Resistencia a la insulina, síndrome metabólico y metabolismo de la glucosa en pacientes con hipertensión arterial esencial / Insulin resistance, metabolic syndrome and glucose metabolism in patients with essential arterial hypertension

Objetivo: La hipertensión arterial esencial es un trastorno asociado a la resistencia a la insulina (RI), al síndrome metabólico (SM) y a las alteraciones del metabolismo glucídico. Se evalúa su prevalencia en una población de pacientes hipertensos esenciales. Material y métodos: Estudio transversal sobre 204 pacientes hipertensos no diabéticos conocidos que acudieron a la Unidad de Hipertensión o de Medicina Interna, en el Hospital Clínico Universitario de Valladolid. Se determinaron datos antropométricos, concentraciones plasmáticas de lípidos, glucemia e insulina basal y a los 120 minutos tras la sobrecarga oral de glucosa con 75 g de glucosa. Se consideró RI cuando el índice de HOMA (homeostasis model assessment) fue ≥ 3,8. Se utilizaron los criterios de la Federación Internacional de Diabetes para el diagnóstico del SM y los de la Asociación Americana de Diabetes para el de las alteraciones de la glucosa. Resultados: La edad fue de 58,28 ± 9,86 años, siendo el 43,6% hombres. Presentaron un índice de masa corporal de 29,79 ± 3,55 kg/m2 y una circunferencia de cintura de 92,76 ± 11,92 cm. El 15,2% fue diagnosticado de RI, el 6,4% de alteración de la glucosa en ayunas, el 29,4% de intolerancia a la glucosa y el 14,7% de diabetes mellitus. El 34,3% tenían un metabolismo de la glucosa normal. El 19,1% fueron diagnosticados de SM. El 10,3% presentaron hipertrofia ventricular izquierda. No hubo diferencias significativas en cuanto al sexo salvo en los niveles de lipoproteínas de alta densidad y en el perímetro de la circunferencia, más elevados en la mujer (p < 0,001). Conclusiones: La RI, el SM y las alteraciones de la glucosa son muy frecuentes en la hipertensión arterial, lo que aumenta el riego para las enfermedades cardiovasculares(AU)

Objectives: Essential hypertension is a disorder associated to insulin resistance (IR), metabolic syndrome (MS), and glucose metabolism disorders. Its prevalence in a population of essential hypertensive patients is evaluated. Material and methods: This is a cross-sectional study on 204 hypertensive patients, with no known diabetes, who came to the hypertension unit or internal medicine service in the University Clinic Hospital of Valladolid (Spain). Anthropometrics parameters, fasting lipid profile, glycemia and basal insulin were measured at enrolment and at 120 minutes after a standard oral glucose tolerance test. IR was considered to exist when the HOMA index (homeostasis model assessment) ≥ 3.8. International Diabetes Federation criteria were used to diagnose MS and American Diabetes Association criteria to diagnose glucose disorders. Results: Patients were aged 58.28 ± 9.86 years old, with 43.6% men. Body masss index was 29.79 ± 3.55 kg/m2 and abdominal perimeter was 92.76 ± 11.92 cm. IR was observed in 15.2% of the patients, glucose disorders in 6.4%, glucose intolerance in 29.4% and 14.7% patients suffered from silent diabetes. Only 34.3% had normal glucose metabolism. 19.1% were diagnosed of MS and 10.3% had ventricular hypertrophy. There were no differences between genders and the rest of variables studied, except high density lipoproteins levels and abdominal perimeter, were higher in women (p < 0.001). Conclusions: IR, MS and glucose metabolism disorders are very frequent in essential hypertension, which increases the risk of cardiovascular diseases(AU)

Anemia ferropénica crónica en paciente joven / No disponible

No disponible

[Clinical and therapeutic characteristics in patients with heart failure cared for in an internal medicine department]. / Características clínicas y terapeúticas de los pacientes ingresados en un Servicio de Medicina Interna por insuficiencia cardiaca.

