[Usefulness of aplanation tonometry in primary care]. / Utilidad de la tonometría de aplanación en atención primaria.

OBJECTIVE: To assess the usefulness of the aplanation tonometer (Glaucotest model) for primary care screening of ocular hypertension (OH) in 40 to 80-year olds. DESIGN: A descriptive prospective study. SETTING: Teruel Health Centre (urban). PATIENTS: Users between 40 and 80 of both sexes, selected after four on-demand consultations. The sample was randomised and stratified for age against the general public seeking care. Patients diagnosed with glaucoma or OH, or who were blind for any reason, were excluded. INTERVENTION: Measurement of intraocular pressure (IOP) with a Heine Glaucotest aplanation tonometer with a head for 18 mmHg. Those patients with IOP figures above 18 mmHg were referred to the ophthalmology service, so that they could be tested there with a Goldmann tonometer. OH was defined as IOP above 21 mmHg. MEASUREMENTS AND MAIN RESULTS: There was a sample of 354 patients, 38% men and 62% women, average age 63.5. A tonometer reading > 18 mmHg was recorded in 49 cases. These were referred to the ophthalmologist, who confirmed IOP in 10 cases (2.8% of the total). The positive predictive value for IOP, with a cut-off point at 18 mm Hg in our study, was 20.4%. 60% of patients with IOP presented risk factors. CONCLUSIONS: We found that the aplanation tonometer used was suitable for IOP screening in primary care centers.

[Medicosocial profile of the crucial caregiver. Is he/she an occult patient?]. / Perfil medicosocial del cuidador crucial. Se trata de un paciente oculto?

OBJECTIVE: To determine the prevalence of physical pathology (morbidity felt) and psychological unease (anxiety-depression) in crucial carers for disabled patients, and so establish a profile of them. DESIGN: An observational study. Analysis of two historical cohorts. SETTING: Primary care. Urban health centre. PATIENTS: The exposed cohort was made up of 54 carers for disabled patients, chosen at random from the records at our Centre. The non-exposed cohort (n = 54), matched for age, gender and educational level, was chosen at random from the consulting rooms. MEASUREMENTS AND MAIN RESULTS: By means of a questionnaire, descriptive variables were collected, i.e. the morbidity felt, consumption of medicine, psychological unease (Goldberg's anxiety-depression scale), perception of social support (modified Duke Unl), index of the effort of the carer (IEC) and the profile of the person being cared for. The "typical" carer was a 57-year old woman (CI 95: 54-61), with a low educational level, daughter or wife of the disabled person, who received external help in few cases (11%). Problems of health referred to by carers (Arthralgia, migraines, asthenia, feeling depressed and insomnia), are more frequent (p < 0.001) than in non-carers. 75% took some medication, as against 45% of non-carers (p < 0.001). 83% displayed anxiety and 63% depression, against 36 and 37%, respectively, in the non-exposed cohort. A high IEC implied greater risk of anxiety (p < 0.05) and depression (p < 0.001). CONCLUSIONS: The crucial carer has a greater prevalence of physical and psychological morbidity. A high IEC and a perception of low social support create the conditions for higher anxiety and depression. Caring for the carer needs to be integrated into care for the disabled patient.

[Prognostic value of plasma levels of fibronectin in septic shock]. / Valor pronóstico de los niveles plasmáticos de fibronectina en el shock séptico.

AIM: The aim of the study was to assess possible changes in fibronectin serum levels in patients with septic shock and to analyze its usefulness as prognosis marker in this kind of shock. METHOD: Fibronectin serum levels were determined in 20 patients with septic shock at 1, 3, 6, 12, 24 and 72 hours after the diagnosis was made. RESULTS: Serum level of fibronectin drops between 6 and 24 hours after shock starts, reaching its lower value around hour 12. The level recovered after 24 hours in those cases with good clinical evolution, but not in patients with bad outcomes. CONCLUSIONS: The analysis of fibronectin plasma level is a good prognostic marker for predicting survival in patients with septic shock.

[Plasma concentrations of fibronectin in septic, hypovolemic, and cardiogenic shock. Prognostic usefulness of their variation]. / Concentraciones plasmáticas de fibronectina en el shock séptico, hipovolémico y cardiogénico. Utilidad pronóstica de sus variaciones.

BACKGROUND: Fibronectin is a protein with opsonic capacity. Its plasma level is diminished in septic shock. The aim of the present was to study its behavior in other types of shock. METHODS: A prospective study of 60 patients in shock (septic, hypovolemic and cardiogenic) was carried out. Serial plasma levels of fibronectin were determined in these patients over a period of 72 hours. The values of the cases which evolved favorably were compared with the values of those which did not. RESULTS: In all the cases, the plasma levels of fibronectin were diminished within a minimum of approximately 12 hours with a tendency to recovery of initial values being observed within 72 hours, except in cases in which the evolution of the patient was poor. In these cases fibronectin values remained diminished in such statistical significant. CONCLUSIONS: Plasma levels of fibronectin behave similarly in the three types of shock studied (septic, hypovolemic and cardiogenic). Serial determination of fibronectin provides a good prognostic index in patients with shock.