Estudio Descriptivo: Frecuencia y factores de riesgo de la enfermedad arterial periférica en pacientes con Diabetes Mellitus II del Hospital José Carrasco Arteaga, Cuenca / Descriptive Study: Frequency and risk factors of peripheral arterial disease in patients with type II Diabetes Mellitus of Hospital José Carrasco Arteaga, Cuenca

INTRODUCCIÓN: La enfermedad arterial periférica (EAP) es más frecuente en pacientes conDiabetes Mellitus tipo 2 (DM2) que en la población general, convirtiéndolos en un grupo de alto riesgo de morbimortalidad. El objetivo del presente estudio fue determinar la frecuencia de EAP, mediante la medición del ITB y la frecuencia de sus factores de riesgo en los pacientes con Diabetes Mellitus tipo 2 del Hospital José Carrasco Arteaga. MATERIALES Y MÉTODOS: Estudio descriptivo, de corte transversal, con una muestra aleatoria simple de pacientes con diagnóstico de DM2 que acudieron a consulta externa del Hospital José Carrasco Arteaga, Cuenca-Ecuador, en el año 2017 (315 pacientes).Se aplicó una entrevista a los pacientes con datos sobre las características sociodemográficas y ciertos antecedentes médicos de importancia para el estudio; se determinó el ITB; se valoraron los exámenes complementarios de laboratorio realizados en los seis meses previos al estudio. Finalmente, se describieron frecuencias y porcentajes de cada una de las variables, se utilizó el programa IBM SPSS versión 22. RESULTADOS: Del total de pacientes se observó un promedio de edad de 62.9 años, con predominio del sexo femenino. Se determinó que la frecuencia de EAP en los pacientes con DM2 fue del 35.30%. LA EAP fue más frecuente en: el grupo de edad mayor a 50 años (38.8%), el sexo masculino (43.9%), en el grupo de pacientes con tiempo de evolución de la DM2 ≥ a 5 años (35.5%), en los pacientes con tabaquismo (38.4%), en los pacientes con niveles elevados de hemoglobina glicosilada (HbA1c ≥7%) (40.6%), los pacientes con hipertrigliceridemia, en los pacientes con LDL elevado y en hombres con HDL por debajo de valores normales. CONCLUSIÓN: Podemos concluir que la frecuencia de enfermedad arterial periférica en los pacientes con Diabetes Mellitus tipo 2, en el Hospital José Carrasco Arteaga, utilizando el índice tobillo brazo como método diagnóstico fue del 35.30%.(au)

BACKGROUND: Peripheral arterial disease (PAD) is more common in patients with type 2 Diabetes Mellitus (DM2) than in the general population, making them a high-risk group for morbidity and mortality. The aim of this study was to determine the frequency of peripheral arterial disease, by measuring ankle-brachial index, and the frequency of its risks factors in patients with type 2 Diabetes Mellitus at Hospital José Carrasco Arteaga. METHODOS: descriptive, cross-sectional study, with a simply randomized sample of patients diagnosed with Type 2 Diabetes Mellitus, who attended the outpatient clinic of Hospital José Carrasco Arteaga, Cuenca - Ecuador, in 2017 ( 315 patients). An interview was applied to the patients, to collect data on sociodemographic characteristics and certain important medical history; ankle-brachial index was determined; complementary laboratory tests made six months prior to the study were evaluated. Finally, frequencies and percentages of each variable were described; we used IMB SPSS version 22 software. RESULTS: Of the total number of patients, the average age was 62.9 years, with a predominance of the female sex. The frequency of PAD in patients with DM2 was 35.30%. PAD was more frequent in: age group over 50 years (38.8%), male sex (43.9%), disease evolution time ≥ 5 years (35.5%), in smoking patients(38.4%), in patients with elevated glycosylated hemoglobin levels (HbA1c ≥7%)(40.6%),in patients with hypertriglyceridemia, in patients with elevated LDL and in men with low HDL values. CONCLUSION: we can conclude that the peripheral arterial disease frequency in patients with type 2 Diabetes Mellitus, at Hospital José Carrasco Arteaga, using the ankle-brachial index as a diagnostic method was 35.50%.(au)

