SEA 2022 Standards for Global Control of Cardiovascular Risk. / Estándares SEA 2022 para el control global del riesgo cardiovascular.

One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to better knowledge of vascular disease, its prevention and treatment. It is well known that cardiovascular diseases are the leading cause of death in our country and entail a high degree of disability and health care costs. Arteriosclerosis is a multifactorial disease and therefore its prevention requires a global approach that takes into account the different risk factors with which it is associated. Therefore, this document summarizes the current level of knowledge and includes recommendations and procedures to be followed in patients with established cardiovascular disease or at high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or requested for those in special situations. It also includes vascular risk estimation, the diagnostic criteria of the different entities that are cardiovascular risk factors, and makes general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not usually referenced in the literature, such as the organization of a vascular risk consultation.

¿Han influido el algoritmo de prescripción de la Administración y las guías de manejo de la dislipemia de la ACC/AHA 2013 en el manejo de la dislipemia? Proyecto MEJORA-LO CV / Have the Government's prescription algorithm and the 2013 American College of Cardiology/American Heart Association guidelines for managing dyslipidaemia influenced the management of dyslipidaemia? The MEJORALO-CV Project

OBJETIVO: Conocer el manejo de la dislipemia en atención primaria tras la publicación de la Guía de la American College of Cardiology/American Heart Association (ACC/AHA) del año 2013 y el algoritmo de la Administración. MÉTODO: Estudio transversal descriptivo con encuesta a médicos de atención primaria de la Comunidad Valenciana entre enero y octubre de 2016. RESULTADOS: Participaron 199 facultativos con una media (desviación típica) de 48,9 (11) años de edad y 21,3 (11,1) años de experiencia. Las guías más seguidas eran las de la European Society of Cardiology (37,5%) y las de la Administración (23,4%). El 6,3% seguía la de la ACC/AHA 2013. El 88% establecía objetivos según colesterol LDL y riesgo cardiovascular. La elección del hipolipemiante estaba basada en su capacidad reductora de colesterol LDL (28,6%), algoritmo de la Administración (23,4%) y seguridad (20,4%). Estatinas, ezetimiba y fibratos eran los hipolipemiantes preferidos, y la combinación (51%) e incremento de dosis (35%) las estrategias en ausencia de control. Se determinaba perfil lipídico, transaminasas y creatincinasa cada 6 (59,5; 52,3 y 54,3%, respectivamente) o 12 meses (25,1; 29,2 y 30,3%, respectivamente). Un 41% era conocedor de la polémica con la Guía ACC/AHA 2013, y aunque un 60% reconocía su relevancia, solo un 21% modificó su quehacer diario por ella. CONCLUSIONES: El algoritmo de la Administración tuvo mayor impacto que la Guía ACC/AHA 2013 en atención primaria. Campos de mejora fueron el bajo uso de guías y tablas de riesgo validadas, y racionalización de la periodicidad de las analíticas

OBJECTIVE: To determine the management of dyslipidaemia in primary care after the publication of the American College of Cardiology/American Heart Association (ACC/AHA) 2013 guidelines and Valencian government's algorithm. METHOD: We conducted a cross-sectional descriptive study that employed a survey of primary care physicians of the Community of Valencia between January and October 2016. RESULTS: A total of 199 physicians (mean age, 48.9±11.0 years; experience, 21.3±11.1 years) participated in the survey. The most followed guidelines were those of the European Society of Cardiology (37.5% of respondents) and Valencian government (23.4% of respondents). Some 6.3% of the respondents followed the 2013 ACC/AHA guidelines, and 88.0% established objectives based on LDL cholesterol and cardiovascular risk. The choice of lipid-lowering drug was based on its LDL cholesterol lowering capacity (28.6% of respondents), on the Valencian government's algorithm (23.4%) and on the drug's safety (20.4%). Statins, ezetimibe and fibrates were the preferred hypolipemiant agents, and their combination (51% of respondents) and dosage increases (35%) were the strategies employed for poor control. Lipid profile and transaminase and creatine kinase levels were measured every 6 (59.5%, 52.3% and 54.3% of respondents, respectively) or 12 months (25.1%, 29.2% and 30.3%, respectively). Forty-one percent of the respondents were aware of the controversy surrounding the 2013 ACC/AHA guidelines. Although 60% of the respondents acknowledged its relevance, only 21% changed their daily practices accordingly. CONCLUSIONS: The Valencian government's algorithm had a greater impact than the 2013 ACC/AHA guidelines in primary care in Valencia. Areas for improvement included the low use of validated guidelines and risk tables and the streamlining of laboratory test periodicity

