Hiponatremia secundaria a diuréticos / Secondary hyponatremia caused by diuretics

La Hiponatremia secundaria al tratamiento diurético es la primera causa de hiponatremias en los adultos. La correcta utilización de los diuréticos por el médico de Familia requerirá un conocimiento de la farmacología de cada grupo así como la fisiopatología de la enfermedad de cada paciente (AU)

Disfunción Tiroidea Subclínica / Subclinical thyroid disfunction

El desarrollo de Técnicas más económicas para la determinación de la tirotropina hipofisaria (TSH) y de las hormonas tiroideas (T3 Ft4) ha permitido su utilización en el ámbito de la Atención Primaria, incrementándose de forma notable a este nivel el diagnóstico de difusión tiroidea subclínica (cifras alteradas de TSH con niveles normales de fT) (AU)

[Attitude change of Spanish cardiologist with respect to hypolipidemic treatment in secondary prevention. The role of outside hospital care]. / Cambio de actitud de los cardiólogos españoles con respecto al tratamiento hipolipemiante en prevención secundaria. Papel de la asistencia extrahospitalaria.

INTRODUCTION AND OBJECTIVES: Hypolipemic treatment is a matter of controversy. The objective of this paper is to analyze how Spanish cardiologist knows the lipid role in ischemic heart disease and their intention of treatment hypercholesterolemia in ischemic cardiomiopathy patients. We also evaluate the grade of control and treatment of hypercholesterolemia in patients with ischemic heart disease who belong to a primary care center. MATERIAL AND METHODS: Two inquests were done to 1,850 Spanish cardiologist using a question paper in 1993 and 1996. At the Primary Care Center of Fuencarral (Madrid) we made a transversal study from February till March 1996. RESULTS: In 1993, 11% answered the questionnaire and 25% in 1996. Cardiologists who considered the ideal level of cholesterol lower than 200 mg/dl raised from 62% in 1993 to 86% in 1996 (p < 0.001). Cardiologists who considered that cholesterol linked to low density lipoproteins should be lower than 100 mg/dl raised from 0% in 1993 to 28% in 1996 (p < 0.001). Drug treatment was prescribed by 68% when total cholesterol levels were higher than 300 mg/dl in 1993 and 14% of cardiologists never prescribed drugs. In 1996, 71% prescribed drug treatment when total cholesterol was between 200 and 250 mg/dl (p < 0.001). Cardiologists who worked at hospitals began with drugs with a lower cholesterol levels than out-hospital cardiologists. Hypercholesterolemia was considered as the most important risk factor in secondary prevention. We review 94 patients with ischemic heart disease; 37 did not receive hypolipemic treatment, though they had more than 200 mg/dl of cholesterol. Just 12 of the 45 treated reached figures below 200 mg/dl. 32% of the patients where controlled by family doctor's. CONCLUSIONS: Results of the two surveys in 1993 and 1996 have produced a change in Spanish cardiologist attitude about indication of hypolipemic treatment for patients suffering from ischemic cardiomiopathy. Family doctor's and cardiologists must assume secondary prevention. Indeed, it is necessary to make them both become aware of the importance of a correct treatment of those patients.