INTRODUCTION: The Heart Failure (HF) is a very common clinic syndrome in the clinical practise, and a great sanitary social problem. In Spain, it is the main cause of hospitalization in Internal Medicine Services in patients over 65 years old, due to its high comorbidity, in many cases. OBJECTIVE: To determine the profile of admitted patients with HF to an Internal Medicine Service. MATERIAL AND METHODS: It is a retrospective and descriptive study. The following variables were analysed: sex, age, cause of admission, aetiology, risk factors, Framingham diagnostic criteria, type of HF, treatment-on-released, average stay, number of readmissions and the type of ventricular dysfunction (echocardiography). Chi-square test of Pearson or Fisher test were used as statistical methods. P < 0.05 was considered to be statistically relevant. RESULTS: 104 patients were analysed. The percentage of HF was 13.76%. 52.88% were men with an average age of 72.16 +/- 17.78 year. Average age for women was 82.92 +/- 7.24 year. The main cause of admission was dysnea (74%). Hypertension was the principal risk factor (70.13%). When it comes to aetiology, HTA (68.57%) was the main one. Global and left HF (33.65% either) were the most common type of HF. 5.17% of women and 20.69% of men suffered from systolic dysfunction (p < 0.023). 32.76% of women and 41.38% of men had diastolic dysfunction. The base treatment-on-release for the majority of patients consisted of diuretics and digoxin. Patients stayed 15.49 days on average, and the number of readmitted ones came up to 26.67%. CONCLUSIONS: The diagnosis and treatment of HF in an Internal Medicine Service is acceptable. It will be very important to promote the use of beta blockers and angiotensina-converting enzyme inhibitors.

Características clínicas y terapeúticas de los pacientes ingresados en un Servicio de Medicina Interna por insuficiencia cardiaca / Clinical and therapeutic characteristics in patients with heart failure cared in an Internal Medicine department

Introducción: La insuficiencia cardiaca (IC) es un síndrome muy frecuente en la práctica clínica y de gran importancia socio sanitaria. En España constituye, en pacientes mayores de 65 años, la primera causa de ingreso hospitalario en los Servicios de Medicina Interna (MI). Objetivo: determinar el perfil de los pacientes ingresados en un servicio de MI por IC. Material y métodos: Se trata de un estudio retrospectivo descriptivo. Se analizaron las siguientes variables: sexo, edad, motivo del ingreso, etiología, factores de riesgo asociados, cumplimiento de los criterios diagnósticos de Framingham, tipo de IC, tratamiento al alta, estancia media, número de reingreso y el tipo de disfunción ventricular (ecocardiografía). Método estadístico, el test Chi-cuadrado de Pearson o el test exacto de Fisher. Aquellos valores de p < 0,05 han sido considerados estadísticamente significativos. Resultados: Se analizaron un total de 104 pacientes. El porcentaje con IC, fue del 13,76%. El 52,88% fueron hombres, con una edad media de 82,92 ± 7,24 años para las mujeres y 72,16 ± 17,78 años para los hombres. Motivo principal de ingreso: disnea (74%). Factores de riesgo asociados: la HTA como más prevalente (70,13%). En cuanto a la etiología el primer lugar lo ocupa la HTA con el 68,57%. Los tipos de IC más frecuente fueron la global (33,65%) y la izquierda (33,65%). El 5,17% de las mujeres y el 20,69% de los hombres presentaron disfunción sistólica (p 0,023). Presentaban disfunción diastólica el 32,76% de las mujeres y el 41,38% de los hombres. Al alta la mayoría de los pacientes recibieron como tratamiento de fondo diuréticos y digitálicos. La estancia media fue de 15,49 días y los reingresos alcanzaron el 26,67% . Conclusión: El diagnóstico y el tratamiento de la IC en el servicio de MI es aceptable. Sería importante potenciar el uso de betabloqueantes e inhibidores de la aldosterona