Have the Government's prescription algorithm and the 2013 American College of Cardiology/American Heart Association guidelines for managing dyslipidaemia influenced the management of dyslipidaemia? The MEJORALO-CV Project. / ¿Han influido el algoritmo de prescripción de la Administración y las guías de manejo de la dislipemia de la ACC/AHA 2013 en el manejo de la dislipemia? Proyecto MEJORA-LO CV.

OBJECTIVE: To determine the management of dyslipidaemia in primary care after the publication of the American College of Cardiology/American Heart Association (ACC/AHA) 2013 guidelines and Valencian government's algorithm. METHOD: We conducted a cross-sectional descriptive study that employed a survey of primary care physicians of the Community of Valencia between January and October 2016. RESULTS: A total of 199 physicians (mean age, 48.9±11.0 years; experience, 21.3±11.1 years) participated in the survey. The most followed guidelines were those of the European Society of Cardiology (37.5% of respondents) and Valencian government (23.4% of respondents). Some 6.3% of the respondents followed the 2013 ACC/AHA guidelines, and 88.0% established objectives based on LDL cholesterol and cardiovascular risk. The choice of lipid-lowering drug was based on its LDL cholesterol lowering capacity (28.6% of respondents), on the Valencian government's algorithm (23.4%) and on the drug's safety (20.4%). Statins, ezetimibe and fibrates were the preferred hypolipemiant agents, and their combination (51% of respondents) and dosage increases (35%) were the strategies employed for poor control. Lipid profile and transaminase and creatine kinase levels were measured every 6 (59.5%, 52.3% and 54.3% of respondents, respectively) or 12 months (25.1%, 29.2% and 30.3%, respectively). Forty-one percent of the respondents were aware of the controversy surrounding the 2013 ACC/AHA guidelines. Although 60% of the respondents acknowledged its relevance, only 21% changed their daily practices accordingly. CONCLUSIONS: The Valencian government's algorithm had a greater impact than the 2013 ACC/AHA guidelines in primary care in Valencia. Areas for improvement included the low use of validated guidelines and risk tables and the streamlining of laboratory test periodicity.

Gene expression profile following an oral unsaturated fat load in abdominal obese subjects.

PURPOSE: Our aim was to evaluate the postprandial effect of an oral fat load test (OFLT) rich in unsaturated fatty acids on gene expression profile in peripheral blood mononuclear cells (PBMC) from subjects with abdominal obesity as an insulin resistance model and controls. METHODS: A total of 20 controls and 20 abdominal obese patients were studied. Metabolic parameters and oxidative stress markers were measured with standardized protocols. The whole gene expression at fasting state and after the OFLT (0, 4 and 8 h) was analysed using human HT-12-v4 expression beadchips, from Illumina. RESULTS: We found a significant decrease in plasma glucose, insulin and oxidative stress markers in abdominal obese patients and controls. We found beneficial metabolic postprandial gene expression in three genes: FKBP5, DDIT4 and DHRS9. Following an OFLT, the postprandial mRNA expression of FKBP5, and DDIT4 was downregulated while that of DHRS9 was overexpressed, both in nondiabetic normolipidemic subjects and in insulin-resistant subjects with abdominal obesity. CONCLUSIONS: Our results suggest that an OFLT rich in unsaturated fatty acids downregulates the expression of FKBP5, coding for the glucocorticoid receptor pathway, and that of DDIT4, involved in the oxidative stress response. These changes could favourably influence the insulin resistance and oxidative stress status in the postprandial state.