Hipertrigliceridemia severa refractaria a tratamiento médico y pancreatitis aguda recurrente: uso de plasmaféresis crónica ambulatoria en el Hospital San Pablo de Coquimbo. Reporte de un caso

Severe Hypertriglyceridemia (HTG) is associated with complications such as acute pancreatitis (AP) with high morbidity and mortality rates. We report a 42 years-old man with refractory HTG diagnosed at 19 years of age, and multiple episodes of AP, admitted with the suspicion of a new AP episode. Serum triglycerides were over 2000 mg/dl. His body mass index was 18 kg/m2, there was no evidence of xanthomas or xanthelasmas, but lipemia retinalis was found. Management included heparin and insulin, added to his usual treatment with fibrates, statins, omega-3 fatty acids, and orlistat. Due to lack of response, apheresis was started. After five sessions, triglycerides decreased to 588 mg/dl (82% reduction) and levels remained below 1000 mg/dl with daily apheresis. The patient continued with weekly sessions as outpatient with a sustained good response.

Cintura hipertrigliceridémica en adultos pertenecientes al Policlínico Héroes del Moncada, en La Habana / Hypertriglyceridemic waist in adult patients belonging to Héroes del Moncada Polyclinic in Havana

Introducción: La hipertrigliceridemia es una forma de dislipidemia frecuentemente asociada con enfermedad ateroesclerótica. La obesidad se encuentra entre los factores de riesgo implicados en la aceleración del proceso ateroesclerótico. El desorden fisiopatológico provocado por el tejido adiposo disfuncionante es causa de afectaciones cardiovasculares, endocrinometabólicas y neoplásicas. Objetivo: Identificar la relación entre la presencia de hipertrigliceridemia con la circunferencia de la cintura en adultos mayores, a partir de la evaluación del índice de masa corporal, cintura-cadera y la presencia de hipertrigliceridemia, según la edad y el sexo. Métodos: Estudio descriptivo transversal realizado entre 2015-2017, con una muestra de 386 adultos de ambos sexos. La recogida de datos se realizó según el modelo de recolección del dato primario del Centro de Investigación y Referencias de Aterosclerosis de La Habana. El análisis de los datos se realizó con el programa SPSS v16- y las técnicas de Chi-Square. Resultados: La edad media de la muestra fue de 55,5 años y el 70,6 por ciento eran mujeres. El 57 por ciento presentaba hipertrigliceridemia y el 63,4 por ciento un índice de masa corporal aumentado, un 37,8 por ciento de personas con sobrepeso y un 26,5 por ciento con obesidad. El índice de masa corporal fue superior en mujeres perimenopáusicas, en las que tuvieron el predominio de cintura hipertrigliceridémica. Se observó un incremento de obesidad abdominal con la edad. Conclusiones: Los factores de riesgo cardiovascular, así como, la asociación existente entre los triglicéridos y la medida de la circunferencia de cintura, requiere una valoración sistemática por sexo y edad. La consulta de enfermería de la Atención Primaria es un lugar ideal para promover estrategias de intervención para monitorizar el riesgo clínico cardiovascular a través de los diferentes parámetros antropométricos(AU)

Introduction: Hypertriglyceridemia is a form of dyslipidemia frequently associated with the atherosclerotic disease. Obesity is among the risk factors involved in the acceleration of the atherosclerotic process. The pathophysiologic disorder caused by the dysfuncional adipose tissue is the cause of cardiovascular, endocrinometabolic and neoplastic diseases. Objective: To identify the relationship between the presence of hypertriglyceridemia and waist circumference in older adults from the assessment of the body mass index, waist-hip ratio and the presence of hypertriglyceridemia, according to age and gender. Methods: Descriptive, cross-sectional study conducted from 2015 to 2017, with a sample of 386 adults of both sexes. Data collection was performed according to the model of primary data collection of the Center for Research and of Atherosclerosis References of Havana. The data analysis was performed with the SPSS v16- software and the Chi-Square techniques. Results: The average age of the sample was 55.5 years and 70.6 percent were women. The 57 percent had hypertriglyceridemia and 63.4 percent an increased body mass index; 37.8 percent of the people had overweight and 26.5 percent had obesity. Body mass index was higher in perimenopausal women, who had a predominance of hypertriglyceridemic waist. It was noticed an increase of the abdominal obesity with aging. Conclusions: The cardiovascular risk factors as well as the association between triglycerides and the measure of waist circumference require a systematic assessment by sex and age. The nursing consultation in Primary Care is an ideal place to promote intervention strategies to monitor the cardiovascular clinical risk through the different anthropometric parameters(AU)

