Prevalencia de enfermedad renal crónica en España: impacto de la acumulación de factores de riesgo cardiovascular / Chronic kidney disease in Spain: Prevalence and impact of accumulation of cardiovascular risk factors

INTRODUCCIÓN: La enfermedad renal crónica (ERC) constituye un problema de salud pública a nivel mundial. Los objetivos de este estudio fueron estimar la prevalencia de ERC en España y evaluar el impacto de la acumulación de factores de riesgo cardiovascular (FRCV) en la prevalencia. MATERIAL Y MÉTODOS: Análisis del Estudio de Nutrición y Riesgo Cardiovascular en España (ENRICA), estudio epidemiológico de ámbito nacional, de base poblacional, con una muestra de 11.505 sujetos representativos de la población adulta española. La información se recogió mediante cuestionarios estandarizados, exploración física y colección de muestras de sangre y orina que se analizaron en un laboratorio centralizado. La ERC se definió según las guías KDIGO en curso. Se analizó la relación de la ERC con 10 FRCV (edad, hipertensión arterial, obesidad, obesidad abdominal, tabaquismo, colesterol LDL elevado, colesterol HDL disminuido, hipertrigliceridemia, diabetes y sedentarismo. RESULTADOS: La prevalencia de ERC fue del 15,1% (IC 95%: 14,3-16,0). La ERC fue más frecuente en varones (23,1% vs. 7,3% en mujeres), según aumentaba la edad (4,8% en sujetos de 18-44 años, 17,4% en sujetos de 45-64 años, y 37,3% en sujetos ≥ 65 años), y en sujetos con enfermedad cardiovascular (39,8% vs. 14,6% en sujetos sin enfermedad cardiovascular); todas las comparaciones con p < 0,001. La ERC afectó al 4,5% de los sujetos con 0-1FRCV, con un aumento progresivo desde el 10,4 al 52,3% en sujetos con 2 a 8-10FRCV (p de tendencia < 0,001). CONCLUSIONES: La ERC afecta a uno de cada 7 adultos en España, una prevalencia más elevada que la estimada en estudios previos en nuestro país y similar a la observada en Estados Unidos. La ERC afecta particularmente a los varones, a sujetos de edad avanzada o con enfermedad cardiovascular. La prevalencia de ERC aumenta de forma marcada con la acumulación de FRCV, lo que sugiere que la ERC en la población podría considerarse como un trastorno cardiovascular

BACKGROUND: Chronic kidney disease (CKD) is a public health problem worldwide. We aimed to estimate the CKD prevalence in Spain and to examine the impact of the accumulation of cardiovascular risk factors (CVRF). MATERIAL AND METHODS: We performed a nationwide, population-based survey evaluating 11,505 individuals representative of the Spanish adult population. Information was collected through standardised questionnaires, physical examination, and analysis of blood and urine samples in a central laboratory. CKD was graded according to current KDIGO definitions. The relationship between CKD and 10CVRF was assessed (age, hypertension, general obesity, abdominal obesity, smoking, high LDL-cholesterol, low HDL-cholesterol, hypertriglyceridaemia, diabetes and sedentary lifestyle). RESULTS: Prevalence of CKD was 15.1% (95%CI: 14.3-16.0%). CKD was more common in men (23.1% vs 7.3% in women), increased with age (4.8% in 18-44 age group, 17.4% in 45-64 age group, and 37.3% in ≥ 65), and was more common in those with than those without cardiovascular disease (39.8% vs 14.6%); all P <.001. CKD affected 4.5% of subjects with 0-1CVRF, and then progressively increased from 10.4% to 52.3% in subjects with 2 to 8-10CVRF (P trend <.001). CONCLUSIONS: CKD affects one in seven adults in Spain. The prevalence is higher than previously reported and similar to that in the United States. CKD was particularly prevalent in men, older people and people with cardiovascular disease. Prevalence of CKD increased considerably with the accumulation of CVRF, suggesting that CKD could be considered as a cardiovascular condition

A propósito de las discrepancias entre documentos de consenso, guías de práctica clínica y normativa legal en el tratamiento de la diabetes tipo 2 / About the discrepancies between consensus documents, clinical practice guidelines, and legal regulations in the treatment of type 2 diabetes

