Homocisteína y actividad física / Homocysteine and physical activity

Introducción. Se estudia la relación entre la homocisteína y la actividad física, teniendo en cuenta la asociación con otros factores como el sexo, la edad, la vitamina B12 y el ácido fólico. Método. Muestra de 40 adultos, trabajadores del Hospital Universitario Virgen de la Victoria de Málaga. La actividad física se midió mediante podómetro y por encuesta retrospectiva. Resultados. En la muestra global, la homocisteína está relacionada inversamente con la actividad física, medida mediante podómetro, con el sexo femenino, con el ácido fólico y directamente con la edad. En el análisis multivariante, la asociación significativa permanece únicamente con el sexo. Las mujeres muestran más actividad física diaria y valores de homocisteína más bajos, que en los varones. Los datos de ejercicio físico obtenidos por encuesta no revelan ninguna asociación, aunque los varones tiene una tendencia, no significativa, a realizar más ejercicio físico estructurado. Conclusiones. A la vista de las referencias bibliográficas existentes, se comentan los resultados con la finalidad práctica de matizar las recomendaciones que se realizan a la población en el ejercicio físico con fines preventivos y promotores de salud (AU)

Introduction. We examined the relationship between homocysteine levels and physical activity, taking into account other factors such as gender, age, folic acid and vitamin B12. Methods. The sample included 40 adults, workers of the Hospital Universitario Virgen de la Victoria of Málaga (Spain). The physical activity was measured by pedometer and by retrospective questionnaire. Results. In the overall sample homocysteine is inversely related with physical activity, measured by pedometer, but not when done by a retrospective questionnaire on structured physical exercise, with the female sex and with the folic acid levels, and was directly related with the age. Multivariant step by step statistical study shows that the significany association remains only with gender. Women have higher values of homocysteine than men. The women also accomplished higher physical activity than men, when the pedometer results were calculated, but not by the results of the retrospective questionnaire. In the last case, the values were higher, but with no significant differences between sexes. Conclusions. These results suggest, according to the literature, the need for qualifying the interplay of the different existing factors when making recommendations for the population to carry out physical exercise in order to improve their health status (AU)

[Pharmacological interactions in patients treated with oral anticoagulants in a rural health area]. / Interacciones farmacológicas en pacientes tratados con anticoagulantes orales en una zona de salud rural.

OBJECTIVES: To estimate the prevalence of drugs that interact with oral anticoagulants and establish relationships between variables and haemorrhagic complications. DESIGN: Longitudinal, retrospective study of patient anticoagulant. SETTING: Colmenar basic health area, Malaga, Spain. PARTICIPANTS: Patients on anticoagulants followed up in primary care. MAIN MEASUREMENTS: Indications, time of follow-up, value of last prothrombin time (INR), complications and therapeutic groups of major use. RESULTS: The 74.2% of the patients had a prothrombin time (INR) in the therapeutic range; 16.14% had minor complications; 60.2% of the patients complied with the criteria of multiple medication and 88.2% complied with the criteria of multiple medication in the last 6 months. The drugs used with a higher capacity to interact are: anti-ulcer (26.9%), locomotor system (10.7%), cardiovascular drugs (2.2%), lipid lowering drugs (8.6%), and antidiabetics (17.2%). The number of drugs used in the last 6 months is associated with the presence of haemorrhagic complications (odds ratio [OR], 1.10). Allopurinol and pantoprazole had a significant relationship with the presence of minor haemorrhages (OR, 19.25 and 7.37, respectively). The variables associated with the presence of a haemorrhage were: allopurinol (OR, 25.84), number of controls with an INR outside the therapeutic range in the last 6 months (OR, 1.31) and time on treatment (OR, 1.07). CONCLUSIONS: The percentage of patients within the therapeutic range in the last determination of INR indicates good quality. The number of minor complications exceeded the consensus standard for the control of patients on anticoagulants. The use of drugs with a higher capacity for interacting with oral anticoagulants was very high in the anti-ulcer and antidiabetic groups. Pharmacological control of patients on anticoagulants is necessary and multiple medications should be avoided.