Establishing cut-off values for apolipoprotein B and non-HDL-C according to LDL-C values in a South European population.

BACKGROUND: Low-density lipoprotein cholesterol (LDL-C) remains the primary target of therapy in most strategies of dyslipidaemia management focused on cardiovascular disease prevention. Different guidelines have identified specific LDL-C cut-off points as targets for therapeutic intervention. Many clinical situations characterised by dyslipidaemia and elevated triglycerides are common in our environment and in overall industrialised countries. Thus, lipid goals based only on LDL-C could misclassify an important percentage of subjects. The objective of the present study was to establish cut-off point values for apoB and non-HDL-C in relation to the identified LDL-C cut-off points for cardiovascular risk in a South European population. METHODS: We performed a cross-sectional study including 1501 subjects (770 women and 731 men) between 18 and 80 years of age. Samples were collected after 12-14 h of fasting. Cholesterol, HDL-C, triglycerides and apoB levels were measured using direct methods. LDL-C was calculated by the Friedewald formula. Non-HDL-C was calculated as total cholesterol minus HDL-C. RESULTS: The Spearman's rank correlations between apoB and LDL-C (r 0.86, p < 0.0001), and between apoB and non-HDL-C (r 0.91, p < 0.0001) were both significant. The proposed cut-off points for apoB, according to LDL-C goals (70, 100, 130 and 160 mg/dl) in our population are 70, 80, 100 and 115 mg/dl respectively. The proposed cut-off values for non-HDL-C are 100, 120, 150 and 190 mg/dl respectively. CONCLUSION: The established LDL-C cut-off values could not be accurate to estimate cardiovascular risk in subjects with mild hypertriglyceridaemia, as frequently occurs in our Mediterranean population. To take into consideration the burden of atherogenic particles and better classify patients at risk we propose cut-off values for apoB or the equivalent for non-HDL-C. Prospective trials including cardiovascular variables are needed to validate our assumption.

Plasma homocysteine levels are associated with ulceration of the foot in patients with type 2 diabetes mellitus.

BACKGROUND: To examine the association of biochemical markers of risk (plasma Hcy, microalbuminuria, lipoprotein (a)(Lp(a)) and diabetic dyslipidaemia) with the prevalence of diabetic foot ulceration in type 2 diabetic patients. METHODS: Case/control study conducted in 198 type 2 diabetic patients. 89 patients have foot ulcers and 109 have no foot ulcers (control group), in order to establish ORs for diabetic foot ulceration. In all subjects plasma Hcy, Lp(a), total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoprotein B, HbA(1c) and microalbuminuria were measured using standard procedures. RESULTS: Plasma Hcy, microalbuminuria, HbA(1c) and apolipoprotein B levels were significantly higher in patients with foot ulceration compared with the control group. Plasma lipids, Lp(a), vitamin B12 and folic acid values were similar in both groups. In the logistic regression model, plasma Hcy (OR 1.09; 95% CI 1.04-1.69), microalbuminuria (OR 1,01; 95% CI 1.01-1.17) and HbA(1c) levels (OR 1.33; 95% CI 1.04-1.69) were independent risk factors for the presence of diabetic foot ulceration. CONCLUSIONS: In our study, for each micromol increase in plasma Hcy levels there was a 10% increase in the risk of diabetic foot ulceration. In addition, plasma homocysteine, HbA(1c) and microalbuminuria accounted for 50% prevalence risk of diabetic foot ulceration. Further prospective studies should be conducted to confirm the association of plasma Hcy levels with the risk of foot ulceration.

Increased plasma xanthine oxidase activity is related to nuclear factor kappa beta activation and inflammatory markers in familial combined hyperlipidemia.