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Guía Europea de Prevención Cardiovascular en la Práctica Clínica. Adaptación española del CEIPC 2008 / European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. CEIPC 2008 Spanish Adaptation

Presentamos la adaptación española realizada por el Comité Español Interdisciplinario para la Prevención Cardiovascular (CEIPC) de la Guía Europea de Prevención de las Enfermedades Cardiovasculares 2008. Esta guía recomienda el modelo SCORE de riesgo bajo para valorar el riesgo cardiovascular. El objetivo es prevenir la mortalidad y la morbilidad debidas a las enfermedades cardiovasculares (ECV) mediante el tratamiento de sus factores de riesgo en la práctica clínica. La guía hace énfasis en la prevención primaria y en el papel del médico y el personal de enfermería de atención primaria en la promoción de un estilo de vida cardiosaludable, basado en el incremento de los grados de actividad física, la adopción de una alimentación saludable y, en los fumadores, el abandono del tabaco. La meta terapéutica para la presión arterial es en general<140/90mmHg; pero en pacientes con diabetes mellitus, enfermedad renal crónica o ECV el objetivo es 130/80mmHg. El colesterol debe mantenerse por debajo de 200mg/dl (colesterol unido a lipoproteínas de baja densidad [cLDL]<130mg/dl); en los pacientes con ECV o diabetes mellitus el objetivo es cLDL<100mg/dl (80mg/dl si factible en individuos de riesgo muy alto). En pacientes con diabetes mellitus tipo 2 y en pacientes con síndrome metabólico se debe reducir el peso y aumentar la actividad física y, en su caso, utilizar los fármacos indicados, para alcanzar los objetivos del índice de masa corporal y de perímetro de cintura. El objetivo en pacientes con diabetes mellitus tipo 2 debe ser alcanzar una hemoglobina glucosilada<7%. La amplia difusión de las guías y el desarrollo de los programas destinados a favorecer su implantación, en los que se identifiquen barreras y se busquen soluciones, son objetivos prioritarios del CEIPC, como uno de los medios fundamentales para trasladar las recomendaciones establecidas a la práctica clínica diaria(AU)

The present CEIPC Spanish adaptation of the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD by means of dealing with its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care doctors in promoting a healthy life style, based on increasing physical activity, changing dietary habits, and not smoking. The therapeutic goal is to achieve a Blood Pressure<140/90mmHg, but in patients with diabetes, chronic kidney disease, or definite CVD, the objective is<130/80mmHg. Serum cholesterol should be<200mg/dl and cLDL<130mg/dl, although in patients with CVD or diabetes, the objective is<100mg/dl (80mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, with the objective guided by body mass index and waist circumference. In diabetic type 2 patients, the objective is glycated haemoglobin<7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to put the recommendations into practice(AU)

Guía Europea de Prevención Cardiovascular en la Práctica Clínica. Adaptación española del CEIPC 2008 / European guidelines on cardiovascular disease prevention in clinical practice. CEIPC (Comité Español Interdisciplinario para la Prevención Cardiovascular) 2008 Spanish Adaptation

Presentamos la adaptación española realizada Cardiovasculares 2008. Esta guía recomienda el por el Comité Español Interdisciplinario para la modelo SCORE de riesgo bajo para valorar el Prevención Cardiovascular (CEIPC) de la Guía riesgo cardiovascular. El objetivo es prevenir la Europea de Prevención de las Enfermedades mortalidad y la morbilidad debidas a las enfermedades cardiovasculares (ECV) mediante el tratamiento de sus factores de riesgo en la práctica clínica. La guía hace énfasis en la prevención primaria y en el papel del médico y el personal de enfermería de atención primaria en la promoción de un estilo de vida cardiosaludable, basado en el incremento de los grados de actividad física, la adopción de una alimentación saludable y, en los fumadores, el abandono del tabaco. La meta terapéutica para la presión arterial es en general < 140/90 mmHg; pero en pacientes con diabetes mellitus, enfermedad renal crónica o ECV el objetivo es 130/80 mmHg. El colesterol debe mantenerse por debajo de 200 mg/dl (colesterol unido a lipoproteínas de baja densidad [cLDL] < 130 mg/dl); en los pacientes con ECV o diabetes mellitus el objetivo es cLDL < 100 mg/dl (80 mg/dl si factible en individuos de riesgo muy alto). En pacientes con diabetes mellitus tipo 2 y en pacientes con síndrome metabólico se debe reducir el peso y aumentar la actividad física y, en su caso, utilizar los fármacos indicados, para alcanzar los objetivos del índice de masa corporal y de perímetro de cintura. El objetivo en pacientes con diabetes mellitus tipo 2 debe ser alcanzar una hemoglobina glucosilada < 7%. La amplia difusión de las guías y el desarrollo de los programas destinados a favorecer su implantación, en los que se identifiquen barreras y se busquen soluciones, son objetivos prioritarios del CEIPC, como uno de los medios fundamentales para trasladar las recomendaciones establecidas a la práctica clínica diaria (AU)

