Ultrasound screening for abdominal aortic aneurysm in primary care. / Utilidad de la ecografía en el cribado del aneurisma de aorta abdominal en atención primaria.

INTRODUCTION: Abdominal aortic aneurysm (AAA) constitutes a pathology with high mortality. There is currently no screening program implemented in primary care in Spain. OBJECTIVES: To evaluate the usefulness of ultrasound in the detection of AAA in the at-risk population in primary care. Secondarily, to identify subjects whose vascular risk (VR) should be reclassified and to determine whether AAA is associated with the presence of carotid plaque and other risk factors. MATERIAL AND METHODS: Cross-sectional, descriptive, multicenter, national, descriptive study in primary care. SUBJECTS: A consecutive selection of hypertensive males aged between 65 and 75 who are either smokers or former smokers, or individuals over the age of 50 of both sexes with a family history of AAA. MEASUREMENTS: Diameter of abdominal aorta and iliac arteries; detection of abdominal aortic and carotid atherosclerotic plaque. VR was calculated at the beginning and after testing (SCORE). RESULTS: One hundred and fifty patients were analyzed (age: 68.3±5 years; 89.3% male). Baseline RV was high/very high in 55.3%. AAA was detected in 12 patients (8%; 95% CI: 4-12); aortic ectasia in 13 (8.7%); abdominal aortic plaque in 44% and carotid plaque in 62% of the participants. VR was reclassified in 50% of subjects. The detection of AAA or ectasia was associated with the presence of carotid plaque, current smoking and lipoprotein(a), p<0.01. CONCLUSIONS: The prevalence of AAA in patients with VR is high. Ultrasound in primary care allows detection of AAA and subclinical atherosclerosis and consequently reclassification of the VR, demonstrating its utility in screening for AAA in the at-risk population.

Análogos del glucagon-like peptide-1 (GLP-1): ¿una nueva estrategia de tratamiento para la enfermedad de Alzheimer? / Glucagon-like peptide-1 (GLP-1) mimetics: a new treatment for Alzheimer's disease?

Introducción. Los análogos del glucagon-like peptide-1 (GLP-1) son una opción terapéutica establecida en los pacientes con diabetes tipo 2. Sin embargo, las propiedades de los análogos del GLP-1 van más allá del control estrictamente metabólico del paciente diabético. Los efectos neuroprotectores de los análogos del GLP-1 se han puesto de manifiesto en estudios recientes y han abierto nuevos campos de investigación en trastornos neurodegenerativos como la enfermedad de Alzheimer (EA), entre otros. Objetivo. Revisión sistemática de los estudios experimentales y ensayos clínicos en humanos que demuestran las propiedades neuroprotectoras de los análogos del GLP-1 en la EA. Desarrollo. Los estudios experimentales que se han llevado a cabo en modelos de roedores con EA demuestran las propiedades neuroprotectoras de los análogos del GLP-1 sobre el sistema nervioso central que reducen las placas de β-amiloide, el estrés oxidativo y la respuesta inflamatoria cerebral. Recientemente se han puesto en marcha estudios con análogos del GLP-1 en humanos con deterioro cognitivo y EA. Conclusiones. Los análogos del GLP-1 presentan propiedades neuroprotectoras. Al considerarse la diabetes tipo 2 un factor de riesgo para el deterioro cognitivo y la demencia, deben considerarse los beneficios de los análogos del GLP-1 sobre la cognición. Del mismo modo, los análogos del GLP-1 suponen un tratamiento prometedor en la EA (AU)

Introduction. The glucagon-like peptide-1 (GLP-1) mimetics are an established therapeutic option for patients with type 2 diabetes. However, the properties of the GLP-1 mimetics go beyond the strict metabolic control of the patients with diabetes. The neuroprotective effects of GLP-1 have been shown in recent studies opening new areas of research in neurodegenerative diseases such as Alzheimer’s disease (AD), among others. Aim. Systematic review including experimental studies and human clinical trials demonstrating the neuroprotective properties of GLP-1 mimetics in AD. Development. The experimental studies that have been conducted in rodent models of AD have demonstrated the neuroprotective properties of GLP-1 in the central nervous system reducing β-amyloid plaques, the oxidative stress and the inflammatory brain response. Clinical trials in patients with cognitive impairment and AD testing the effects of GLP-1 analogs have recently started. Conclusion. The GLP-1 analogs have neuroprotective properties. Considering that type 2 diabetes is a risk factor for cognitive impairment and dementia, the benefits of GLP-1 mimetics on cognition must be considered. Likewise, the GLP-1 mimetics represent a promising treatment for neurodegenerative diseases such as AD (AU)

[Glucagon-like peptide-1 (GLP-1) mimetics: a new treatment for Alzheimer's disease?]. / Análogos del glucagon-like peptide-1 (GLP-1): ¿una nueva estrategia de tratamiento para la enfermedad de Alzheimer?

