Prevención cardiovascular en Atención Primaria en situación de crisis: estudio comparativo multicéntrico antes, durante y después de la pandemia por SARS-COVID-19 / Cardiovascular prevention in primary care in crisis situations: multicenter comparative study before, during and after the SARS-COVID-19 pandemic

Objetivo:Evaluar si la aparición de una situación de crisis como la que ha supuesto la pandemia por el SARS-CoV-2, junto a los cambios organizativos adoptados en Atención Primaria, han influido en la implementación de actividades preventivas cardiovasculares en pacientes de 40 a 74 años. Diseño: Estudio descriptivo multicéntrico retrospectivo durante tres años (2019-2022) en Atención Primaria.Ámbito: 35 centros de salud de Atención Primaria de la Dirección Asistencial Norte de Madrid. Participantes: Se incluyeron 1.008 pacientes de ambos sexos entre 40 y 74 años con diagnósticos de hipertensión, diabetes mellitus y/o dislipemia. Método: Se recogen a partir de la historia clínica informatizada las siguientes variables: actividades preventivas sobre el estilo de vida (consumo de tabaco, alcohol, consumo de dieta mediterránea y práctica de ejercicio) considerando óptimo tres de los cuatro parámetros; datos de exploración (registro de tensión arterial) y registro de analítica (glucemia, HbA1c, colesterol total, HDL, LDL) considerando óptimo cuatro de los cinco parámetros. Se analizan diferencias entre tiempo de prepandemia (15/03/2019-14/03/2020), pandemia (15/03/2020-14/03/2021) y transición (15/03/2021-14/03/2022). Análisis estadístico: Prueba de McNemar para comparar las variables principales entre los periodos de estudio. Resultados: Se recogen datos de 1.008 pacientes. El registro de actividades preventivas sobre el estilo de vida fue de 180 pacientes (17,9%) (IC 95%: 0,155-0,204) en prepandemia, 29 pacientes (2,9%) (IC 95%: 0,019-0,041) en pandemia y 55 pacientes (5,5%) (IC 95%: 0,041-0,070) en la etapa de transición (p < 0,05). La exploración estaba registrada en 393 pacientes (39%) (IC 95%: 0,360-0,421) en la prepandemia, 133 pacientes (13,2%) (IC 95%: 0,112-0,154) en pandemia y en 218 pacientes (21,6%) (IC 95%: 0,191-0,243) en la transición (p < 0,05).(AU)

Objective:To assess whether the appearance of a crisis situation such as the one caused by the SARS-COV-2 pandemic, together with the organizational changes adopted in Primary Care, have influenced the implementation of cardiovascular preventive activities in patients aged 40 to 74 years. Design: Retrospective multicenter descriptive study for three years (2019-2022) in Primary Care. Setting: 35 health centers of the Primary Care of the Northern Assistance Directorate of Madrid. Participants: 1008 patients of both sexes between 40 and 74 years with diagnosed of hypertension, Diabetes Mellitus and/or dyslipidemia. Method: The variables analyzed from the computerized clinical history were lifestyle activities (consumption of tobacco, alcohol, consumption of Mediterranean diet and exercise) considering 3 of the 4 parameters optimal; examination data (blood pressure record) and analytical record (glycemia, hbA1c, total cholesterol, HDL, LDL)considering 4 of the 5 parameters optimal. Differences are analyzed between based pre-pandemic (03/15/2019-03/14/2020), pandemic (03/15/2020-03/14/2021), and transition (03/15/2022-03/14/2022). Statistical analysis: MC Nemar's test to compare the main variables between the study periods. Results: Data from 1008 patients are collected. The registration of preventive activities on lifestyle was 180 patients (17.9%) (IC95%: 0,155-0,204) in pre-pandemic, 29 patients (2.9%) (IC 95%: 0,019-0,041) in pandemic and 55 patients (5.5%) (IC 95%: 0,041-0,070) in the transition stage (p < 0.05). Exploration was registered in 393 patients (39%) (IC95%: 0,360-0,421) in the pre-pandemic, 133 patients 13,2% (IC 95%: 0,112-0,154) in the pandemic, and 218 patients (21,6%) (IC 95%: 0,191-0,243) in the transition (p < 0.05). The analytical record was 33 patients (3.3%) (IC955: 0,023-0,046), 10 patients (1%) (IC95%: 0,005-0,018) and 23 patients (2.3%) (IC95%: 0,015-0,034) respectively in each phase with one (P < 0.05).(AU)

[Cardiovascular prevention in primary care in crisis situations: multicenter comparative study before, during and after the SARS-COVID-19 pandemic]. / Prevención cardiovascular en Atención Primaria en situación de crisis: estudio comparativo multicéntrico antes, durante y después de la pandemia por SARS-COVID-19.