BACKGROUND AND AIMS: Xanthine oxidase (XO) has been described as one of the major enzymes producing free radicals in blood. Oxidative stress and inflammatory processes have been implicated in the pathogenesis of endothelial dysfunction and the progression of atherosclerosis but until now, there is little data about the influence of vascular prooxidant systems and inflammation in familial combined hyperlipidemia (FCH). Our goal was to evaluate whether XO activity was altered in FCH and if it was related to the inflammatory process represented by NFkB, IL-6 and hsCRP, and assessing the correlation between XO activity and insulin resistance (IR). METHOD AND RESULTS: 40 Non-related subjects with FCH and 30 control subjects were included, all of them non-diabetic, normotensive and non-smokers. We measured lipid profile, glucose, insulin, uric acid, XO activity, malondialdehyde (MDA), IL-6 and hsCRP in plasma and NFkB activity in circulating mononuclear cells. Patients with FCH showed significantly higher levels of uric acid, XO activity, MDA, NFkB activity, IL-6 and hsCRP than controls. XO activity was independently related to NFkB activity with an odds ratio of 4.082; to IL-6 with an odds ratio of 4.191; and to IR with an odds ratio of 3.830. Furthermore, mean NFkB activity, IL-6 levels, and IR were highest in the highest percentile of XO activity. CONCLUSIONS: Subjects with FCH showed increased XO and NFkB activities and low grade inflammatory markers related to atherosclerosis. XO activity was correlated with higher inflammatory activity and IR. These data could explain, in part, the high cardiovascular disease risk present in these patients.

Circulating mononuclear cells nuclear factor-kappa B activity, plasma xanthine oxidase, and low grade inflammatory markers in adult patients with familial hypercholesterolaemia.

BACKGROUND: Few data are available on circulating mononuclear cells nuclear factor-kappa B (NF-kB) activity and plasma xanthine oxidase (XO) activity in heterozygous familial hypercholesterolaemia (FH). The goal of the study was to analyse circulating mononuclear cells NF-kB and plasma XO activities in FH patients. MATERIALS AND METHODS: Thirty FH index patients and 30 normoglycaemic normocholesterolaemic controls matched by age, gender, body mass index, abdominal circumference and homeostasis model assessment index were studied. Plasma XO and inflammatory markers were measured by standard methods. NF-kB was assayed in circulating mononuclear cells. RESULTS: Familial hypercholesterolaemia patients showed a significantly higher NF-kB (75.0 +/- 20.7 vs. 42.7 +/- 16.8 relative luminiscence units) and XO (0.44 +/- 0.13 vs. 0.32 +/- 0.09 mU mL(-1)) activities than controls. In addition, interleukin-1, interleukin-6, high sensitivity C reactive protein (hsCRP) and oxidized LDL (LDL-ox) were also significantly higher in FH patients. In the total group (FH and controls), XO was significantly associated with LDL-cholesterol (LDL-C), apolipoprotein B (apoB), NF-kB and hsCPR, and NF-kB activity was significantly associated with XO, hsCPR, LDL-ox, LDL-C and apoB plasma values. Using multiple regression analysis, XO was independently associated with hsCPR and NF-kB, and NF-kB activity in circulating mononuclear cells was independently associated with apoB and LDL-ox plasma values. CONCLUSION: Familial hypercholesterolaemia patients show increased activities of NF-kB and XO, and higher values of low grade inflammatory markers related to atherosclerosis. NF-kB activity was independently associated with apoB plasma values. These data could explain in part the high cardiovascular disease risk present in these patients.

¿Cómo diseñar un estudio genético? Extracción de ADN y ARN / How to design a genetic study? DNA and RNA extraction

Un gran número de enfermedades tienen origen genético o están influidas por variantes genéticas. Algunas formas de diabetes son de origen monogénico (MODY y síndromes diabéticos) pero la más común, la diabetes mellitus tipo 2, es una enfermedad multifactorial causada por una interrelación entre variantes genéticas y ambientales. Hasta la fecha, se conoce poco acerca de la genética de la diabetes y sobre qué factores genéticos están implicados en su regulación y en el daño orgánico que se origina. El conocimiento de la genética de la diabetes mejorará la comprensión de esta enfermedad tan importante en nuestra sociedad, permitiendo una mejor prevención y tratamiento. El presente seminario pretende exponer los principales puntos que deben tenerse en cuenta cuando se diseña un estudio genético sobre diabetes (entre ellos el tipo de investigación, la patogenicidad de las variaciones o las asociaciones genotipo-fenotipo), así como explicar el fundamento para la extracción de ADN y ARN y las pautas para su almacenamiento (AU)