Control del tratamiento anticoagulante oral en atención primaria de la provincia de Málaga / Evaluation of follow-up of anticoagulant patients in primary care in the province of Malaga (Spain)

Objetivo: Evaluar el programa tratamiento anticoagulante oral (TAO) en la provincia de Málaga mediante un estudio longitudinal retrospectivo referido a los pacientes anticoagulados seguidos en centros de atención primaria de la provincia de Málaga. Pacientes y método: 735 pacientes anticoagulados seguidos en atención primaria; 140 abandonos. Mediciones principales: cobertura, duración del seguimiento, indicaciones de anticoagulación, tiempo de seguimiento, valor de la última razón normalizada internacional (INR) y complicaciones. Resultados: Edad media, 70 años; el 55,6%, mujeres. Indicaciones: fibrilación auricular, 58,4%; prótesis valvulares, 13,5%, y tromboembolia venosa, 11,3%. Media ± desviación estándar de seguimiento en atención primaria, 15,33 ± 8,46 meses. INR media = 2,5. El 75,4% tenía la INR en el intervalo terapéutico, el 14,2% estaba infratratado y el 10,4%, tratados en exceso. Complicaciones: hemorragias mayores, 0,7%; hemorragias menores, 6,8%; episodios tromboembólicos, 0,2%. Por cada semana que permanecen en rango terapéutico, disminuye el riesgo de hemorragias menores en un 4,5%. Portar prótesis valvulares multiplica por 1,7 el riesgo de estar fuera de rango. Conclusiones: La evaluación del programa provincial, de compleja elaboración, muestra resultados positivos que alientan a seguir ajustando procedimientos y obtención de datos. Se observa buen control de la anticoagulación. La proporción entre el número de casos infratratados y el de tratados en exceso indica una dosificación terapéutica ajustada. Fue necesario aumentar la frecuencia de determinaciones en el caso de prótesis valvulares porque presentó más controles fuera de rango. Se detectaron pocas complicaciones respecto a otros autores. Las trombosis fueron mínimas, en concordancia con el menor número de casos con INR por debajo de rango

Objective: To evaluate the oral anticoagulant therapy (OAT) program in the province of Málaga (Spain) by means of a longitudinal retrospective study of anticoagulant patients in primary care centers in Malaga. Patients and method: A total of 735 anticoagulant patients followed up in primary care, of which 140 were lost to follow-up. Main measurements: coverage, length of follow-up, anticoagulant indications, time of follow-up, value of last international normalized ratio (INR), and complications. Results: The mean age was 70 years; 55.6% of the patients were women. Indications for OAT were atrial fibrillation in 58.4%, valvular prosthesis in 13.5%, and venous thromboembolism in 11.3%. The mean length of follow-up in primary care was 15.33 months (SD ± 8.46). The mean INR value was 2.5. INR was within the therapeutic range in 75.4%, low in 14.2% and high in 10.4%. Complications consisted of major hemorrhage in 0.7%, minor hemorrhage in 6.8%, and thromboembolic episodes in 0.2%. For every week the patient was within the therapeutic range, the risk of minor hemorrhages was reduced by 4.5%. Having a valvular prosthesis increased the risk of INR values outside the therapeutic range by 1.7-fold. Conclusions: Evaluation of a complex provincial program shows positive results that encourage the practice of adjusting procedures and obtaining data. Good anticoagulant control was observed. The proportion of patients with INR values within the therapeutic range indicated good adjustment of dosage. Because of the number of patients with valvular prosthesis who had values outside the therapeutic range, the frequency of determinations in these patients was increased. Few complications were detected in comparison with those reported in other studies. There were few episodes of thrombosis, in agreement with the small number of patients with INR values below the therapeutic range

