Incidencia de litiasis vesicular asintomática en pacientes con complicaciones biliares / Incidence of asymptomatic gallstones in patients with biliary complications / Incidência de cálculos biliares asintomáticos em pacientes com complicações biliares

Introducción: Las complicaciones de la litiasis biliar (LB) son una causa importante de morbilidad en nuestro país y en el mundo entero y generan elevados costos en salud. Objetivo: El objetivo de este trabajo fue determinar, que pacientes con una complicación de su patología litiásica de la vía biliar (colecistitis, colangitis aguda, pancreatitis aguda), fueron previamente asintomáticos, resultando dicha complicación el debut de la enfermedad. Lugar: Sanatorio Asociación Española de Socorros Mutuos, Montevideo Uruguay. Diseño: Estudio observacional descriptivo, retrospectivo, análisis de historias clínicas. Materiales y Métodos: Se analizaron 234 casos clínicos. Se constató en este grupo de pacientes, características epidemiológicas, metodología diagnóstica, tratamientos recibidos y complicaciones. Resultados: Del total de pacientes (n=234), 109 (46.6%) tenían una litiasis vesicular asintomática (LVA) y la complicación biliar, fue el debut de su enfermedad. La colecistitis aguda fue la complicación más frecuente (68%), en segundo lugar, la colangitis aguda (22%) y en tercer lugar la pancreatitis aguda (10%). La edad promedio de presentación de la enfermedad fue los 59 años. Conclusiones: Casi la mitad de los pacientes (46.6%) que presentaron una complicación de su litiasis biliar eran asintomáticos. Este sería un argumento importante para indicar la colecistectomía laparoscópica con un criterio profiláctico en pacientes con una LVA.

Introduction : Complications of gallstones are an important cause of morbidity in our country and throughout the world and generate high health costs. Objective: The objective of this study was to determine which patients with a complication of their bile duct stone pathology (cholecystitis, acute cholangitis, acute pancreatitis) were previously asymptomatic, and this complication resulted in the onset of the disease. Place: Sanatorium Asociación Española de Socorros Mutuos, Montevideo Uruguay. Design: Descriptive and retrospective observational study with an analysis of medical records. Materials and Methods: 234 clinical cases were analyzed. Epidemiological characteristics, diagnostic methodology, treatments received, and complications were assessed in this group of patients. Results: Of the total number of patients (n=234), 109 (46.6%) had an asymptomatic gallbladder lithiasis and the biliary complication was the debut of their disease. Acute cholecystitis was the most frequent complication (68%), followed by acute cholangitis (22%) and third by acute pancreatitis (10%). The average age of presentation of the disease was 59 years. Conclusions: Almost half of the patients (46.6%) who presented a complication of their gallstones were asymptomatic. This would be an important argument to indicate laparoscopic cholecystectomy with a prophylactic criterion in patients with asymptomatic gallbladder lithiasis.

Introdução: As complicações dos cálculos biliares são uma importante causa de morbidade em nosso país e em todo o mundo e geram altos custos de saúde. Objetivo: O objetivo deste estudo foi determinar quais pacientes com uma complicação de sua patologia de cálculo do ducto biliar (colecistite, colangite aguda, pancreatite aguda) eram previamente assintomáticos, e essa complicação resultou no aparecimento da doença. Local: Sanatório Asociación Española de Socorros Mutuos, Montevidéu - Uruguai. Desenho: Estudo observacional descritivo, retrospectivo, análise de histórias clínicas. Materiais e Métodos: Foram analisados ​​234 casos clínicos. Características epidemiológicas, metodologia diagnóstica, tratamentos recebidos e complicações foram avaliadas neste grupo de pacientes. Resultados: Do total de pacientes (n=234), 109 (46,6%) apresentavam litíase vesicular assintomática e a complicação biliar foi o início da doença. A colecistite aguda foi a complicação mais frequente (68%), seguida da colangite aguda (22%) e a terceira da pancreatite aguda (10%). A idade média de apresentação da doença foi de 59 anos. Conclusões: Quase metade dos pacientes (46,6%) que apresentaram complicação de seus cálculos biliares eram assintomáticos. Esse seria um argumento importante para indicar a colecistectomia laparoscópica com critério profilático em pacientes com litíase vesicular assintomática.

A short guide to cancer screening: increase effectiveness, maximize benefits and minimize harm

The purpose of cancer screening tests is to detect pre-cancer or early-stage cancer in asymptomaticindividuals so that timely diagnosis and early treatment can be offered, where this treatment can leadto better outcomes for some people. The aim of a cancer screening programme is either to reducemortality and morbidity in a population by early detection and early treatment of a cancer (forexample, breast screening) or to reduce the incidence of a cancer by identifying and treating itsprecursors (such as cervical and colorectal screening). This short guide is designed to be a quickreference that contains the important ideas about cancer screening. Readers should refer to otherpublications for comprehensive discussion and detailed guidance on cancer screening programmes.

La salud pública en la primera ola: una agenda para la cooperación ante Covid-19 / Public health in the first wave: a research agenda for cooperation under Covid-19

Resumen El Covid-19 representa uno de los retos más grandes en la historia reciente de la salud pública. Es fundamental que se fortalezcan los lazos de cooperación científica bajo un objetivo común: proteger la salud de la población. En este artículo se presentan ideas que necesitan un desarrollo urgente y colaborativo. Se discute la estimación de la magnitud de la epidemia mediante un panel nacional de seroprevalencia y nuevas estrategias para mejorar el monitoreo en tiempo real de la epidemia. También se analizan las externalidades negativas asociadas con la respuesta a la pandemia. Finalmente, se presenta un marco general para el desarrollo de ideas para salir del confinamiento, resaltando la importancia de implementar acciones estructurales, sostenibles y equitativas. Se hace un llamado a la solidaridad y la cooperación, donde nuestros esfuerzos y creatividad se dediquen a la resolución de los problemas que enfrentan México y el mundo.

Abstract Covid-19 represents one of the largest challenges in the recent history of public health. It is fundamental that we strengthen scientific cooperation under a common goal: to protect the health of the population. In this article, we present ideas that need urgent and collaborative efforts. We discuss the estimation of the magnitude of the epidemic through a nationwide seroprevalence panel, as well as new strategies to monitor the epidemic in real time. We also analyze the negative externalities associated to the pandemic. Finally, we present a general framework to develop ideas to come out of the lockdown, highlighting the importance of implementing sustainable and equitable structural interventions. We call for solidarity and cooperation, focusing our efforts and creativity in the resolution of the problems that currently affect Mexico and the world.