INTRODUCTION: The glucagon-like peptide-1 (GLP-1) mimetics are an established therapeutic option for patients with type 2 diabetes. However, the properties of the GLP-1 mimetics go beyond the strict metabolic control of the patients with diabetes. The neuroprotective effects of GLP-1 have been shown in recent studies opening new areas of research in neurodegenerative diseases such as Alzheimer's disease (AD), among others. AIM. Systematic review including experimental studies and human clinical trials demonstrating the neuroprotective properties of GLP-1 mimetics in AD. DEVELOPMENT: The experimental studies that have been conducted in rodent models of AD have demonstrated the neuroprotective properties of GLP-1 in the central nervous system reducing beta-amyloid plaques, the oxidative stress and the inflammatory brain response. Clinical trials in patients with cognitive impairment and AD testing the effects of GLP-1 analogs have recently started. CONCLUSION: The GLP-1 analogs have neuroprotective properties. Considering that type 2 diabetes is a risk factor for cognitive impairment and dementia, the benefits of GLP-1 mimetics on cognition must be considered. Likewise, the GLP-1 mimetics represent a promising treatment for neurodegenerative diseases such as AD.

TITLE: Analogos del glucagon-like peptide-1 (GLP-1): una nueva estrategia de tratamiento para la enfermedad de Alzheimer?Introduccion. Los analogos del glucagon-like peptide-1 (GLP-1) son una opcion terapeutica establecida en los pacientes con diabetes tipo 2. Sin embargo, las propiedades de los analogos del GLP-1 van mas alla del control estrictamente metabolico del paciente diabetico. Los efectos neuroprotectores de los analogos del GLP-1 se han puesto de manifiesto en estudios recientes y han abierto nuevos campos de investigacion en trastornos neurodegenerativos como la enfermedad de Alzheimer (EA), entre otros. Objetivo. Revision sistematica de los estudios experimentales y ensayos clinicos en humanos que demuestran las propiedades neuroprotectoras de los analogos del GLP-1 en la EA. Desarrollo. Los estudios experimentales que se han llevado a cabo en modelos de roedores con EA demuestran las propiedades neuroprotectoras de los analogos del GLP-1 sobre el sistema nervioso central que reducen las placas de beta-amiloide, el estres oxidativo y la respuesta inflamatoria cerebral. Recientemente se han puesto en marcha estudios con analogos del GLP-1 en humanos con deterioro cognitivo y EA. Conclusiones. Los analogos del GLP-1 presentan propiedades neuroprotectoras. Al considerarse la diabetes tipo 2 un factor de riesgo para el deterioro cognitivo y la demencia, deben considerarse los beneficios de los analogos del GLP-1 sobre la cognicion. Del mismo modo, los analogos del GLP-1 suponen un tratamiento prometedor en la EA.

Incidencia de cáncer en una cohorte de pacientes con lupus eritematoso sistémico / Rheumatology in the community of Madrid: current availability of rheumatologists and future needs using a predictive model

Objetivo. Determinar la incidencia y prevalencia del cáncer en una cohorte de pacientes con lupus eritematoso sistémico (LES) e identificar los factores de riesgo asociados. Pacientes y métodos. El estudio incluyó una cohorte dinámica de los pacientes con LES (de noviembre de 1989 a diciembre del 2006) en un centro hospitalario de tercer nivel. Se utilizó un control externo ajustado por edad y sexo a través de un registro hospitalario de tumores de la misma área sanitaria. Resultados. El estudio incluyó a 175 pacientes con LES (90% mujeres), con un tiempo en riesgo de 1370,5 pacientes-año. Catorce mujeres (8%) murieron, principalmente por eventos cardiovasculares. Ningún paciente falleció por tumor maligno. Se encontraron 35 tumores en 28 pacientes, 25 de ellos después del diagnóstico de LES, de los cuales 5 fueron malignos. La tasa de tumores benignos fue de 14,6/1000 pacientes-año (IC del 95%, 8,9–22,5) y de los tumores malignos 3,6/1000 pacientes-año (IC del 95%, 1,5 a 8,8), con una razón de momios de incidencia cruda para los tumores malignos de 3,5 (IC del 95%, 01,05 a 07,09). Sin embargo, esta significación se perdió cuando se estandarizaron las tasas. En cuanto a los factores de riesgo asociados, se encontraron diferencias en la velocidad de sedimentación globular media (HR 1,4 [1,1–1,7]), y la presencia de trombosis (HR 6,9 [1,49 a 41,2]), en especial la trombosis arterial. Conclusiones. Encontramos una tasa cruda de incidencia de cáncer casi 4 veces mayor en los pacientes con LES en comparación con la tasa esperada en nuestra área de influencia del hospital (zona oeste de Málaga) (AU)