The present CEIPC Spanish adaptation of the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD by means of dealing with its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care doctors in promoting a healthy life style, based on increasing physical activity, changing dietary habits, and not smoking. The therapeutic goal is to achieve a Blood Pressure < 140/90 mmHg, but in patients with diabetes, chronic kidney disease, or definite CVD, the objective is < 130/80 mmHg. Serum cholesterol should be < 200 mg/dl and cLDL < 130 mg/dl, although in patients with CVD or diabetes, the objective is < 100 mg/dl (80 mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, with the objective guided by body mass index and waist circumference. In diabetic type 2 patients, the objective is glycated haemoglobin < 7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to put the recommendations into practice (AU)

Carrapatos do gênero amblyomma (acari: ixodidae) e suas relações com os hospedeiros em área endêmica para febre maculosa no Estado de São Paulo / Ticks of genus Amblyomma (Acari: Ixodidae) and their relationship with hosts in endemic area for spotted fever in the state of São Paulo

Seven species of mammals and 36 of birds were investigated to determine the tick prevalence and intensity of infestation. The study was conducted at the Esalq/USP in Piracicaba municipality, State of São Paulo. It was collected 52 mammals and 158 birds parasitized by 12,418 ticks. Adult ticks (N= 7,343) were found on capybaras, while the immature were mainly collected on small mammals and birds. The main hosts for immatures in descending order were opossums (69.1 percent), capybara (24.4 percent) and black vultures (3.7 percent). Among the avifauna, the black vulture (Cathartidae) had the heaviest infestation (69.9 percent) followed by species of the Thamnophilidae and Turdidae families. Adult ticks collected on capybaras were A. cajennense (80.8 percent) and A. dubitatum (19.2 percent). Both tick species were also found on opossums corresponding to 72.4 percent and 27.6 percent, respectively. Due to easy capture and attractiveness for ticks, opossums could be used as bioindicators in Brazilian zoonotic areas with spotted fever. Considering the prevalence and also abundance of ticks, host attractiveness, proliferation and susceptibly for R. rickettsi infection, capybaras and opossums are the main amplifying hosts for this microorganism at the ESALQ/Campus, while horses, black vultures and stray cats act as secondary hosts.

Foram avaliadas 7 espécies da mastofauna e 36 da avifauna quanto à prevalência e intensidade de infestação por carrapatos na ESALQ/USP, no Município de Piracicaba, SP. Analisaram-se 52 indivíduos da mastofauna e 158 da avifauna, parasitados por 12418 carrapatos. Os exemplares adultos (N= 7343) foram encontrados em parasitismo nas capivaras enquanto que os imaturos foram, na maioria, coletados de pequenos mamíferos e aves. Os principais hospedeiros para as formas imaturas, em ordem decrescente, foram gambás (69,1 por cento), capivaras (24,4 por cento) e urubus (3,7 por cento). Entre a avifauna, o urubu apresentou o maior número de carrapatos com 69,9 por cento, seguido por indivíduos das famílias Thamnophilidae e Turdidae. Os carrapatos adultos encontrados em capivaras foram A. cajennense (80,8 por cento) e A. dubitatum (19,2 por cento). Ambas as espécies foram também coletadas em gambás, correspondendo a 72,4 por cento e 27,6 por cento, respectivamente. Pela facilidade de captura e atratividade de Amblyomma spp. o gambá pode ser usado como bioindicador de infestação em locais endêmicos para febre maculosa. Considerando os índices de parasitismo e prevalência bem como de abundância de carrapatos, susceptibilidade dos hospedeiros, proliferação e susceptibilidade para infecção por R. rickettsi, capivaras e gambás são potenciais hospedeiros amplificadores desse microrganismo no Campus da ESALQ, enquanto eqüídeos, urubus e gatos atuam como hospedeiros secundários.