Influencia del hipotiroidismo e hipertiroidismo en el desarrollo de enfermedad cardiovascular / Influence of hypothyroidism and hyperthyroidism in the development of cardiovascular disease

INTRODUCCIÓN. El hipotiroidismo e hipertiroidismo, constituyen patologías tiroideas, que si no reciben tratamiento apropiado llegan a provocar alteraciones sistémicas, siendo una de las principales las cardiovasculares. OBJETIVO. Conocer la influencia que tiene el hipotiroidismo e hipertiroidismo como factores de riesgo para el desarrollo de enfermedad cardiovascular. MATERIALES Y MÉTODOS. Estudio retrospectivo de enfoque cuantitati-vo; desarrollado en una población y muestra conocida de 111 pacientes, que acudieron al Servicio de Endocrinología del Hospital Manuel Ygnacio Monteros Valdivieso de la ciudad de Loja, atendidos en el año 2015. RESULTADOS. Predominó el sexo femenino, con un 20,72% (23; 69) en el grupo etario de 61 a 70 años de las pacientes hipotiroideas; y las de 51 a 60 años en 5,40% (6; 11) de las hipertiroideas. De acuerdo a los parámetros que pue-den condicionar mayor riesgo cardiovascular, el sobrepeso y obesidad presentaron una mayor frecuencia para hipotiroidismo en 67,70% (65; 111) e hipertiroidismo en un 66,67% (10; 111). El riesgo bajo cardiovascular prevaleció en 75,00% (72; 96) de la población hipo-tiroidea y 93,33% (14; 15) de la hipertiroidea. La hipertensión arterial fue la patología car-diovascular diagnosticada con mayor frecuencia sobre todo en los pacientes hipotiroideos representado por el 14,58% (14; 19). CONCLUSIÓN. Estas patologías, de no controlarse pudieran condicionar en la población de estudio un mayor riesgo cardiovascular.

INTRODUCTION. Hypothyroidism and hyperthyroidism, constitute thyroid pathologies, that if they do not received appropriate treatment, cause systematic alterations, treatment, cause systematic cardiovascular diseases being one of the main ones. OBJECTIVE. Know the influence of hypothyroidism and hyperthyroidism as risk factors for the development of cardiovascular disease. MATERIALS AND METHODS. Retrospective study of quantitative approach; developed in a population and known sample of 111 patients, who went to the Endocrinology Service of the Manuel Ygnacio Monteros Valdivieso Hospital in the city of Loja, attended in 2015. RESULTS. The female sex predominated, with 20,72% (23; 69) in the age group predominated 61 to 70 years of age in 5,40% (6; 11) of hyperthyroids. According to the parameters that may condition higher cardiovascular risk, overweight and obesity presented a higher frequency for hypothyroidism in 67,70% (65; 111) and hyperthyroidism in 66,67% (10; 111). Low cardiovascular risk prevailed in 75,00% (72; 96) of the hypothyroid population and 93,33% (14; 15) of the hyperthyroid population. Arterial hypertension was the most frequently diagnosed cardiovascular disease, especially in hypothyroid patients by 14,58% (14; 19). CONCLUSION. These pathologies, if not controlled, could condition a higher cardiovascular risk in the study population.