A wide number of diseases have a genetic origin or are influenced by genetic variants. Some forms of diabetes are monogenic (MODY and diabetic syndromes) but the most common one, type 2 diabetes, is a multifactorial disease caused by an interrelation of genetic variants and the environment. Up to date, little is known about the genetics of diabetes and genetic factors involved in its regulation and the associated organ damage. Understanding diabetes genetics will improve our understanding of such an important disease in our society, allowing a better prevention and treatment. The current seminar will try to point out the keys to take into account when planning a genetic study in diabetes research, such as the study type, variant pathogenicity, genotype-phenotype associations, etc., and will explain the DNA and RNA extraction methodology and storage guidelines (AU)

Técnicas para el estudio del ADN y el ARN. Introducción al estudio de proteínas / Techniques for the study of DNA and RNA. Introduction to the study of proteins

La metodología para el estudio del ADN, el ARN y las proteínas ha experimentado un gran avance en los últimos años, existiendo en la actualidad numerosas técnicas para la investigación de diferentes aspectos de estas moléculas. Así, hoy en día es posible analizar desde uno o unos pocos polimorfismos a millones de ellos en un solo experimento, fenómeno que se repite para el estudio de los niveles de ARN y proteínas. En relación con la productividad o el número de datos que proporcionan las diferentes técnicas, éstas pueden clasificarse como de bajo, medio o alto rendimiento. Esta metodología puede aplicarse al estudio de aspectos muy variados de la diabetes, como pueden ser sus causas, los factores de riesgo, las consecuencias de la diabetes a nivel orgánico y celular en los diferentes tejidos, sus complicaciones crónicas, etc. En este seminario expondremos unas nociones generales sobre las técnicas más importantes para el estudio del ADN, el ARN y las proteínas, aplicadas a la diabetes (AU)

The methodology for the study of DNA, RNA and proteins has been greatly improved in recent years. Nowadays, we can study from one or several polymorphisms to millions in a single experiment; the situation is similar in the study of RNA or protein levels. On the basis of the productivity or the number of data provided by the different techniques, we can classify their throughput as low, medium or high. All this technology can be used to investigate different aspects of diabetes, such as the causes, risk factors, consequences at the organ r cellular levels in different tissues, chronic complications, etc. In this review, we discuss the general aspects of the most innovative techniques in the analysis of DNA, RNA and proteins as applied to diabetes (AU)

Dificultad en el tratamiento del hipertiroidismo por amiodarona. Presentación de un caso / Difficult treatment of amiodarone-induced thyrotoxicosis: a case report

La amiodarona puede alterar la función tiroidea en un 15-20% de los pacientes que la toman, dando lugar a hipotiroidismo o hipertiroidismo. La sobrecarga de yodo y la toxicidad directa sobre el tiroides inducida por amiodarona pueden provocar hipertiroidismo. Describimos un caso de tirotoxicosis grave por amiodarona que se diagnosticó buscando la causa que descompensó la cardiopatía de base del paciente, condicionando ésta el pronóstico y el manejo terapéutico. El tratamiento precisó un estrecho seguimiento y se basó en dosis elevadas de propiltiouracilo y dexametasona que no controlaron las consecuencias del hipertiroidismo a nivel cardiaco necesitando la tiroidectomia total. Creemos, con la experiencia aportada, que en determinados casos la cirugía es una opción que debería ser planteada con más precocidad