[Ticks of genus Amblyomma (Acari: Ixodidae) and their relationship with hosts in endemic area for spotted fever in the State of São Paulo]. / Carrapatos do gênero Amblyomma (Acari: Ixodidae) e suas relações com os hospedeiros em área endêmica para Febre Maculosa no estado de São Paulo.

Seven species of mammals and 36 of birds were investigated to determine the tick prevalence and intensity of infestation. The study was conducted at the Esalq/USP in Piracicaba municipality, State of São Paulo. It was collected 52 mammals and 158 birds parasitized by 12,418 ticks. Adult ticks (N= 7,343) were found on capybaras, while the immature were mainly collected on small mammals and birds. The main hosts for immatures in descending order were opossums (69.1%), capybara (24.4%) and black vultures (3.7%). Among the avifauna, the black vulture (Cathartidae) had the heaviest infestation (69.9%) followed by species of the Thamnophilidae and Turdidae families. Adult ticks collected on capybaras were A. cajennense (80.8%) and A. dubitatum (19.2%). Both tick species were also found on opossums corresponding to 72.4% and 27.6%, respectively. Due to easy capture and attractiveness for ticks, opossums could be used as bioindicators in Brazilian zoonotic areas with spotted fever. Considering the prevalence and also abundance of ticks, host attractiveness, proliferation and susceptibly for R. rickettsi infection, capybaras and opossums are the main amplifying hosts for this microorganism at the ESALQ/Campus, while horses, black vultures and stray cats act as secondary hosts.

[European Guidelines on Cardiovascular Disease Prevention in Clinical Practice: CEIPC 2008 Spanish adaptation]. / Guía europea de prevención cardiovascular en la práctica clínica: Adaptación española del CEIPC 2008.

We present the Spanish adaptation from the CEIPC of the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD by means of dealing with its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care medical doctors in promoting a healthy life style, based on increasing physical activity, change dietary habits, and non smoking. The therapeutic goal is to achieve a Blood Pressure <140/90 mmHg, but among patients with diabetes, chronic kidney disease, or definite CVD, the objective is <130/80 mmHg. Serum cholesterol should be <200 mg/dl and cLDL <130 mg/dl, although among patients with CVD or diabetes, the objective is <100 mg/dl (80 mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, with the objective guided by BMI -body mass index- and waist circumference. In diabetic type 2 patients, the objective is glycated haemoglobin <7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to put the recommendations into practice.

Seudofeocromocitoma como causa de hipertensión arterial grave y paroxística / Pseudopheochromocytoma as cause of severe and paroxysmal hypertension

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Avifauna em fragmentos da Mata Atlântica / Avifauna in Atlantic Forest fragments

O estudo foi realizado em área localizada na Serra do Mar, no domínio da Mata Atlântica, na formaçäo florestal denominada Floresta Ombrófila Densa Atlântica, no Município de Paraibuna, Estado de Säo Paulo, Brasil (localizado entre 23º31Æ e 23º33Æ de latitude Sul, 45º39Æ e 45º42Æ de longitude Oeste, e entre 944 a 1,136m de altitude). Foram estudados três fragmentos de vegetaçäo natural de 47, 26 e 4 hectares, e uma área de plantio de eucaliptos adjacente, sendo a vegetaçäo dos fragmentos composta por mata ciliar em estágio médio de regeneraçäo secundária. O método utilizado para o registro da avifauna foi o de observaçöes por pontos fixos. O principal objetivo foi analisar os grupos de aves afetados pela fragmentaçäo florestal e avaliar os impactos causados pela fragmentaçäo e isolamento destas áreas. Considerando-se o método utilizado e todas as áreas estudadas, foi possível registrar 113 espécies de aves, distribuídas em 27 famílias e 13 ordens, sendo as principais guildas a insetívora, onívora e granívora, todas ocupando o sub-bosque. A composiçäo de espécies foi afetada pela fragmentaçäo e reduçäo da área de vegetaçäo natural. A quantidade e diversidade de aves apresentou relaçäo direta com o tamanho dos fragmentos e estrutura da vegetaçäo, e inversa com o grau de isolamento