Sintomatología asociada al estrés y condiciones laborales de operarios de taxi de un sitio de la Ciudad de México / Stress-related symptoms and working conditions among Mexico City taxi drivers

Introducción: Los estilos de vida no saludables se relacionan con hábitos y conductas que deterioran los órganos y sus funciones generando envejecimiento prematuro y enfermedades crónicodegenerativas, estas condiciones se ven agravadas por las desigualdades sociales en ciertos grupos laborales, tal es el caso de los conductores de taxis, los cuales presentan riesgos ambientales, físicos, químicos, bioquímicos, así como exigencias laborales como son extensión de jornada, bajos salarios, las formas de organización y la falta de apoyo sindical. Estudiar el proceso salud/enfermedad de estos trabajadores, permite identificar el desgaste laboral y la integridad mental determinada por la cantidad e intensidad de trabajo y proponer medidas de prevención. Método: Se diseñó un estudio transversal, observacional y descriptivo, se aplicó una encuesta, valoración antropométrica, análisis bioquímicos, cuyos resultados tuvieron un procesamiento para identificar asociaciones y significancia estadística. Resultados: el 32.5% de la muestra conduce más de 9 horas. al día sin descansos, el 21.8% presentó supervisión estricta y 48.7% son obligados a cubrir cuotas diarias. Más de la mitad de la muestra se encuentra con exposición constante a condiciones adversas tanto en la unidad como en el lugar de trabajo. Se encontró asociación de estas condiciones con la prevalencia de enfermedades crónico degenerativas como diabetes mellitus, hipertrigliceridemia e hipercolesterolemia, más altas con las reportadas a nivel nacional. Conclusiones: las condiciones de los conductores de taxis tanto laborales como de salud mental y física se encuentran deterioradas de manera extrema por lo cual se necesitan estrategias multidisciplinarias para su disminución(AU)

Introduction: Unhealthy lifestyles are related to habits and behaviors that can contribute to the deterioration and function of organ systems, leading to premature aging and degenerative chronic diseases. These conditions are aggravated due to the social inequality in certain occupations. Such is the case of taxi drivers, who experience environmental, physical, chemical, and biochemical risks, as well as high work demands such as long work days, low pay and little union support. By studying the health / disease process of these workers we can identify occupational burnout and mental integrity determined by the amount and intensity of the work, and propose preventive measures. Methods: A cross-sectional, observational and descriptive study was designed. We obtained data via a survey, anthropometric measurements, and laboratory testing. We examined associations and tested them for statistical significance. Results: Of the overall respondents, 32.5% reported driving more than 9 hours a day without breaks; 21.8% mentioned strict supervision and 48.7% reported being required to meet daily fee quotas. More than half the sample was continuously exposed to adverse conditions in the cab and the workplace. We found associations between these working conditions and the prevalence of chronic degenerative diseases, including diabetes, hypertriglyceridemia and hypercholesterolemia, higher than national average prevalence figures. Conclusion: occupational, physical and psychological working conditions among taxi drivers are very poor, and multidisciplinary strategies are needed to diminish them(AU)

Prevalence of metabolic syndrome in pre- and postmenopausal women

ABSTRACT Objective The objective of this study was to determine the prevalence of metabolic syndrome (MS) and its components among pre- and postmenopausal women, as well as the association between menopausal status and MS. Materials and methods A retrospective study was conducted at a reference cardiology outpatient clinic in a city located in Northwestern Paraná State, Brazil. A total of 958 medical records of symptomatic climacteric women evaluated between 2010 and 2014 were analyzed. The study consisted of two groups: pre- and post-menopausal women. MS was characterized according to the criteria of the National Cholesterol Education Program’s Adult Treatment Panel III – NCEP-ATP III-2005. Results MS was observed in 18.5% of the total study population; 9.4% of the premenopausal women and 22.2% of the postmenopausal women displayed MS, corresponding to a relative risk of 2.75. In addition, the frequency of MS increased with age. Regarding the components of MS, postmenopausal women were more likely to have high density lipoprotein (HDL-C) levels < 50 mg/dL; systolic blood pressure (SBP) values ≥ 130 mmHg or diastolic blood pressure (DBP) values ≥ 85 mmHg; and fasting glucose levels ≥ 100 mg/dL. Conclusion MS was more prevalent among postmenopausal women than among premenopausal women.