Comparación de puntajes de riesgo para predecir aterosclerosis subclínica / Comparison of risk scores to predict subclinical atherosclerosis

La aterosclerosis subclínica es un potente predictor de eventos cardiovasculares, aunque se desconoce cuál de los puntajes de riesgo es más eficaz para predecir su presencia en una población latinoamericana. El objetivo fué comparar la performance de los puntajes de riesgo: Framingham, Regicor y Atherosclerotic Cardiovascular Disease Risk Estimator para predecir la existencia de aterosclerosis subclínica en pacientes asintomáticos sin enfermedad cardiovascular conocida; así como determinar la prevalencia y distribución en los distintos lechos vasculares. Desde 2014 a 2017 se evaluaron pacientes de 35 a 75 años asintomáticos y sin enfermedad cardiovascular conocida, a quienes se les realizó una eco Doppler carotídea y femoral, y score de calcio. Se definió como aterosclerosis subclínica a la presencia de placas en las arterias carótidas y/o femorales o a la presencia de calcio en las coronarias (score de Agatston > 0). Se estudiaron así 212 pacientes, edad media 53 ± 7 años, de los cuales el 60% (128) eran varones. La prevalencia de aterosclerosis subclínica fue 62% (131 casos). De esos 131 con placa en alguno de los territorios, el Atherosclerotic Cardiovascular Disease Risk Estimator fue el que identificó el mayor número de casos con riesgo cardiovascular elevado (39%), Framingham detectó 20%, y Regicor 0% (p < 0.01). La reclasificación neta fue del 41%, 50% y 60% respectivamente (< 0.01). La prevalencia de aterosclerosis subclínica en sujetos asintomáticos sin antecedentes de enfermedad cardiovascular fue 62%. El calculador Atherosclerotic Cardiovascular Disease Risk Estimator fue el más efectivo para predecir aterosclerosis subclínica en esta población.

Subclinical atherosclerosis is a powerful predictor of cardiovascular events, although it is unknown which of the risk scores is more useful to predict its presence in a Latin American population. The objective was to compare the performance of the risk scores: Framingham, Regicor and Atherosclerotic Cardiovascular Disease Risk Estimator to predict the presence of subclinical atherosclerosis in asymptomatic persons without known cardiovascular disease; as well as determining its prevalence and distribution in the different vascular beds. From 2014 to 2017, patients from 35 to 75 years, asymptomatic and without known cardiovascular disease who underwent a carotid and femoral Doppler echo and calcium score were evaluated. Subclinical atherosclerosis was defined as the presence of plaques in the carotid and/or femoral arteries or the presence of calcium in the coronary arteries (Agatston score > 0). A total of 212 patients were included. The mean age was 53 ± 7 years, of which 60% (128) were male. The prevalence of subclinical atherosclerosis was 62% (131 cases). Of these 131 subjects with a plaque in any of the territories, the Atherosclerotic Cardiovascular Disease Risk Estimator was the one that identified the highest number of cases with high cardiovascular risk (39%), Framingham detected 20%, and Regicor 0% (p < 0.01). The net reclassification was 41%, 50% and 60% respectively (< 0.01). The prevalence of subclinical atherosclerosis in asymptomatic persons without a history of cardiovascular disease was 62%. The Atherosclerotic Cardiovascular Disease Risk Estimator was the most effective predictor of subclinical atherosclerosis in this population.

Litiasis vesicular asintomática: ¿expectar o intervenir?. Revisión de literatura / Asymptomatic biliary lithiasis . Expectant behaviour or active treatment?

Contexto: La litiasis vesicular asintomática es un cuadro clínico cuyo abordaje terapéutico resulta controversial. Objetivos: Definir qué pacientes con litiasis vesicular son asintomáticos, identificar riesgos y beneficios de la conducta expectante en pacientes asintomáticos, mencionar qué grupos de pacientes asintomáticos se beneficia con la cirugía preventiva. Material y métodos: Se realizó una revisión de trabajos publicados en la plataforma. Pubmed para identificar y analizar aquellos que consideramos más representativos sobre litiasis vesicular asintomática, y así describir la conducta más apropiada ante dicha situación. Resultados: Al realizar la revisión de artículos con bajo nivel de evidencia (C-D) observamos que par la litiasis vesicular asintomática la conducta expectante es la más recomendada. Sin embargo varios trabajos hacen referencia a grupos de pacientes seleccionados que debido a su condición de base se beneficiarían con la cirugía. Conclusiones: Con la información obtenida de los artículos analizados se concluye que No está recomendada de forma rutinaria la colecistectomía profiláctica en los pacientes con litiasis asintomática; los pacientes que se benefician de la cirugía y en los cuales la indicación de colecistectomía es clara son: pacientes con riesgo elevado de desarrollar cáncer de vesícula (existencia de pólipos vesiculares con crecimiento rápido o mayor de 1 cm, vesícula en porcelana, cáculo mayor de 3 cm, mujer joven de origen ameroindio) y pacientes con mayor riesgo de desarrollar coplicaciones como son los jóvenes con anemia hemolítica crónica. El procedimiento quirúrgico iindicado es la colecistectomía por vía laparoscópica, siendo éste el procedimiento quirúrgico con menor tasa de morbimortalidad y mejor recuperarción postoperatoria disponibe (AU)

The presence of stones in the gallbladder is a condition relatively common in many parts of the world, being present in 10% to 15% of the adult population, and the presence of stones in the gallbladder afficts more than 21.9 % of the population of the city of Buenos Aires. When patients present with symptoms of biliary lithiasis, there is consense toward the surgical removal. But in the patients with asymptomatic gallstones that have no pain and do not have compications, the management of these silent gallstones is somewhat controversial. Data coupled with results suggesting that persons's life expectancy is not increased by prophylactic cholecystectomy, have discouraged surgical tratment of gallstones unless symptoms are present. The aim of this report was to determine which patients with biliary lithiasis should be considered as asymptomatic patients, and to consider which group of the expectant management in asymptomatic patients, and to consider which group of these patients can be beneficiated with a preventive cholecystectomy. A revision of the literature was performed, considering the management of the asymptomatic gallstone disease, whether if it should be preferable the expectant management or instead an active treatment. The expectant management was the mos recommended procedure fot these patients (AU)

Prevalencia y extensión de la calcificación arterial coronaria en población mexicana asintomática cardiovascular: estudio Genética de la Enfermedad Aterosclerosa / Prevalence and extent of coronary artery calcification in an asymptomatic cardiovascular Mexican population: Genetics of Atherosclerotic Disease study