Amiodarone causes changes in thyroid function tests in about 15-20% of patients, inducing either hypothyroidism or thyrotoxicosis. The iodine load and the destructive thyroiditis caused by amiodarone produce thyrotoxicosis. We report a case of amiodarone-induced thyrotoxicosis diagnosed when investigating the reason for worsening of cardiac funtion. Prognosis and treatment of cardiac disorder were determined by thyrotoxicosis. The management needed a closed monitoring of thryroid function. Treatment was based on high doses of propylthiouracil and dexametasone, but they couldn´t control cardiac condition and surgery was warranted. When amiodarone-induced thyrotoxicosis is refractory to medical treatment, we belive surgery should be considered earlier

[Difficult treatment of amiodarone-induced thyrotoxicosis: a case report]. / Dificultad en el tratamiento del hipertiroidismo por amiodarona. Presentación de un caso.

Amiodarone causes changes in thyroid function tests in about 15-20% of patients, inducing either hypothyroidism or thyrotoxicosis. The iodine load and the destructive thyroiditis caused by amiodarone produce thyrotoxicosis. We report a case of amiodarone-induced thyrotoxicosis diagnosed when investigating the reason for worsening of cardiac function. Prognosis and treatment of cardiac disorder were determined by thyrotoxicosis. The management needed a closed monitoring of thyroid function. Treatment was based on high doses of propylthiouracil and dexamethasone, but they couldn t control cardiac condition and surgery was warranted. When amiodarone-induced thyrotoxicosis is refractory to medical treatment, we believe surgery should be considered earlier.

[Effect of gender and obesity on postprandial lipemia in non-diabetic normolipidemic subjects and subjects with familial combined hyperlipidemia]. / Efecto del género y de la obesidad en la lipemia posprandial en sujetos sanos normolipidémicos no diabéticos y sujetos con hiperlipemia familiar combinada.

INTRODUCTION: A new method based on self-measurement of diurnal capillary triglycerides (TG) facilitates the study of postprandial lipemia (PL). The objectives of our study are: to evaluate the effect of gender and obesity on PL measured by self-determination of diurnal capillary TG with Accutrend GCT in normolipidemic non-diabetic subjects and subjects with familial combined hyperlipidemia (FCH). MATERIAL AND METHODS: We studied 23 FCH subjects (10 males) and 45 normolipidemic non-diabetic subjects (29 males). All subjects self-determine 3 diurnal capillary TG profiles during a week. RESULTS: In normolipidemic non diabetic subjects significantly higher diurnal TG profiles and area under the curve of TG (AUCTGc) (25.25 +/-9.09 vs 19.71 +/- 6.16 mmolh/l) were found in males compared to females. In FCH subjects these differences were not found and the AUCTGc correlated with BMI (r = 0.510, p < 0.05) and waist circumference (r = 0.453, p < 0.05). Obese subjects (BMI >or= 27 kg/m2) showed diurnal TG profiles and AUCTGc significantly higher than the non-obese. DISCUSSION: Normolipidemic non diabetic females showed a lower PL compared to males, probably due to the effect of estrogens in PL metabolism. Obesity negatively influences PL in normolipidemic non diabetic subjects and subjects with FCH.

Efecto del género y de la obesidad en la lipemia posprandial en sujetos sanos normolipidémicos no diabéticos y sujetos con hiperlipemia familiar combinada / Effect of gender and obesity on postprandial lipemia in non-diabetic normolipidemic subjects and subjects with familial combined hyperlipidemia

