[Elevated serum aldosterone levels in dialysis patients: Are we underusing renin-angiotensin-aldosterone system blockers?] / Niveles elevados de aldosterona sérica en pacientes en diálisis: ¿estamos infrautilizando los bloqueantes del sistema renina angiotensina aldosterona en diálisis?

Serum aldosteronelevels (SA) are a marker of cardiovascular (CV) risk in the general population. OBJECTIVE: To analyze SA levels in dialysis patients and its relationship with characteristics of dialysis; comorbidity; blood pressure and the use of blocking renin-angiotensin-aldosterone system agents (BSRAA). METHODS: We determined SA in 102 patients: 81 on hemodialysis (HD) and 21 on peritoneal dialysis. Mean age 71.4±12 years; 54.9% male; 29.4% diabetics. Mean time on dialysis 59.3±67 months. In 44 HD patients plasma renin activity (PRA) was measured. RESULTS: Mean SA was 72.6±114.9ng/dl (normal range 1.17-23.6ng/dl). A total of 57.8% of patients had above normal levels which were not related to dialysis characteristics or comorbidity. Only 21% of patients with heart failure and 19.2% with ischemic heart disease used BSRAA. A number of 25 patients treated with BSRAA had significantly lower levels of SA. There was an inverse correlation between AS and systolic blood pressure (SBP), and direct with PRA. The logistic regression analysis conducted to find SA levels above the median associated factors showed that SBP was the only independent risk variable in the overall population (OR 0.97; P=.022); in the 44 patients in whom PRA was determined this was the only independent risk factor (OR 2.24; P=.012). CONCLUSIONS: A high percentage of dialysis patients have elevated levels of SA that are associated to diminished SBP and activated PRA and not to dialysis characteristics. In patients with a history of heart disease we underuse BSRAA.

[Rapid diagnosis of streptococcal pharyngo-tonsillitis in a primary care unit]. / Diagnóstico rápido de faringoamigdalitis estreptocócica en un equipo de atención primaria.

One of the main consulting motives in ambulatory pediatric practice is acute pharyngotonsillitis. This work values the efficacy of a test to confirm rapid diagnosis (30 minutes) of streptococcal pharyngitis. Authors selected 100 children in a office of primary health care whose ages were between two and seven years, from February to July in 1986. They have considered classical clinical symptoms of pharyngitis and have applied a throat culture and rapid test in all. After comparing test results and culture results, obtained sensibility and specificity have been 80% and 95% (p less than 0.01) respectively. According to these results, they believe on the necessity of a test that permits a rapid diagnosis and which enables to treat acute pharyngitis in a more suitable way in ambulatory pediatrics.