Resumen: Objetivo: La prevalencia de calcificación arterial coronaria (CAC), marcador específico de aterosclerosis, no es conocida en México. Nuestro objetivo fue investigar la prevalencia y extensión de CAC y su asociación con factores de riesgo cardiovascular en población mexicana. Métodos: La CAC fue medida por tomografía computarizada multidetector en individuos asintomáticos que participaron en el estudio Genética de la Enfermedad Aterosclerosa. Los factores de riesgo cardiovascular y los medicamentos fueron registrados. Resultados: La muestra incluyó 1,423 individuos (49.5% hombres), con una edad de 53.7 ± 8.4 años. Los portadores de CAC mostraron prevalencias más altas de dislipidemia, diabetes, hipertensión y otros factores de riesgo. La prevalencia de CAC > 0 unidades Agatston fue de 27%, significativamente más alta en hombres (40%) que en mujeres (13%). Los valores medios del puntaje de CAC aumentaron consistentemente con la edad y fueron más altos en hombres que en mujeres en todos los grupos etarios. La edad y el c-LDL elevado se asociaron de manera independiente con la prevalencia de CAC > 0 en hombres y mujeres, mientras que la presión arterial sistólica en las mujeres, y el incremento de la edad en ambos géneros mostró una asociación independiente con la severidad de CAC. Conclusiones: En población mexicana la prevalencia y la extensión de CAC fueron mucho más altas en hombres que en mujeres y aumentaron consistentemente con la edad. Los predictores independientes de la prevalencia de CAC fueron la edad y el c-LDL.

Abstract: Objective: The prevalence of coronary artery calcification (CAC), a specific marker of atherosclerosis, is unknown in Mexico. Our aim was to investigate the prevalence and quantity of CAC and their association with cardiovascular risk factors in a Mexican population. Methods: CAC was measured by multidetector computed tomography in asymptomatic subjects who participated in the Genetics of Atherosclerotic Disease study. Cardiovascular risk factors and medication were recorded. Results: The sample included 1,423 individuals (49.5% men), aged 53.7 ± 8.4 years. Those with CAC showed a higher prevalence of dyslipidaemia, diabetes, hypertension, and other risk factors. The prevalence of CAC > 0 Agatston units was significantly higher among men (40%) than among women (13%). Mean values of CAC score increased consistently with increasing age and were higher in men than women in each age group. Age and high low density lipoprotein cholesterol were independently associated with prevalence of CAC > 0 in men and women, while increasing systolic blood pressure in women and age in both genders showed an independent association with CAC extension. Conclusions: In the Mexican population the prevalence and extent of CAC were much higher in men than in women, and strongly increased with age. Independent predictors of CAC prevalence were age and low density lipoprotein cholesterol (LDL-C).

High frequency of silent brain infarcts associated with cognitive deficits in an economically disadvantaged population

OBJECTIVE: Using magnetic resonance imaging, we aimed to assess the presence of silent brain vascular lesions in a sample of apparently healthy elderly individuals who were recruited from an economically disadvantaged urban region (São Paulo, Brazil). We also wished to investigate whether the findings were associated with worse cognitive performance. METHODS: A sample of 250 elderly subjects (66-75 years) without dementia or neuropsychiatric disorders were recruited from predefined census sectors of an economically disadvantaged area of Sao Paulo and received structural magnetic resonance imaging scans and cognitive testing. A high proportion of individuals had very low levels of education (4 years or less, n=185; 21 with no formal education). RESULTS: The prevalence of at least one silent vascular-related cortical or subcortical lesion was 22.8% (95% confidence interval, 17.7-28.5), and the basal ganglia was the most frequently affected site (63.14% of cases). The subgroup with brain infarcts presented significantly lower levels of education than the subgroup with no brain lesions as well as significantly worse current performance in cognitive test domains, including memory and attention (p<0.002). CONCLUSIONS: Silent brain infarcts were present at a substantially high frequency in our elderly sample from an economically disadvantaged urban region and were significantly more prevalent in subjects with lower levels of education. Covert cerebrovascular disease significantly contributes to cognitive deficits, and in the absence of magnetic resonance imaging data, this cognitive impairment may be considered simply related to ageing. Emphatic attention should be paid to potentially deleterious effects of vascular brain lesions in poorly educated elderly individuals from economically disadvantaged environments.

Chronic and asymptomatic diseases influence the control of hypertension treatment in primary care / Cronicidad y enfermedad asintomática influencian el control de los hipertensos en tratamiento en la atención básica / Cronicidade e doença assintomática influenciam o controle dos hipertensos em tratamento na atenção básica

Abstract OBJECTIVE To identify the association between blood pressure control and the following variables: a) bio-social and lifestyle characteristics of hypertensive patients; and b) factors related to the antihypertensive treatment. METHODS This is an exploratory study with 290 people with hypertension from primary care. We used a specific instrument, self-administered, with 21 questions on factors that can hinder treatment, divided into four dimensions: medication, socioeconomic, institutional and personal beliefs. We adopted a significance level of p <0.05. RESULTS The control of blood pressure was associated (p <0.05) with female gender, Caucasian ethnicity, primary/secondary education, not drinking alcohol, higher income and regular physical activity. Regarding the factors that can hinder treatment, there was association of hypertension control with only two questions: "feel nothing" and "have to do treatment for life". CONCLUSION Sociodemographic variables and beliefs concerning the absence of symptoms and chronicity of the disease influenced the control of hypertension and should be considered in the adherence process to the treatment.

Resumen OBJETIVO Identificar la asociación entre el control de la presión arterial y las siguientes variables: a) características biosociales y hábitos de vida de los hipertensos; y b) factores relacionados con el tratamiento antihipertensivo. MÉTODOS Se llevó a cabo estudio exploratorio con 290 hipertensos de la atención primaria. Se utilizó un instrumento específico, autoaplicable, con 21 cuestiones sobre factores que pueden dificultar el tratamiento, divididas en cuatro dominios: fármacos, socioeconómico, institucional y creencias personales. Se adoptó nivel de confianza de p < 0,05. RESULTADOS El control de la presión arterial se asoció (p < 0,05) con sexo femenino, etnia blanca, educacional básica/media, no ingerir bebida alcohólica, mayores ingresos y actividad física regular. En cuanto a los factores que pueden dificultar el tratamiento, hubo asociación del control con solo dos cuestiones: "no sentir nada" y "tener que hacer tratamiento para toda la vida". CONCLUSIÓN Variables sociodemográficas y creencias relativas a la ausencia de sintomatología y cronicidad de la enfermedad influenciaron el control de los hipertensos y deben considerarse en el proceso de adhesión al tratamiento.