Introducción. Un nuevo método basado en la autodeterminación de triglicéridos (TG) capilares permite un mejor conocimiento de la lipemia posprandial (LP). Los objetivos de nuestro estudio son analizar el efecto del género y la obesidad sobre la LP valorada por medición capilar de TG diurnos mediante Accutrend GCT® en sujetos sanos y sujetos con hiperlipemia familiar combinada (HFC). Material y métodos. Hemos estudiado a 23 sujetos con HFC no relacionados entre sí (10 hombres) y a 45 sujetos (29 hombres) normolipidémicos no diabéticos. Todos ellos realizaron tres perfiles diarios de TG capilares durante una semana. Resultados. En los sujetos sanos normolipidémicos no diabéticos encontramos valores significativamente elevados en el perfil de TG capilares y área bajo la curva de TG capilares (ABCTGc) (25,25 ± 9,09 frente a 19,71 ± 6,16 mmolh/l) en el grupo de hombres frente al de las mujeres. En sujetos con HFC no se hallaron estas diferencias y el ABCTGc se correlacionó con el índice de masa corporal (IMC) (r = 0,510; p < 0,05) y el perímetro de la cintura (r = 0,453; p < 0,05). Al dividir los sujetos estudiados en dos grupos según el IMC, aquellos con IMC ≥ 27 kg/m2 presentaron valores de TG capilares diurnos y el ABCTGc significativamente superiores. Discusión. Las mujeres sanas normolipidémicas no diabéticas presentaron una menor lipemia posprandial que los hombres, probablemente por el efecto de los estrógenos sobre el metabolismo lipídico. La obesidad ejercía un efecto negativo sobre la lipemia posprandial, tanto en sujetos sanos como en sujetos con HFC (AU)

Introduction. A new method based on self-measurement of diurnal capillary triglycerides (TG) facilitates the study of postprandial lipemia (PL). The objectives of our study are: to evaluate the effect of gender and obesity on PL measured by self-determination of diurnal capillary TG with Accutrend GCT® in normolipidemic non-diabetic subjects and subjects with familial combined hyperlipidemia (FCH). Material y methods. We studied 23 FCH subjects (10 males) and 45 normolipidemic non-diabetic subjects (29 males). All subjects self-determine 3 diurnal capillary TG profiles during a week. Results. In normolipidemic non diabetic subjects significantly higher diurnal TG profiles and area under the curve of TG (AUCTGc) (25.25 ±9.09 vs 19.71 ± 6.16 mmolh/l) were found in males compared to females. In FCH subjects these differences were not found and the AUCTGc correlated with BMI (r = 0.510, p < 0.05) and waist circumference (r = 0.453, p < 0.05). Obese subjects (BMI ≥ 27 kg/m2) showed diurnal TG profiles and AUCTGc significantly higher than the non-obese. Discussion. Normolipidemic non diabetic females showed a lower PL compared to males, probably due to the effect of estrogens in PL metabolism. Obesity negatively influences PL in normolipidemic non diabetic subjects and subjects with FCH (AU)

Carcinomatosis meníngea como forma de presentación de un carcinoma epidermoide de pulmón diseminado / Meningeal carcinomatosis as a presentation form of squamous cell carcinoma of disseminated lung

No disponible

Detección y resolución de un episodio de cetosis en un paciente con diabetes tipo 1 tratado con infusión subcutánea continua de insulina (ISCI) mediante la determinación de la cetonemia capilar / Detection and resolution of a ketotic episode in a patient with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) using capillary ketone testing

La monitorización de los cuerpos cetónicos es, junto a la glucemia, de gran importancia en el tratamiento de la diabetes, especialmente en la diabetes tipo 1. En particular, los pacientes diabéticos tipo 1 en tratamiento con infusión subcutánea continua de insulina CISCO tienen un mayor riesgo de cetosis/cetoacidosis. En estas situaciones, la determinación de cetonemia capilar ha demostrado ser un complemento importante en la prevención y tratamiento. En este trabajo se describe la detección y resolución de un episodio de cetosis en un paciente con diabetes tipo 1 tratado con ISCI utilizando la monitorización simultánea de glucemia y cetonemia capilar

Monitoring of ketone bodies besides of glycemia is important in diabetes care, especially in type 1 diabetes. Type 1 diabetic patients under continuous subcutaneous insulin infusion (CSIl) have, particularly, an increased risk of diabetic ketosis and ketoacidosis. In these situations, capillary ketone testing may be particularly relevant for prevention and treatment. In this work, we describe the detection and resolution of a ketosis episode in a type 1 diabetic patient under CSII therapy using the simultaneous determination of capillary glucose and ketone levels