Objective: To determine the incidence and prevalence of cancer in a cohort of patients with systemic lupus erythematosus (SLE) and identify associated risk factors. Patients and methods: The study comprised a dynamic cohort of SLE patients (November 1989 to December 2006) at a tertiary referral centre. An adjusted external control from the hospital tumour registry was used. Results: The study included 175 SLE patients (90% women), with a mean time at risk of 1370.5 patientyears. Fourteen women (8%) died, mainly from cardiovascular events. No patient died due to malignancy. We found 35 tumours in 28 patients, 25 of them after the diagnosis of SLE, of which 5 were malignant. The rate of benign tumours was 14.6/1000 patient-years (95% CI, 8.9–22.5) and of malignant tumours 3.6/1000 patient-years (95% CI, 1.5–8.8), with a crude incidence odds ratio for malignant tumours of 3.5 (95% CI, 1.5–7.9). However, this significance was lost after standardizing the rates. Concerning associated risk factors, differences were found in the mean erythrocyte sedimentation rate [HR 1.4 (1.1–1.7)], and the presence of thrombosis [HR 6.9 (1.49–41.2)], especially arterial thrombosis. Conclusions: We found a crude incidence rate of cancer that was almost four times greater in our SLE patients as compared with the expected rate in the hospital area of western Malaga (AU)

Incidence of cancer in a cohort of Spanish patients with systemic lupus erythematosus.

OBJECTIVE: To determine the incidence and prevalence of cancer in a cohort of patients with systemic lupus erythematosus (SLE) and identify associated risk factors. PATIENTS AND METHODS: The study comprised a dynamic cohort of SLE patients (November 1989 to December 2006) at a tertiary referral centre. An adjusted external control from the hospital tumour registry was used. RESULTS: The study included 175 SLE patients (90% women), with a mean time at risk of 1370.5 patient-years. Fourteen women (8%) died, mainly from cardiovascular events. No patient died due to malignancy. We found 35 tumours in 28 patients, 25 of them after the diagnosis of SLE, of which 5 were malignant. The rate of benign tumours was 14.6/1000 patient-years (95% CI, 8.9-22.5) and of malignant tumours 3.6/1000 patient-years (95% CI, 1.5-8.8), with a crude incidence odds ratio for malignant tumours of 3.5 (95% CI, 1.5-7.9). However, this significance was lost after standardizing the rates. Concerning associated risk factors, differences were found in the mean erythrocyte sedimentation rate [HR 1.4 (1.1-1.7)], and the presence of thrombosis [HR 6.9 (1.49-41.2)], especially arterial thrombosis. CONCLUSIONS: We found a crude incidence rate of cancer that was almost four times greater in our SLE patients as compared with the expected rate in the hospital area of western Malaga.

Síndrome de la arteria de Percheron: variabilidad clínica y diagnóstico diferencial / Percheron artery syndrome: variability in presentation and differential diagnosis

Introducción. El infarto talámico paramediano bilateral sincrónico, asimilado habitualmente al infarto de la arteria de Percheron, se considera infrecuente y de difícil diagnóstico clínico, basándose su caracterización en la descripción original y en pequeñas series. Objetivo. Caracterizar el infarto talámico paramediano bilateral sincrónico clínicamente mediante aglutinación de casos e identificar las claves de su dificultad diagnóstica precoz. Pacientes y métodos. Seis casos de nuestro centro, y 115 mediante búsqueda sistemática y lectura crítica de artículos, cumplieron los criterios de infarto talámico paramediano bilateral sincrónico. Se analizaron las variables edad, género, factores de riesgo vascular, etiología, alteración y fluctuaciones del nivel de consciencia, necesidad de intubación, trastorno cognitivo-conductual, alteraciones pupilares, otra focalidad neurológica y afectación del troncoencéfalo en neuroimagen. Resultados. En nuestra serie, destacan el trastorno del nivel de consciencia (n = 5), sus fluctuaciones (n = 3) y la demora diagnóstica (siete días, con resonancia magnética en cuatro pacientes). Sólo en uno se objetivó lesión bitalámica en la tomografía computarizada inicial. El análisis conjunto determinó edad media de 61 años; predominio masculino (58%); presencia de factores de riesgo vascular en el 77%; etiología dominante, la cardioembólica (el 34% entre los especificados); afectación del sensorio en el 75% (intubación en el 7% y fluctuaciones en el 16,5%), cognitivo-conductual en el 43%, oculomotora en el 73%, pupilar en el 31%, y de otro tipo en el 67%; y lesión del tronco especificada en el 37%. Conclusiones. El infarto talámico paramediano bilateral sincrónico constituye un síndrome de presentación variable, con una tomografía computarizada inicial de baja sensibilidad, y que precisa una resonancia magnética cerebral para su tipificación. Ello explica la dificultad diagnóstica y la probable infraestimación de su frecuencia (AU)