Resumo OBJETIVO Identificar a associação entre o controle da pressão arterial e as seguintes variáveis: a) características biossociais e hábitos de vida dos hipertensos; e b) fatores relacionados ao tratamento anti-hipertensivo. MÉTODOS Realizou-se estudo exploratório com 290 hipertensos da atenção primária. Utilizou-se de instrumento específico, autoaplicável, com 21 questões sobre fatores que podem dificultar o tratamento, divididas em quatro domínios: medicamentos, socioeconômico, institucional e crenças pessoais. Adotou-se nível de significância de p < 0,05. RESULTADOS O controle da pressão arterial se associou (p < 0,05) com sexo feminino, etnia branca, ensino fundamental/médio, não ingerir bebida alcoólica, maior renda e atividade física regular. Quanto aos fatores que podem dificultar o tratamento, houve associação do controle com apenas duas questões: "não sentir nada" e "ter que fazer tratamento para vida toda". CONCLUSÃO Variáveis sociodemográficas e crenças relativas à ausência de sintomatologia e cronicidade da doença influenciaram o controle dos hipertensos e devem ser consideradas no processo de adesão ao tratamento.

Asymptomatic vertebral fractures in patients with low bone mineral density / Fraturas vertebrais assintomáticas em indivíduos com baixa massa óssea

Summary Objective: Vertebral fracture assessment (VFA) is a test technique that can be used to detect asymptomatic vertebral fractures (AVF). It uses dual energy X-ray bsorptiometry (DXA) and can be performed concurrently with bone densitometry. This study aims to assess the prevalence of AVF in patients with low bone mass. Methods: Cross-sectional study including 135 individuals with low bone mineral density (BMD) with a T-score < -2.0 standard deviation (SD) in a densitometry clinic located in the city of Blumenau (state of Santa Catarina). Anthropometric, clinical and lifestyle variables were obtained from history-taking and physical examination. Densitometric variables were obtained by bone mineral densitometry and VFA (Explorer, Hollogic®). Vertebral fractures were classified according to the Genant criteria. Student's t, chi-square and logistic regression were performed for statistical analysis. Results: AVFs occurred in 24.4% of the subjects. They were older compared to those without AVF (65±9.25 versus 60.1±8.66; p=0.005), and had a history of lowimpact fractures (38.24% versus 19.8%; OR 2.5; p=0.03). Half of the patients that reported steroid therapy had AVFs, compared to one fifth of those who did not use steroids (50% versus 21.49%; OR 3.6; p=0.01). Conclusion: Asymptomatic vertebral fractures were present in approximately one fourth of patients. The risk factors associated were history of low-impact fracture, use of steroids and age > 61 years.

Resumo Objetivos: vertebral fracture assessment (VFA) é uma técnica de exame que pode ser aplicada na detecção de fraturas vertebrais assintomáticas (FVA). Utiliza absorciometria de raios-X de dupla energia (DXA) e pode ser realizada concomitantemente ao exame de densitometria óssea. Este estudo visa a avaliar a prevalência de FVA em indivíduos com baixa massa óssea. Métodos: estudo transversal realizado em 135 indivíduos, com baixa densidade mineral óssea (DMO), com T-score < -2,0 desvio padrão (DP), em uma clínica de densitometria de Blumenau (SC). As variáveis antropométricas, clínicas e referentes ao estilo de vida foram obtidas por anamnese e exame clínico; as variáveis densitométricas foram obtidas por DMO e VFA (aparelho modelo Explorer, marca Hollogic®). As fraturas vertebrais foram classificadas de acordo com os critérios de Genant. Os testes estatísticos foram t de student, qui-quadrado e regressão logística. Resultados: FVA ocorreram em 24,4% dos indivíduos. A idade desses indivíduos foi superior à dos indivíduos sem FVA (65±9,25 vs. 60,1±8,66; p=0,005), assim como o antecedente de fratura por baixo impacto (38,24% vs.19,8%; OR 2,5; p=0,03). A metade dos indivíduos que relataram corticoterapia possuíam FVA, contrastando com um quinto dos indivíduos sem corticoterapia (50% vs. 21,49%; OR 3,6; p=0,01). Conclusão: fraturas vertebrais assintomáticas estiveram presentes em aproximadamente um quarto dos pacientes. Os fatores de risco associados foram história de fratura por baixo impacto, corticoterapia e idade > 61 anos.

Restrictive pattern on spirometry: association with cardiovascular risk and level of physical activity in asymptomatic adults / Distúrbio ventilatório restritivo sugerido por espirometria: associação com risco cardiovascular e nível de atividade física em adultos assintomáticos

Objective : To determine whether a restrictive pattern on spirometry is associated with the level of physical activity in daily life (PADL), as well as with cardiovascular disease (CVD) risk factors, in asymptomatic adults. Methods : A total of 374 participants (mean age, 41 ± 14 years) underwent spirometry, which included the determination of FVC and FEV1. A restrictive pattern on spirometry was defined as an FEV1/FVC ratio > 0.7 and an FVC < 80% of the predicted value. After conducting demographic, anthropometric, and CVD risk assessments, we evaluated body composition, muscle function, and postural balance, as well as performing cardiopulmonary exercise testing and administering the six-minute walk test. The PADL was quantified with a triaxial accelerometer. Results : A restrictive pattern on spirometry was found in 10% of the subjects. After multivariate logistic regression, adjusted for confounders (PADL and cardiorespiratory fitness), the following variables retained significance (OR; 95% CI) as predictors of a restrictive pattern: systemic arterial hypertension (17.5; 1.65-184.8), smoking (11.6; 1.56-87.5), physical inactivity (8.1; 1.43-46.4), larger center-of-pressure area while standing on a force platform (1.34; 1.05-1.71); and dyslipidemia (1.89; 1.12-1.98). Conclusions : A restrictive pattern on spirometry appears to be common in asymptomatic adults. We found that CVD risk factors, especially systemic arterial hypertension, smoking, and physical inactivity, were directly associated with a restrictive pattern, even when the analysis was adjusted for PADL and cardiorespiratory fitness. Longitudinal studies are needed in order to improve understanding of the etiology of a restrictive pattern as well as to aid in the design of preventive strategies.