Cintura Hipertrigliceridêmica em Pacientes Hipertensos / Hypertriglyceridemic Waist in Hypertensive Patients

Fundamentos: O uso de diferentes critérios para a determinação da cintura hipertrigliceridêmica (CHT) pode resultar em interpretações imprecisas, podendo comprometer o diagnóstico de pacientes com risco de desenvolver doenças cardiovasculares. Objetivo: Avaliar a concordância no diagnóstico da CHT utilizando diferentes pontos de corte para classificação da circunferência da cintura, em pacientes hipertensos. Métodos: Trata-se de um estudo transversal realizado com 120 pacientes, de 30 a 74 anos de idade, de ambos os sexos em atendimento ambulatorial. Realizou-se avaliação antropométrica (peso, altura e circunferência da cintura) e dos níveis séricos de triglicérides. A CHT foi definida pela presença simultânea da circunferência da cintura aumentada e hipertrigliceridemia. A concordância entre os diagnósticos de cintura hipertrigliceridêmica foi avaliada pelo índice Kappa. Resultados: A prevalência da CHT foi maior em adultos, para ambos os sexos pelos critérios do International Diabetes Federation (IDF) e Organização Mundial de Saúde (OMS) (28%), já pelo National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATP III) foram identificados 22,7% de indivíduos. Identificou-se uma concordância quase perfeita (0,864) entre o diagnóstico da CHT pelos pontos de corte da IDF versus NCEP-ATP III, OMS versus NCEP-ATP III. Entre o IDF e OMS a concordância foi perfeita. Conclusão: A utilização dos pontos de corte da circunferência da cintura propostos pelo IDF e OMS, para caracterizar indivíduos com cintura hipertrigliceridêmica foi melhor do que a do NCEP-ATP III

Background: The adoption of different criteria to determine the occurrence of the hypertriglyceridemic waist (HTW) can result in inaccurate interpretations, compromising the diagnosis of patients at risk of developing cardiovascular diseases. Objective: To evaluate the diagnostic agreement of HTW using different cut-off points for waist circumference in hypertensive patients. Methods: Cross-sectional study including 120 patients of both sexes, aged 30 to 74 years and receiving care on an outpatient basis. We assessed the participants' anthropometric data (weight, height, and waist circumference) and determined their serum triglycerides levels. The diagnosis of HTW was defined by concurrent increased waist circumference and hypertriglyceridemia. The agreement among the diagnoses of HTW was assessed with the kappa index. Results: In adults of both sexes, the HTW had a higher prevalence (28%) when determined by the criteria defined by the International Diabetes Federation (IDF) and the World Health Organization (WHO) than by those defined by the National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATP III, 22.7%). We identified an almost perfect agreement (0.864) between the diagnosis of HTW determined by the cut-off points of the IDF versus NCEP-ATP III and by the WHO versus NCEP-ATP III. The correlation was perfect between the diagnoses established by the IDF and WHO. Conclusion: The cut-off points for waist circumference proposed by the IDF and WHO was better than those by the NCEP-ATP III to characterize individuals with HTW

Diagnostic accuracy of a noninvasive hepatic ultrasound score for non-alcoholic fatty liver disease (NAFLD) in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) / Acurácia diagnóstica de um escore de ultrassonografia hepática não invasivo para doença hepática gordurosa não alcoólica (DHGNA) no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil)