OBJECTIVE: To assess whether the appearance of a crisis situation such as the one caused by the SARS-COV-2 pandemic, together with the organizational changes adopted in Primary Care, have influenced the implementation of cardiovascular preventive activities in patients aged 40 to 74 years. DESIGN: Retrospective multicenter descriptive study for three years (2019-2022) in Primary Care. SETTING: 35 health centers of the Primary Care of the Northern Assistance Directorate of Madrid. PARTICIPANTS: 1008 patients of both sexes between 40 and 74 years with diagnosed of hypertension, Diabetes Mellitus and/or dyslipidemia. METHOD: The variables analyzed from the computerized clinical history were lifestyle activities (consumption of tobacco, alcohol, consumption of Mediterranean diet and exercise) considering 3 of the 4 parameters optimal; examination data (blood pressure record) and analytical record (glycemia, hbA1c, total cholesterol, HDL, LDL)considering 4 of the 5 parameters optimal. Differences are analyzed between based pre-pandemic (03/15/2019-03/14/2020), pandemic (03/15/2020-03/14/2021), and transition (03/15/2022-03/14/2022). STATISTICAL ANALYSIS: MC Nemar's test to compare the main variables between the study periods. RESULTS: Data from 1008 patients are collected. The registration of preventive activities on lifestyle was 180 patients (17.9%) (IC95%: 0,155-0,204) in pre-pandemic, 29 patients (2.9%) (IC 95%: 0,019-0,041) in pandemic and 55 patients (5.5%) (IC 95%: 0,041-0,070) in the transition stage (p < 0.05). Exploration was registered in 393 patients (39%) (IC95%: 0,360-0,421) in the pre-pandemic, 133 patients 13,2% (IC 95%: 0,112-0,154) in the pandemic, and 218 patients (21,6%) (IC 95%: 0,191-0,243) in the transition (p < 0.05). The analytical record was 33 patients (3.3%) (IC955: 0,023-0,046), 10 patients (1%) (IC95%: 0,005-0,018) and 23 patients (2.3%) (IC95%: 0,015-0,034) respectively in each phase with one (P < 0.05). CONCLUSIONS: Activities on lifestyle, physical examination, and laboratory test as part of the cardiovascular prevention strategy are scarce in the prepandemic period and decrease drastically during the pandemic, at the first level of care.

Enfermedad celiaca refractaria: cuando la dieta sin gluten no sana / Refractory celiac disease: when a gluten-free diet does not heal

Presentamos el caso de una mujer de 61 años con antecedentes de enfermedad celiaca desde los 21, que empieza desde hace doce meses con epigastralgias intermitentes postprandiales, alteraciones del hábito intestinal y pérdida de peso. Afirma el cumplimiento estricto de la dieta sin gluten y sin lactosa, comprobándose esto mediante la titulación de anticuerpos, que fueron negativos. Ante esta clínica se realiza una gastroscopia, donde se evidencia atrofia vellositaria y en la biopsia se objetiva una afectación de la mucosa grado Marsh III. Con estas pruebas se alcanza el diagnóstico de enfermedad celiaca refractaria (ECR). La ECR es una entidad rara que padece el 5-8 % de los enfermos celiacos diagnosticados en la edad adulta y que produce un aumento del riesgo de desarrollo de linfoma intestinal. Por tanto, es evidente la importancia de conocerlo y sospecharlo (AU)

We present the case of a 61-year-old woman with celiac disease since age 21, who starts 12 months ago with intermittent postprandial epigastralgia, altered bowel habit and weight loss. The patient affirms the strict observance of the gluten and lactose free diet, which is confirmed by negative antibody titration analysis. Due to these symptoms, a gastroscopy is performed in which an atrophy of the villous architecture is detected. A Marsh grade III mucosa damage is also found in the biopsy, being diagnosed of refractory celiac disease (RCD). RCD is a rare entity present in 5-8% of all celiac patients diagnosed in adulthood; it produces an increased risk of intestinal T-cell lymphoma, this is why it is important to know and suspect this disease (AU)