Objetivo : Determinar se o distúrbio ventilatório restritivo (DVR) sugerido por espirometria está associado ao nível de atividade física na vida diária (AFVD), assim como a fatores de risco para doença cardiovascular (DCV), em adultos assintomáticos. Métodos : Um total de 374 participantes (média de idade, 41 ± 14 anos) realizou espirometria, que incluiu a determinação de CVF e VEF1. O DVR foi definido como a relação VEF1/CVF > 0,7 e CVF < 80% do valor previsto. Após a coleta de dados demográficos, dados antropométricos e dados relacionados aos fatores de risco para DCV, foram avaliados composição corporal, função muscular e equilíbrio postural, assim como realizados teste cardiopulmonar e teste de caminhada de seis minutos. O nível de AFVD foi medido por um acelerômetro triaxial. Resultados : O DVR sugerido por espirometria foi encontrado em 10% dos indivíduos. Após a regressão logística multivariada, ajustada para os fatores de confusão (AFVD e aptidão cardiorrespiratória), as seguintes variáveis permaneceram significativas (OR; IC95%) como preditoras de DVR: hipertensão arterial sistêmica (17,5; 1,65-184,8), tabagismo (11,6; 1,56-87,5), inatividade física (8,1; 1,43-46,4), maior área do centro de pressão durante apoio bipodal em plataforma de força (1,34; 1,05-1,71) e dislipidemia (1,89; 1,12-1,98). Conclusões : O DVR sugerido por espirometria parece ser um achado comum em adultos assintomáticos. Fatores de risco para DCV, principalmente hipertensão arterial sistêmica, tabagismo e sedentarismo, foram diretamente associados ao DVR, mesmo quando a análise foi ajustada para AFVD e aptidão cardiorrespiratória. Estudos longitudinais são necessários para melhorar a compreensão da etiologia do DVR, bem como para auxiliar na concepção de estratégias preventivas.

Risk of hypoglycemia during hemodialysis in diabetic patients is related to lower pre-dialysis glycemia

Objective To compare the occurrence of hypoglycemia during hemodialysis in chronic kidney disease diabetic patients who present different levels of pre-dialysis glycemia both when using dialysis solutions with and without glucose. Subjects and methods Twenty type 2 diabetic patients in maintenance hemodialysis were submitted to three dialysis sessions (at a 7-day interval each) with dialysis solutions without glucose, with glucose at 55 mg/dL, and at 90 mg/dL subsequently. Blood glucose levels were measured immediately pre-dialysis and at 4 moments during the session, and values under 70 mg/dL were considered as hypoglycemia. Results Average pre-dialysis glycemia was lower in those who presented intra-dialytic hypoglycemia than in those who did not, both in glucose-free (140.4 ± 50.7 vs. 277.7 ± 91.0 mg/dL; p = 0.005; 95%CI: 46.4 to 228.1) and in glucose 55 mg/dL (89.5 ± 10.6 vs. 229.7 ± 105.0 mg/dL; p < 0.05; 95%CI: 9.8 to 270.5). In patients with pre-dialysis glycemia under 140 mg/dL, average intradialytic glycemia was significantly lower than pre-dialysis glycemia only when using glucose-free dialysate (p < 0.0001; 95%CI: 29.9 to 56.0 - t-test). Hypoglycemia during dialysis was observed only when using glucose-free or glucose-poor dialysis solutions. Conclusions The use of glucose-free or glucose-poor dialysis solution presents a high risk of intradialytic hypoglycemia in diabetic renal patients, especially in those with presumed better glycemic control. .

Diagnosis and treatment of Paget's disease of bone: a mini-review / Diagnóstico e tratamento da doença de Paget dos ossos: uma minirrevisão

Paget's disease of bone (PDB) is a chronic progressive disorder of bone metabolism that may go undetected for many years, and endocrinologists should be alert to its clinical signs and promptly diagnose and treat PDB before it results in irreversible complications, such as deformity, fracture or neurological sequelae. Most commonly, PDB is suspected upon the incidental finding of elevated serum alkaline phosphatase levels or a radiographic abnormality in an otherwise healthy individual above 55 years of age. Some of these individuals may have symptoms such as bone pain or enlargement with increased warmth. In general, a basic laboratory evaluation of bone metabolism, plain radiographies of affected bones and bone scintigraphy are sufficient to corroborate the diagnosis. Antiresorptive therapy with bisphosphonates is the mainstay of treatment of symptomatic PDB, and intravenous zoledronic acid has emerged as an effective and safe treatment option, leading to sustained remission and improved quality of life. It is extremely important, though, to ensure calcium and vitamin D sufficiency before and during treatment in order to prevent hypocalcemia. The benefit of treating all asymptomatic patients is not clear, but treatment is warranted if the pagetic lesion is located in a site where progression to fracture, deformity, or compression would significantly impair the patient quality of life. This mini-review focuses on important aspects of the diagnosis and treatment of PDB.

A doença de Paget dos ossos (PDB) é uma doença progressiva e crônica do metabolismo ósseo que pode passar despercebida por muitos anos. Os endocrinologistas devem ficar alertas aos seus sinais clínicos e diagnosticar e tratar a PDB imediatamente, antes que ela gere complicações irreversíveis, como deformidade, fratura ou sequelas neurológicas. Mais comumente, suspeita-se da PBD após o achado incidental de níveis elevados de fosfatase alcalina no soro, ou anormalidades radiográficas em indivíduos aparentemente saudáveis com mais de 55 anos de idade. Alguns desses indivíduos podem apresentar sintomas, como a dor ou aumento ósseo com temperatura aumentada. Em geral, a avaliação laboratorial básica de metabolismo ósseo, radiografias simples dos ossos afetados e cintilografia óssea são suficientes para corroborar o diagnóstico. O tratamento antirreabsortivo com bifosfonatos é o principal tratamento da PDB sintomática, e o ácido zoledrônico intravenoso passou a ser uma opção de tratamento segura e eficiente, levando à manutenção da remissão e à melhora da qualidade de vida. É extremamente importante, entretanto, garantir níveis adequados de cálcio e vitamina D antes e durante o tratamento para se evitar a hipocalcemia. O benefício de se tratar todos os pacientes assintomáticos não está claro, mas o tratamento é recomendado se a localização da lesão pagética sugerir progressão para fratura, deformidade ou compressão que comprometam a qualidade de vida. Esta minirrevisão concentra-se em importantes aspectos do diagnóstico e tratamento da PDB.