Introduction: The Heart Failure (HF) is a very common clinic syndrome in the clinical practise, and a great sanitary social problem. In Spain, it is the main cause of hospitalization in Internal Medicine Services in patients over 65 years old, due to its high comorbidity, in many cases. Objective: To determine the profile of admitted patients with HF to an Internal Medicine Service. Material and methods: It is a retrospective and descriptive study. The following variables were analysed: sex, age, cause of admission, aetiology, risk factors, Framingham diagnostic criteria, type of HF, treatmenton- released, average stay, number of readmissions and the type of ventricular dysfunction (echocardiography). Chi-square test of Pearson or Fisher test were used as statistical methods. P < 0.05 was considered to be statistically relevant. Results: 104 patients were analysed. The percentage of HF was 13.76%. 52.88% were men with an average age of 72.16 ± 17.78 year. Average age for women was 82.92 ±7.24 year. The main cause of admission was dysnea (74%). Hypertension was the principal risk factor (70.13%). When it comes to aetiology, HTA (68.57%) was the main one. Global and left HF (33.65% either) were the most common type of HF. 5.17% of women and 20.69% of men suffered from systolic dysfunction (p < 0.023). 32.76% of women and 41.38% of men had diastolic dysfunction. The base treatment-on-release for the majority of patients consisted of diuretics and digoxin. Patients stayed 15.49 days on average, and the number of readmitted ones came up to 26.67%. Conclusions: The diagnosis and treatment of HF in an Internal Medicine Service is acceptable. It will be very important to promote the use of beta blockers and angiotensina-converting enzyme inhibitors

Estudio de la enfermedad arterial periférica en pacientes con diabetes mellitus tipo 2, mediante la medida del índice tobillo/brazo / Evaluation of peripheral arterial disease in patients with type 2 diabetes through the forearm-ankle index

Introducción: El diagnóstico temprano de la enfermedad arterial periférica (EAP) es el primer paso para la prevención de las amputaciones en las extremidades inferiores. Objetivo: El objetivo de este estudio es la detección de EAP en pacientes ambulatorios con diabetes mellitus tipo 2 (DM2) mediante un método Doppler, valorando el índice tobillo/brazo (ITB). Material y métodos: Se realizó un estudio prospectivo observacional sobre 109 pacientes con DM2 que acudieron sucesivamente a la consulta externa de Medicina Interna del Hospital Clínico Universitario de Valladolid. Se recogieron las características de la enfermedad y los parámetros antropométricos. Se determinaron diferentes parámetros analíticos y se valoró el grado de la EAP mediante el ITB. Los datos fueron analizados mediante el programa SPSS versión 12.0. Las pruebas utilizadas han sido la de la *2 para las variables cualitativas y la de la t de Student para las cuantitativas. Como prueba no paramétrica se empleó la U de Mann-Whitney. Se consideró valor significativo p < 0,05. Resultados: El 32,5% presentaba EAP. En el 24,5% la vasculopatía era sintomática en diferentes grados y en el 8,2%, asintomática. Llama la atención, además, el alto porcentaje de obesidad (86,9%) y la dislipemia en la totalidad de la muestra. Se apreciaron diferencias significativas, en cuanto al sexo, en la enfermedad coronaria (p < 0,05) y en el consumo de tabaco y alcohol, que es más prevalente en varones que en mujeres (p < 0,001). Conclusiones: El cálculo del ITB es un buen método para el diagnóstico ambulatorio de la EAP, así como para valorar su intensidad y orientar el pronóstico en los pacientes con DM2 (AU)

Introduction: Early diagnosis of peripheral arterial disease (PAD) is the first step in preventing amputation of the lower limbs. Objective: The aim of this study was to detect PAD in outpatients with type 2 diabetes mellitus (DM2) using a Doppler method to rate the forearm-ankle index. Material and methods: A prospective, observational study was carried out in 109 consecutive patients with DM2 who attended the Internal Medicine Outpatient Clinic at the University Hospital of Valladolid (Spain). Disease characteristics and anthropometric parameters were recorded. Various laboratory parameters were determined and the PAD ratio was evaluated using the forearm-ankle index. Data were analyzed by the SPSS program version 12.0. The statistical distributions applied were the chi-square test for qualitative variables, Student's t­test for quantitative variables and the Mann-Whitney U-test for non-parametric variables. A p-value of less than 0.05 was accepted as indicating statistical significance. Results: PAD was found in 32.5% of the patients. PAD was symptomatic, to various degrees, in 24.5% and was asymptomatic in 8.2%. The high percentage of obesity (86.9%) and dyslipemia in the entire sample was notable. Significant differences were found in sex, coronary disease (p < 0.05), smoking and alcohol consumption, which was more prevalent in men than in woman (p < 0.001). Conclusions: The forearm-ankle index is an effective method for diagnosing PAD in outpatients, evaluating its intensity and indicating prognosis in patients with DM2 (AU)