Síndrome de McCune-Albright: otra forma de neoplasias endocrinas múltiples / McCune-Albright syndrome: another form of multiple endocrine neoplasia

Presentamos el caso de una mujer con síndrome de McCune-Albrightcomo paradigma de afección tumoral en múltiples glándulas endocrinas. El diagnóstico de la enfermedad se basó en la presencia de la tríada clásica (lesiones hiperpigmentadas cutáneas de color café con leche, pubertad precoz y displasia fibrosa). Durante su seguimiento presentó hipertiroidismo secundario a bocio multinodular tóxico, hiperparatiroidismo, probablemente secundario a hiperplasia paratiroidea, y acromegalia secundaria a adenoma hipofisario productor de hormona de crecimiento. Se comenta la base molecular de la enfermedad y su amplia expresión fenotípica (AU)

We report the case of a woman with McCune-Albright syndrome as a paradigm of multiple endocrine neoplasia. The diagnosis was based on the presence of the classical triad (cutaneous hyperpigmentation with café-au-lait spots, precocious puberty, and fibrous dysplasia of bone). In addition, during follow-up the patient presented primary hyperthyroidism due to multiple toxic goiter, primary hyperparathyroidism probably due multiple hyperplasia of parathyroid glands and acromegaly due to growth hormone-secreting pituitary adenoma. We discuss the molecular bases of the disease and its heterogeneous phenotypic expression (AU)

Perfil diurno de triglicéridos en sujetos con hiperlipidemia familiar combinada de una población del sur de Europa / Diurnal triglyceride profile in subjects with familial combined hyperlipidemia in a southern european population

Objetivos. Comparar la lipidemia posprandial valorada por medición de los triglicéridos capilares (TGc) diurnos mediante Accutrend GCT® entre sujetos sanos y sujetos con hiperlipidemia familiar combinada (HFC), y relacionarla con parámetros antropométricos en una población del sur de Europa. Sujetos y método. Se ha analizado a 23 sujetos diagnosticados de HFC no relacionados entre sí (13 mujeres) y 45 sujetos sanos (26 mujeres) normolipémicos no diabéticos. En todos ellos se midieron de forma estandarizada parámetros antropométricos, perfil lipídico, insulinemia y HOMA (homeostasis model assessment) en ayunas. Además, se determinaron mediante Accutrend GCT® durante 3 días los TGc en 6 momentos: en ayunas, al acostarse y antes y 3 h después de la comida y cena. Resultados. Los sujetos con HFC presentaron significativamente mayores concentraciones de insulinemia, HOMA, TGc diurnos y área bajo la curva de TGc que los controles. Tanto en sujetos sanos como en sujetos con HFC el área bajo la curva de TGc, como expresión de la lipidemia posprandial, se correlacionó de forma positiva con el tipo y grado de obesidad. Conclusiones. La HFC es un modelo genético de hiperlipidemia posprandial. La obesidad y el depósito de grasa abdominal se relacionan con la lipidemia posprandial, probablemente por medio de la resistencia a la insulina (AU)

Objectives. To compare postprandial lipidemia, evaluated by diurnal capillary triglyceride (cTG) profile measured with Accutrend GCT®, between control and familial combined hyperlipidemic (FCH) subjects from a Southern European population. Subjects and method. 23 non related FCH subjects (13 women) and 45 non-diabetic normolipidemic controls (26 women) were studied. Anthropometric parameters, lipid profile, insulinemia and HOMA were measured in fasting state in all. In addition, TGc were determined by Accutrend GCT® for 3 days at 6 points: fasting, bedtime and before and 3 hours after dinner and lunch, respectively. Results. FCH subjects showed significantly higher fasting insulinemia, HOMA values, TGc and area under the curve of TGc (AUCTGc) compared with controls. AUCTGc, as expression of postprandial lipidemia, correlated positively with obesity in all subjects. Conclusions: FCH is a genetic model of postprandial hyperlipidemia. Obesity and abdominal fat deposits are positively related to postprandial lipidemia, probably due to insulin resistance (AU)