Prevalence of weathering nodules of the ear in patients treated at the state civil servant's hospital of São Paulo, Brazil* / Prevalência de pápulas climáticas das orelhas nos pacientes atendidos no hospital do servidor público estadual de São Paulo, Brasil

Weathering nodules of the ear are pale yellow, asymptomatic lesions which predominate on the helices of the ears. Although their pathogenesis remains unknown, there is an association with chronic exposure to ultraviolet radiation, age and thermal injuries. Few studies have been conducted to date, and these involved a very small number of patients. Study the prevalence of weathering nodules of the ear in patients treated in the Dermatology Service of the State Civil Servant's Hospital of São Paulo, and evaluate their probable relationship with sun exposure, age and phototypes I and II. Four hundred patients older than 20 years of age were examined between July 2008 and December 2008. A questionnaire evaluating age, sex, place of birth, origin, occupation and history of sun exposure was applied. All patients were examined and evaluated for the presence of lesions by only one person. The data showed that 155 (38.8%) patients had a lesion in at least one of the ears. The Chi-Square Test was used for the comparative analysis between the groups of patients with and without lesions. In the group of patients with lesions, 29% were 70 to 79 years old, 78.1% had a history of sun exposure and 45.1% belonged to FITZPATRICK skin phototypes I and II (p<0.05%). The findings suggest relevant prevalence, probable association with chronic sun exposure, advanced age and phototypes I and II. .

Pápulas climáticas das orelhas são lesões assintomáticas de coloração amarelo-pálida que predominam na hélice das orelhas. Sua patogênese permanece desconhecida, no entanto é descrita a associação com exposição crônica à radiação ultravioleta, idade e injúrias térmicas. Poucos estudos foram realizados até o momento e os mesmos envolveram número muito reduzido de pacientes. Estudar a prevalência de pápulas climáticas das orelhas nos doentes atendidos no Serviço de Dermatologia no Hospital Servidor Estadual de São Paulo e avaliar a provável relação com exposição solar, idade e tipo de pele. Foram examinados 400 pacientes com idade superior a vinte anos no período compreendido entre os meses de julho de 2008 a dezembro de 2008. Foi aplicado questionário que avaliou idade, sexo, naturalidade, procedência, profissão e história de exposição solar Todos os sujeitos da pesquisa foram examinados por um único observador e avaliados quanto à presença de lesão. Os dados revelaram que 155 (38,8%) pacientes apresentavam lesão em pelo menos uma das orelhas. Foi utilizado o teste do Qui-Quadrado para análise comparativa entre o grupo de pacientes com e sem lesão. No grupo de pacientes com lesão 29% tinham idade entre 70 e 79 anos, 78,1% tinham história de exposição solar e 45,1% pertenciam ao fototipo I e II da classificação de FITZPATRICK (p<0,05%). Os achados sugerem prevalência relevante, provável associação ...

La electrofisiología del Wolff-Parkinson-White en el paciente asintomático con actividad o riesgo profesional alto / The electrophysiology of Wolff-Parkinson-White in the asymptomatic patient with activity or with high professional risk

Objetivo: Describir las características electrofisiológicas en individuos con Wolff-Parkinson-White asintomático con actividad deportiva o alta responsabilidad profesional. Métodos: Se evaluaron 19 individuos, edad media 33 ± 13 años (grupo A). Las características electrofisiológicas fueron comparadas con un grupo control similar con WPW sintomático (grupo B). Resultados: En estado basal el periodo refractario anterógrado y la conducción anterógrada 1:1 sobre el fascículo accesorio fueron más largos en el grupo A (300 ± 48 ms vs 262 ± 32 ms, p < 0.05) y (355 ± 108 ms vs 307 ± 86 ms, p < 0.05), respectivamente. Ningún individuo del grupo A tuvo un periodo refractario anterógrado < 250 ms; y 58% no tuvieron conducción retrógrada sobre el fascículo accesorio vs 4% del grupo B (p< 0.001). La inducción de taquicardia fue significativamente menor (5.2%) en el grupo A vs grupo B (95%) (p < 0.001). Se indujo fibrilación auricular (FA) sólo en uno del grupo A vs en 32% grupo B (p< 0.001). Conclusión: Se confirman las características electrofisiológicas benignas en individuos asintomáticos comparados con sintomáticos. La deficiente conducción anterógrada junto con ausencia de conducción retrógrada explica la baja frecuencia de taquiarritmias y no apoyaría la investigación rutinaria en toda la población asintomática, pero debido a las posibles consecuencias, se mantiene la indicación sistemática con fines de ablación preventiva en el subgrupo de individuos asintomáticos con actividad deportiva o alta responsabilidad profesional.

Objective: Describe the electrophysiological characteristics in subjects with asymptomatic Wolff-Parkinson-White with sports activities or high professional responsibility. Methods: Nineteen subjects, mean age 33 ± 13 years (group A). The electrophysiological characteristics were compared with a matched group with symptomatic WPW (group B). Results: At baseline the anterograde refractory period and the anterograde conduction 1:1 over the accessory pathway were longer in group A (300 ± 48 ms vs 262 ± 32 ms, p <0.05 and 355 ± 108 ms vs 307 ± 86 ms, p <0.05), respectively. None of group A had a anterograde refractory period < 250 ms and 58% showed absence of retrograde conduction over the accessory pathway vs 4% of group B (p < 0.001). Induction of tachycardia was significantly less in group A (5%) than in group B (92%) (p < 0.001). Atrial fibrillation was induced in only one of group A vs 32% of group B (p< 0.001). Conclusion: We confirm the benign electrophysiological characteristics in asymptomatic compared to symptomatic subjects. Poor anterograde conduction along with absence of retrograde conduction explains the low frequency of tachyarrhythmias and would not support the routine investigation of all asymptomatic subjects. But, due to possible consequences, remains the systematic indication for preventive ablation in the subgroup of asymptomatic subjects with sporting activities or high professional responsibility.

Ultrasound detected asymptomatic cholelithiasis: an age-based protocol for management / Colelitiasis asintomática detectada por ultrasonido: un protocolo basado en la edad para el tratamiento

OBJECTIVE: This study was undertaken to examine the correlation between age and gender and the presence of ultrasound findings of acute or chronic cholecystitis in adult patients with cholelithiasis. METHOD: The demographic data of all patients diagnosed with cholelithiasis and cholecystitis on ultrasound between January 1, 2002 and December 31, 2006 were reviewed and statistically analysed. RESULTS: Five hundred adults, 373 females (74.6%) and 127 males (25.4%), were diagnosed with cholelithiasis during the five-year period. Ages ranged from 18 to 94 years with a median age of 47 years. The diagnosis of cholecystitis was equivocal in 11 patients. Of the remaining 489, 22.1% (108) were diagnosed as positive for cholecystitis by ultrasound, the remaining 77.9% (381) being negative. No association was found between gender and cholecysytitis in bivariate analysis, (χ² = 1.82, df =1, p = 0.177). A statistically significant relation was found between age group category and ultrasound-determined cholecystitis status (χ² = 32.58, df = 4, p < 0.001). Higher proportions of persons in the 20-39-year (40.9%) and 40-59-year (20.4%) age groups had cholecystitis on ultrasound examination compared to other age categories where corresponding rates were approximately 11% or less. CONCLUSION: Patients 60 years or older who were diagnosed with cholelithiasis on ultrasound examination were less likely to have cholecystitis than younger patients.