Introduction. Synchronous bilateral paramedian thalamic stroke (SBPTS), usually equated to Percheron artery infarction, is considered to be uncommon and difficult to diagnose clinically. Its characterization is based on the original description plus a few small series. Aim. To characterize SBPTS clinically by collecting cases and identifying the key difficulties for an early diagnosis. Patients and methods. Six cases at our centre plus another 115 located by systematic literature search and critical reading of articles fulfilled the criteria for SBPTS. An analysis was made of the variables age, gender, vascular risk factors, aetiology, alterations and fluctuations of consciousness, need for intubation, cognitive-behavioural disorders, pupillary changes, other neurological focal disorders and brainstem involvement on imaging studies. Results. Of note in our series were disorders of consciousness (n = 5), their fluctuations (n = 3) and the diagnostic delay (seven days, with MRI in four patients). In only one case was a bilateral thalamic lesion seen on the initial CT. Joint analysis of all the cases showed a mean age of 61 years, a predominance of men (58%), the presence of vascular risk factors in 77%, a mainly cardioembolic aetiology (34% among those that were specified), sensory involvement in 75% (intubation in 7% and fluctuations in 16.5%), cognitive-behavioural disorders in 43%, oculomotor in 73%, pupillary in 31%, other in 67% and specified brainstem lesion in 37%. Conclusions. The SBPTS syndrome has a variable presentation with a low sensitivity on the initial CT, requiring brain MRI for typification. This explains the diagnostic difficulty and the fact that its frequency is probably underestimated (AU)

Enfermedad arterial periférica oculta en población diabética seguida en atención primaria / Occult peripheral arterial disease in patients with type 2 diabetes in primary care

Introducción El objetivo del estudio fue estimar la prevalencia de enfermedad arterial periférica (EAP) no diagnosticada, mediante el índice tobillo-brazo (ITB), en pacientes diabéticos tipo 2 de una zona urbana seguidos en Atención Primaria (AP) y los factores asociados a la misma. Métodos Estudio descriptivo transversal (de prevalencia). Muestreo aleatorio sistemático de pacientes diabéticos tipo 2, entre 50–80 años, seguidos en AP. Nuestra variable dependiente fue la presencia de EAP diagnosticada mediante un ITB<0,9. Variables independientes: demográficas, clínicas y de laboratorio. Para determinar las variables asociadas a un ITB patológico se utilizó la regresión logística binaria por pasos hacia adelante. Resultados Muestra de 456 pacientes, de los que 243 (53%) eran hombres, con una edad media de 61±6 años. Presentaron ITB<0,9: 126 pacientes (27,6%), ITB entre 0,9 y 1,3: 310 pacientes (68%) y un ITB>1,3: 20 pacientes (4,4%). Mediante análisis multivariante las variables relacionadas con un ITB<0,9 fueron el ser o haber sido fumador, los años de evolución de la diabetes, el número de plaquetas y la hipertrigliceridemia, mientras que con un ITB>1,3 fueron el perímetro de cintura y las complicaciones microvasculares. Conclusiones La prevalencia de enfermedad arterial periférica es elevada en diabéticos tipo 2, consistente con lo publicado. Esta alta prevalencia de ITB alterado refuerza la recomendación de realizar el índice tobillo-brazo a todos los diabéticos tipo 2 mayores de 50 años valorados y seguidos en AP (AU)

Introduction The aim of our study was to estimate the prevalence and associated factors of occult peripheral arterial disease (PAD) assessed by the ankle-brachial index (ABI) in subjects with type 2 diabetes mellitus followed up in a single urban Primary Care Center. Methods This is a cross-sectional study involving subjects who were sampled randomly from patients with type 2 diabetes and aged 50 to 80 years-old. The dependent variable was the presence of PAD, assessed by an ABI below 0.9. Demographic, clinical and laboratory parameters were also recorded. A forward, stepwise, logistic binary regression was built in order to examine variables associated with abnormal ABI.ResultsFour-hundred and fifty-six patients were included; they were 61±6 years-old, of which 243 (53%) were men. An ABI<0.9 was found in 126 patients (27.6%), 310 (68%) patients had an ABI 0.9–1.3 and only 20 patients (4.4%) had and ABI higher than 1.3. Using multivariate analyses, past or present smoking, duration of diabetes, platelet count and hypertriglyceridemia, were independently associated to PAD; on the contrary, only waist cincumference and the presence of microvascular disease were associated to an ABI higher than 1.3.Conclusion The prevalence of PAD was high and consistent with the literature, thus reinforcing the measurement of ABI for all patients with type 2 diabetes followed up in primary care. Smoking, duration of diabetes, platelet count and hypertriglyceridemia were independently associated to a low ABI (AU)