CONTEXT AND OBJECTIVE: Noninvasive strategies for evaluating non-alcoholic fatty liver disease (NAFLD) have been investigated over the last few decades. Our aim was to evaluate the diagnostic accuracy of a new hepatic ultrasound score for NAFLD in the ELSA-Brasil study. DESIGN AND SETTINGS: Diagnostic accuracy study conducted in the ELSA center, in the hospital of a public university. METHODS: Among the 15,105 participants of the ELSA study who were evaluated for NAFLD, 195 individuals were included in this sub-study. Hepatic ultrasound was performed (deep beam attenuation, hepatorenal index and anteroposterior diameter of the right hepatic lobe) and compared with the hepatic steatosis findings from 64-channel high-resolution computed tomography (CT). We also evaluated two clinical indices relating to NAFLD: the fatty liver index (FLI) and the hepatic steatosis index (HSI). RESULTS: Among the 195 participants, the NAFLD frequency was 34.4%. High body mass index, high waist circumference, diabetes and hypertriglyceridemia were associated with high hepatic attenuation and large anteroposterior diameter of the right hepatic lobe, but not with the hepatorenal index. The hepatic ultrasound score, based on hepatic attenuation and the anteroposterior diameter of the right hepatic lobe, presented the best performance for NAFLD screening at the cutoff point ≥ 1 point; sensitivity: 85.1%; specificity: 73.4%; accuracy: 79.3%; and area under the curve (AUC 0.85; 95% confidence interval, CI: 0.78-0.91)]. FLI and HSI presented lower performance (AUC 0.76; 95% CI: 0.69-0.83) than CT. CONCLUSION: The hepatic ultrasound score based on hepatic attenuation and the anteroposterior diameter of the right hepatic lobe has good reproducibility and accuracy for NAFLD screening. .

CONTEXTO E OBJETIVO: Estratégias não invasivas para avaliar doença hepática gordurosa não alcoólica (DHGNA) têm sido investigadas nas últimas décadas. Nosso objetivo foi avaliar a acurácia diagnóstica de um novo escore de ultrassonografia hepática para DHGNA no estudo ELSA-Brasil. TIPO DE ESTUDO E LOCAL: Estudo de acurácia diagnóstica realizado no centro ELSA, no hospital de uma universidade pública. MÉTODOS: Dos 15.105 participantes do estudo ELSA avaliados para DHGNA, 195 indivíduos foram incluídos neste estudo. Foi realizada ultrassonografia hepática (atenuação do feixe de profundidade, índice hepatorrenal e diâmetro anteroposterior do lobo direito do fígado) que foi comparada aos achados de esteatose hepática da tomografia computadorizada (TC) de alta resolução de 64 canais. Avaliamos também dois índices clínicos relacionados à DHGNA: o índice de gordura hepática (FLI) e o índice de esteatose hepática (HSI). RESULTADOS: Entre os 195 participantes, a frequência de DHGNA foi de 34,4%. Altos índices de massa corpórea, circunferência de cintura, diabetes e hipertrigliceridemia foram associados a aumento da atenuação hepática e do diâmetro anteroposterior do lobo hepático direito, mas não ao índice hepato-renal. A pontuação da ultrassonografia hepática, que incluiu atenuação hepática e diâmetro anteroposterior do lobo direito do fígado, apresentou o melhor desempenho para o rastreio DHGNA sob o ponto de corte ≥ 1 ponto (sensibilidade: 85.1%; especificidade: 73.4%; acurácia: 79.3%), e área sob a curva (AUC, 0,85, IC 95%: 0,78-0,91). FLI e HSI apresentaram menor desempenho (AUC 0,76; IC 95%: 0,69-0,83) comparados à TC. CONCLUSÃO: O escore de ultrassonografia hepática, que incluiu atenuação hepática e o diâmetro anteroposterior do lobo direito do fígado, possui boa reprodutibilidade e acurácia para o rastreio de DHGNA. .

Insegurança alimentar em domicílios de indivíduos portadores de hipertensão e/ou diabetes / Food insecurity in households of patients with hypertension and diabetes