OBJETIVO: Este estudio fue emprendido para examinar la correlación entre edad y género, y los hallazgos en ultrasonidos de colecistitis aguda o crónica en pacientes adultos con colelitiasis. MÉTODO: Se revisaron y analizaron estadísticamente los datos demográficos de todos los pacientes diagnosticados con colelitiasis y colecistitis a partir de ultrasonidos realizados entre el enero 1 de 2002 y diciembre 31 de 2006. RESULTADOS: Quinientos adultos - 373 hembras (74.6%) y 127 varones (25.4%) - fueron diagnosticados con colelitiasis durante el periodo de cinco años. Las edades fluctuaron de 18 a 94 con una edad mediana de 47 años. El diagnóstico de colecistitis fue equívoco en 11 pacientes. De los restantes 489, 22.1% (108) fueron diagnosticados positivos a la colecistitis por ultrasonido, resultando los restantes 7.9% (381) negativos. No se halló ninguna asociación entre el género y la colecistitis en el análisis bivariado, (χ² = 1.82, df =1, p = 0.177). Se halló una relación estadísticamente significativa entre la categoría del grupo etario y la condición de colecistitis determinada por el ultrasonido (χ² = 32.58, df = 4, p < 0.001). Las proporciones más altas de personas en los grupos de edad de 20 - 39 años (40.9%) y 40 - 59 años (20.4%) tenían colecistitis al ser examinadas con ultrasonido, comparadas a otras categorías de edad en las que las tasas correspondientes fueron aproximadamente 11% o menos. CONCLUSIÓN: Los pacientes de 60 o más años de edad, a quienes se les diagnosticó colelitiasis en el examen de ultrasonido, presentaban menos probabilidad de tener colecistitis que los pacientes más jóvenes.

The impact of asymptomatic vertebral fractures on quality of life in older community-dwelling women: the São Paulo Ageing & Health Study

OBJECTIVES: The aim of this study was to investigate the impact of asymptomatic vertebral fractures on the quality of life in older women as part of the Sao Paulo Ageing & Health Study. METHODS: This study was a cross-sectional study with a random sample of 180 women 65 years of age or older with or without vertebral fractures. The Quality of Life Questionnaire of the European Foundation for Osteoporosis was administered to all subjects. Anthropometric data were obtained by physical examination, and the body mass index was calculated. Lateral thoracic and lumbar spine X-ray scans were obtained to identify asymptomatic vertebral fractures using a semi-quantitative method. RESULTS: Women with asymptomatic vertebral fractures had lower total scores [61.4(15.3) vs. 67.1(14.2), p = 0.03] and worse physical function domain scores [69.5(20.1) vs. 77.3(17.1), p = 0.02] for the Quality of Life Questionnaire of the European Foundation for Osteoporosis compared with women without fractures. The total score of this questionnaire was also worse in women classified as obese than in women classified as overweight or normal. High physical activity was related to a better total score for this questionnaire (p = 0.01). Likewise, lower physical function scores were observed in women with higher body mass index values (p<0.05) and lower physical activity levels (p,0.05). Generalized linear models with gamma distributions and logarithmic link functions, adjusted for age, showed that lower total scores and physical function domain scores for the Quality of Life Questionnaire of the European Foundation for Osteoporosis were related to a high body mass index, lower physical activity, and the presence of vertebral fractures (p<0.05). CONCLUSION: Vertebral fractures are associated with decreased quality of life mainly physical functioning in older community-dwelling women regardless of age, body mass index, and physical activity. Therefore, the results highlight the importance of preventing and controlling asymptomatic vertebral fractures to reduce their impact on quality of life among older women.

Estenose aórtica grave em pacientes assintomáticos: o dilema do tratamento clínico versus cirúrgico / Severe aortic stenosis in asymptomatic patients: the dilemma of clinical versus surgical treatment / Estenosis aórtica grave en pacientes asintomáticos: el dilema del tratamiento clínico versus quirúrgico

A estenose valvar aórtica é cada vez mais prevalente concordante com o envelhecimento populacional. Por conseguinte, torna-se mais comum o atendimento de pacientes assintomáticos com estenose aórtica grave. Embora os pacientes com estenose aórtica grave sem sintomas façam parte de um mesmo grupo, são heterogêneos sob o ponto de vista clínico, laboratorial e ecocardiográfico. A abordagem desses pacientes traz à tona o dilema do tratamento clínico versus cirúrgico: submeter o paciente aos riscos da cirurgia ou mantê-lo em observação clínica sob o perigo do dano miocárdio irreversível ou mesmo da morte súbita? Sob esta perspectiva, baseando-se na literatura atual, este artigo fornece ferramentas que auxiliam na estratificação dos pacientes. A área valvar, grau de calcificação, velocidade de fluxo transvalvar aórtico, hipertrofia ventricular esquerda e teste de esforço alterado são os fatores que colocam os portadores de estenose aórtica grave assintomáticos em um grupo denominado de muito alto risco, em que a estratégia cirúrgica passa a ser considerada.

Aortic valve stenosis has become increasingly prevalent, in agreement with the aging of the population. Thus, it has become increasingly common to treat asymptomatic patients with severe aortic stenosis. Although the patients with asymptomatic aortic stenosis belong to the same group, they are heterogeneous from a clinical, laboratory and echocardiographic point of view. The treatment of these patients raises the dilemma of the clinical versus the surgical treatment: should we submit the patient to the risks of surgery or keep the patient under clinical observation, running the risk of irreversible myocardial damage or even sudden death? Under this perspective and based on the current literature, this study supplies tools that help to stratify the patients. The valvular area, degree of calcification, transvalvular aortic flow velocity, left ventricular hypertrophy and stress test alterations are the factors that place asymptomatic individuals with severe aortic stenosis in a group called very-high risk, in which the surgical approach starts to be considered.

