol, HDL-colesterol, triglicéridos. El periodo de estudio fue del 1 de enero a 31 de diciembre de 1999. Para comparar ambos métodos calculamos el coeficiente de correlación de Pearson, coeficiente de correlación intraclase (CCI) y se hizo la representación gráfica usando el modelo de Bland y Altman. Resultados: la media de riesgo al utilizar PROCAM es de 8,56 ñ 9,3 per cent, frente a 10,85 ñ 6,8 per cent del Framingham por categorías; el coeficiente de correlación de Pearson es de 0,859 (p< 0,001),el CCI fue de 0,778 (p< 0,001). La diferencia media PROCAM-Framingham ha sido de -2,2 per cent ñ 4,9 p< 0,001. Conclusiones: a pesar de tener coeficientes de correlación superiores a 0,75 y que la media de las diferencias es de sólo 2,2 per cent, existe una gran variabilidad en las diferencias individuales a medida que el riesgo aumenta. Para riesgos bajos, PROCAM infravalorada el riesgo, mientras que lo supravalora para riesgos altos, comparando con Framingham por categorías (AU)

High density lipoprotein cholesterol increases with living altitude.

BACKGROUND: The relationship between high density lipoprotein cholesterol (HDL) serum level and the altitude at which people live is controversial. METHODS: A cross-sectional study was carried out in the adult population (30-64 years) of the Island of El Hierro (Canary Islands, Spain). In all, 594 individuals representative of the El Hierro population for gender, age, district and the altitude at which they lived were included. The factors measured included HDL, living altitude, body mass index (BMI), smoking habits, alcohol consumption, diabetes, menopause in women, and physical activity and dietary habits. RESULTS: The HDL showed a correlation with living altitude (r = 0.14, P < 0.01) and with BMI (r = -0.19, P < 0.01). Smokers had lower HDL levels than ex-smokers and non-smokers (P < 0.05). Men who were moderate drinkers had higher HDL levels than heavy or mild drinkers and non-drinkers (P < 0.01). Physical activity was only related to HDL in men with levels >1.52 mmol/l, who walked on the average more than the rest (P < 0.05). Variables not showing the expected relationship with HDL were diabetes and the menopause in women (probably due to a low statistical power of their subsamples). Regression analysis, with HDL as dependent variable showed that the association between HDL and altitude persists when taking altitude as a categorical or a continuous variable. CONCLUSIONS: High density lipoprotein cholesterol levels are linearly and significantly increased when living at a higher altitude. This fact should be taken into account when comparing cardiovascular risk in populations living at different altitudes.

Carcinomas mamarios. Anatomia patologica. / Breast carcinomas. Anatomo-pathology

Es importante que el patologo realice un estudio completo y que el clinico sepa interpretar el informe entregado para establecer un prognostico y un tratamiento correcto. Anatomopatologicamente se estudian las caracteristicas del tumor en cuanto a tamano, margen tumoral, infiltracion de piel y/o planos profundos, tipo histologico, grado de diferenciacion, invasion de vasos sanguineos o linfaticos e infiltracion linfocitica peritumoral. El analisis de los ganglios debe considerar el numero total de comprometidos en relacion al numero total de estudiados, el tamano macro o microscopico de la metastasis la localizacion y la existencia de invasion mas alta de la capsula.El estudio del resto de la mama y la presencia de otros focos tumorales o la patologia benigna asociada completan el examen.Se describe la clasificacion histopatologica de los canceres de mama y una relacion entre el tipo histologico y el pronostico