Interacciones farmacológicas en pacientes tratados con anticoagulantes orales en una zona de salud rural / Pharmacological interactions in patients treated with oral anticoagulants in a rural health area

Objetivos. Estimar la prevalencia de fármacos que interaccionan con los anticoagulantes orales y establecer asociaciones entre variables y complicaciones hemorrágicas. Diseño. Estudio longitudinal, retrospectivo. Emplazamiento. Zona básica de salud de Colmenar, Málaga. Participantes. Pacientes anticoagulados seguidos en atención primaria. Mediciones principales. Indicaciones, tiempo de seguimiento, valor del último INR, complicaciones y grupos terapéuticos de mayor uso. Resultados. El 74,2% de los pacientes tiene un tiempo de protrombina (INR) en el rango terapéutico. El 16,14% presenta complicaciones menores. El 60,2% de pacientes cumple criterios de polimedicación. El 88,2% cumple criterios de polimedicación en los últimos 6 meses. Los fármacos usados con mayor capacidad de interacción son: antiulcerosos (26,9%), del aparato locomotor (10,7%), fármacos cardiovasculares (2,2%), hipolipidemiantes (8,6%) y antidiabéticos (17,2%). El número de fármacos usados en los últimos 6 meses se relaciona con presencia de complicaciones hemorrágicas (odds ratio [OR] = 1,10). El alopurinol y el pantoprazol tienen una relación significativa con la presencia de hemorragias menores (OR = 19,25 y 7,37, respectivamente). Las variables relacionadas con la presencia de hemorragia fueron: alopurinol (OR = 25,84), número de controles con una INR fuera de rango en los últimos 6 meses (OR = 1,31) y tiempo de tratamiento (OR = 1,07). Conclusiones. El porcentaje de pacientes en rango terapéutico en la última determinación de INR indica una buena calidad. El número de complicaciones hemorrágicas menores supera el estándar del consenso para el control de los enfermos anticoagulados. El uso de fármacos con mayor capacidad de interacción con los anticoagulantes orales presenta valores muy altos en los grupos antiulcerosos y antidiabéticos. Es necesario realizar un control farmacológico en los pacientes anticoagulados y evitar la polimedicación

Objectives. To estimate the prevalence of drugs that interact with oral anticoagulants and establish relationships between variables and haemorrhagic complications. Design. Longitudinal, retrospective study of patient anticoagulant. Setting. Colmenar basic health area, Malaga, Spain. Participants. Patients on anticoagulants followed up in primary care. Main measurements. Indications, time of follow-up, value of last prothrombin time (INR), complications and therapeutic groups of major use. Results. The 74.2% of the patients had a prothrombin time (INR) in the therapeutic range; 16.14% had minor complications; 60.2% of the patients complied with the criteria of multiple medication and 88.2% complied with the criteria of multiple medication in the last 6 months. The drugs used with a higher capacity to interact are: anti-ulcer (26.9%), locomotor system (10.7%), cardiovascular drugs (2.2%), lipid lowering drugs (8.6%), and antidiabetics (17.2%). The number of drugs used in the last 6 months is associated with the presence of haemorrhagic complications (odds ratio [OR], 1.10). Allopurinol and pantoprazole had a significant relationship with the presence of minor haemorrhages (OR, 19.25 and 7.37, respectively). The variables associated with the presence of a haemorrhage were: allopurinol (OR, 25.84), number of controls with an INR outside the therapeutic range in the last 6 months (OR, 1.31) and time on treatment (OR, 1.07). Conclusions. The percentage of patients within the therapeutic range in the last determination of INR indicates good quality. The number of minor complications exceeded the consensus standard for the control of patients on anticoagulants. The use of drugs with a higher capacity for interacting with oral anticoagulants was very high in the anti-ulcer and antidiabetic groups. Pharmacological control of patients on anticoagulants is necessary and multiple medications should be avoided

Infección y lipoproteínas / Infection and lipoproteins

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