La estenosis valvular aórtica es cada vez más prevalente concordante con el envejecimiento poblacional. Por consiguiente, se vuelve más común la atención de pacientes asintomáticos con estenosis aórtica grave. Aunque los pacientes con estenosis aórtica grave sin síntomas hagan parte de un mismo grupo, son heterogéneos bajo el punto de vista clínico, de laboratorio y ecocardiográfico. El abordaje de esos pacientes trae a cuento el dilema del tratamiento clínico versus quirúrgico: someter el paciente a los riesgos de la cirugía o mantenerlo en observación clínica bajo el peligro de daño miocárdico irreversible o aun de muerte súbita? Bajo esta perspectiva, basándose en la literatura actual, este artículo provee herramientas que auxilian en la estratificación de los pacientes. El área valvar, grado de calcificación, velocidad de flujo transvalvar aórtico, hipertrofia ventricular izquierda y test de esfuerzo alterado son los factores que colocan a los portadores de estenosis aórtica grave asintomáticos en un grupo denominado de muy alto riesgo, en que la estrategia quirúrgica pasa a ser considerada.

Influência da aterosclerose subclínica na função diastólica em indivíduos sem doença cardiovascular / Influence of subclinical atherosclerosis on diastolic function in individuals free of cardiovascular disease / Influencia de la aterosclerosis subclínica en la función diastólica en individuos sin enfermedad cardiovascular

FUNDAMENTO: É plausível que a aterosclerose subclínica altere a reserva coronariana e comprometa a função diastólica do ventrículo esquerdo. Entretanto, a associação entre os estágios subclínicos da aterosclerose e a função diastólica não foi estabelecida em indivíduos livres de doença cardiovascular. OBJETIVO: Testar a hipótese de que a aterosclerose subclínica tenha uma associação negativa com a função diastólica. MÉTODOS: Indivíduos > 35 anos de idade, sem doença cardiovascular, com pressão arterial normal e teste de esforço na esteira negativo, foram selecionados para avaliação da espessura da camada íntima-média (EIM) carotídea através de ultrassonografia e dos parâmetros de função diastólica através de ecocardiografia, primariamente a razão E'/A' através do Doppler tecidual. RESULTADOS: Quarenta e oito indivíduos, com idade de 56 ± 10 anos, 67 por cento do sexo feminino foram estudados. A EIM carotídea apresentou uma correlação negativa significante com a razão E'/A' no Doppler tecidual (r = - 0,437, p = 0,002). Indivíduos no quarto quartil da EIM apresentavam uma razão E'/A' significantemente mais baixa no Doppler tecidual (0,76 ± 0,25), quando comparados a indivíduos no primeiro (1,2 ± 0,29), segundo (1,2 ± 0,36) e terceiro quartis (1,1 ± 0,25) - p = 0,002. A EIM carotídea no quarto quartil (> 0,8 mm) foi preditor independente da razão E'/A' (p = 0,02), após ajustes para variáveis potencialmente confundidoras, tais como idade, sexo feminino, circunferência da cintura, pressão arterial diastólica, HDL-colesterol e Risco de Framingham. CONCLUSÃO: O estágio inicial da doença arterial aterosclerótica está negativamente associado com os parâmetros de função diastólica em indivíduos saudáveis, independente da idade e características clínicas.

BACKGROUND: It is plausible that subclinical atherosclerosis alters coronary reserve and impairs diastolic function of the left ventricle. However, the relationship between subclinical stages of atherosclerosis and diastolic function has not been established in subjects free of cardiovascular disease. OBJECTIVE: To test the hypothesis that subclinical atherosclerosis has a negative association with diastolic function. METHODS: Individuals > 35 years old, free of cardiovascular disease, with normal blood pressure and negative treadmill stress test, were selected to have common carotid intima-media thickness (IMT) assessed by ultrasound and parameters of diastolic function by echocardiography, primarily tissue Doppler E'/A' ratio. RESULTS: Forty-eight subjects were studied, aged 56 ± 10 years, 67 percent females. Composite common carotid IMT had a significant negative correlation with tissue Doppler E'/A' ratio (r = - 0.437, p = 0.002). Individuals in the fourth quartile of IMT had a significant lower tissue Doppler E'/A' ratio (0.76 ± 0.25), as compared with the first (1.2 ± 0.29), second (1.2 ± 0.36) and third quartiles (1.1 ± 0.25) - p = 0.002. Composite common carotid IMT in the fourth quartile (> 0.8 mm) independently predicted E'/A' ratio (p = 0.02), after adjustment for potentially confounding variables, such as age, female gender, waist circumference, diastolic blood pressure, HDL-cholesterol and Framingham Risk. CONCLUSION: Early stage of subclinical atherosclerotic disease is negatively associated with diastolic function parameters in healthy individuals, regardless of age and clinical characteristics.

FUNDAMENTO: Es plausible que la aterosclerosis subclínica altere la reserva coronaria y comprometa la función diastólica del ventrículo izquierdo. Entre tanto, la asociación entre los niveles subclínicos de la aterosclerosis y la función diastólica no fue establecida en individuos libres de enfermedad cardiovascular. OBJETIVO: Testear la hipótesis de que la aterosclerosis subclínica tenga una asociación negativa con la función diastólica. MÉTODOS: Individuos > 35 años de edad, sin enfermedad cardiovascular, con presión arterial normal y test de esfuerzo en la cinta negativo, fueron seleccionados para evaluación del espesor de la capa íntima-media (EIM) carotídea a través de ultrasonografía y de los parámetros de función diastólica a través de ecocardiografia, primariamente a razón E'/A' a través del Doppler tisular. RESULTADOS: Cuarenta y ocho individuos, con edad 56 ± 10 años, 67 por ciento del sexo femenino. La EIM carotídea presentó una correlación negativa significativa con la razón E'/A' en el Doppler tisular (r = - 0,437, P = 0,002). Individuos en el cuarto cuartil de la EIM presentaban una razón E'/A' significativamente más baja en el Doppler tisular (0,76 ± 0,25), cuando fueron comparados a individuos en el primero (1,2 ± 0,29), segundo (1,2 ± 0,36) y tercer cuartiles (1,1 ± 0,25) - P = 0,002. La EIM carotídea en el cuarto cuartil (> 0,8 mm) fue predictor independiente de la razón E'/A' (P = 0,02), después de ajustes para variables potencialmente confundidoras, tales como edad, sexo femenino, circunferencia de la cintura, presión arterial diastólica, HDL-colesterol y Riesgo de Framingham. CONCLUSIÓN: El nivel inicial de la enfermedad arterial aterosclerótica está negativamente asociado a los parámetros de función diastólica en individuos sanos, independientemente de la edad y características clínicas.