Grado de cumplimiento de los objetivos de control metabólico y de los factores de riesgo cardiovascular en pacientes diabéticos tipo 2 en un área de Atención Primaria / Degree of fulfillment of the objectives of control metabolico and the factors of diabetic cardiovascular risk in patients type 2 in an area of Primary Attention

La diabetes mellitus tipo 2 (DM2) representa un importante problema de salud pública, debido a su elevada prevalencia y alta morbimortalidad, que se incrementa, aún más, por su asociación a determinados factores de riesgo cardiovascular (FRV). Por ello es importante una acción conjunta sobre todas estas alteraciones, ya que su control previene las manifestaciones vasculares. Objetivo: Se basa en la detección y determinación del grado de control de los factores de riesgo asociados a pacientes con DM2, según los datos dados por las diferentes organizaciones internacionales, estudiados en un Centro de Salud de Valladolid. Método: Se trata de un estudio transversal descriptivo para evaluar el control de distintos FRV en pacientes diagnosticados y tratados de DM2 de acuerdo a los diferentes criterios establecidos. La muestra está formada por 74 pacientes adultos (41 varones y 33 mujeres), incluidos en el Programa de Diabetes Mellitus de un “cupo” perteneciente al Centro de Salud de Rondilla 2, del Área Este de Atención Primaria de Valladolid, para la consulta programada de control de riesgo cardiovascular. Resultados y conclusiones: Se detecta un pobre control de la mayoría de los FRV, por lo que deberán indicarse medidas de control más estrictas, con el fin de prevenir las complicaciones vasculares relacionadas con ellos

Diabetes mellitus type is one of de most important health problem in the world, due to its high prevalence and morbidity and its relation with several cardiovascular risk factors. That´s why a global action, aimed to prevent these vascular syndromes, is needed. Objective: the goal of this study is to detect and determine how cardiovascular risk factor are controlled in diabetic type 2 patients, according to the date supplied by several international organization that have been studied at a Health Centre of Valladolid. Methods: It is a descriptive cross-sectional study to evaluate the control of several cardiovascular risk factors in diabetic patients according to the different stablished criteria. The sample is formed by 74 adult patients (41 men and 33 women), included in the Diabetes Mellitus Programm at Health Centre of Rondilla 2, at East Area of Primary Care of Valladolid, in the programmed consultation of cardiovascular risk factors control. Results and conclusion: I has been observed that the majority of these cardiovascular risk factors are not well controlled. In this way, stringent mesures of control should be considered in order to prevent the cardiovascular complications related to them

[Degree of fulfillment of the objectives of metabolic control and cardiovascular risk factors in patients with type 2 diabetes in an area of primary attention]. / Grado de cumplimiento de los objetivos de control metabólico y de los factores de riesgo cardiovascular en pacientes diabéticos tipo 2 en un área de Atención Primaria.

UNLABELLED: Diabetes mellitus type is one of de most important health problem in the world, due to its high prevalence and morbidity and its relation with several cardiovascular risk factors. That s why a global action, aimed to prevent these vascular syndromes, is needed. OBJECTIVE: the goal of this study is to detect and determine how cardiovascular risk factor are controlled in diabetic type 2 patients, according to the date supplied by several international organization that have been studied at a Health Centre of Valladolid. METHODS: It is a descriptive cross-sectional study to evaluate the control of several cardiovascular risk factors in diabetic patients according to the different established criteria. The sample is formed by 74 adult patients (41 men and 33 women), included in the Diabetes Mellitus Program at Health Centre of Rondilla 2, at East Area of Primary Care of Valladolid, in the programmed consultation of cardiovascular risk factors control. RESULTS AND CONCLUSION: I has been observed that the majority of these cardiovascular risk factors are not well controlled. In this way, stringent measures of control should be considered in order to prevent the cardiovascular complications related to them.