Fundamentos: Pessoas que residem em domicílios com insegurança alimentar normalmente consomem uma dieta monótona, pobre em carboidratos complexos e rica em açúcares simples e gorduras. Tal condição associada à obesidade, diabetes mellitus (DM) e hipertensão arterial (HA) compromete a qualidade de vida e contribui para um maior risco de morbimortalidade, principalmente por doenças cardiovasculares. Objetivos: Avaliar fatores de risco cardiovascular (FRCV) em portadores de HA e/ou DM e sua relação com a condição socioeconômica e a situação de insegurança alimentar (IA) nos domicílios. Métodos: Estudo transversal. Avaliados: (In) segurança alimentar domiciliar segundo a Escala brasileira de insegurança alimentar (EBIA): IA leve, moderada e severa; classe econômica e FRCV. Utilizou-se o teste do qui-quadrado, análise logística bivariada, OR com IC de 95% e p≤0,05.Resultados: Estudados 225 indivíduos: 74,0% (n=166) hipertensos (H), 18,0% (n=41) hipertensos diabéticos (HD) e 8,0% (n=18) diabéticos (D); 80,9% eram mulheres, média de idade 60,3±11,19 anos e 64,0% pertencentes à classe econômica D. Residiam em domicílios em IA: 78,0% dos H, 73,0% dos HD e 78,0% dos D. A frequência de FRCV entre os indivíduos em IA foi elevada: 92,0% hipertensão, 80,0% hipercolesterolemia, 79,0% hiperglicemia, 76,0% sobrepeso/obesidade,73,0% obesidade abdominal e 72,0% hipertrigliceridemia. Verificou-se associação positiva entre IA e hipertensão (p=0,034), obesidade abdominal (p=0,009) e hipertrigliceridemia (p=0,001). Conclusões: A condição de insegurança predominante nos domicílios da população estudada representa fator de risco adicional, uma vez que a dificuldade de acesso a uma alimentação saudável em quantidade e qualidade compromete o tratamento e controle desses agravos.

Background: People living in households with food insecurity typically have a monotonous diet, low in complex carbohydrates and rich in simple sugars and fats. Such condition associated with obesity, diabetes mellitus (DM) and hypertension (HA) compromises the quality of life and contributes to an increased risk of morbidity and mortality, especially from cardiovascular diseases. Objectives: To evaluate cardiovascular risk factors (CVRF) in patients with HA and/or diabetes mellitus and its relationship with the socioeconomic status and the situation of food insecurity (IA) in households.Methods: Cross-sectional study. Patients evaluated: (In) household food security according to the Brazilian Scale of food insecurity (EBIA): Mild, moderate and severe FI; economic status and CVRF. We used the chi-square test, bivariate logistic regression, OR with 95% CI and p≤0.05. Results: The study included 225 patients: 74.0% (n=166) hypertensive (M), 18.0% (n=41) diabetic hypertensive (HD) and 8.0% (n=18)diabetic patients (D); 80.9% were women, mean age 60.3±11.19 years and 64.0% belonging to the economy class D. The patients resided in households in FI: 78.0% of H, 73.0% of HD and 78.0% of D. The frequency of CVRF among individuals in FI was high:92.0% hypertension, 80.0% hypercholesterolemia, 79.0% hyperglycemia, 76.0% overweight/obesity, 73.0% abdominal obesity and 72.0% hypertriglyceridemia. There was a positive association between FI and hypertension (p=0.034), abdominal obesity (p=0.009) and hypertriglyceridemia (p=0.001). Conclusions: The predominant unsafe condition in the households of the population studied represents an additional risk factor, since thedifficulty of access to healthy food both in quantitative and quality terms compromises the treatment and control of these diseases.

The prevalence of the metabolic syndrome increases through the quartiles of thyroid stimulating hormone in a population-based sample of euthyroid subjects / Prevalência de síndrome metabólica aumenta em quartis de hormônio tireoestimulante em uma amostra de sujeitos eutiroides baseada na população

Objective The aim of the study was to assess the prevalence and characteristics of metabolic syndrome (MetS) and its elements in relation to TSH in euthyroid subjects. Materials and methods In the cross-sectional study, 2,153 euthyroid adults, 47.2 ± 14.5 years (20-94) with no current antithyroid or thyroid replacement therapy were enrolled. All participants filled a questionnaire on past and current morbidities, medication and smoking. Body weight, height, waist circumference, serum TSH, glucose and lipids were measured. The subjects were stratified by quartiles of TSH (QTSH) and the prevalence of the MetS elements was calculated. MetS was determined by the IDF 2005 criteria. Results Overweight prevalence was 37.2% (35.2-39.2), obesity in 25.1% (23.3-26.9), abdominal obesity – 61.4% (59.3-63.5), hypertension – 42.1% (38.9-43.1), diabetes/increased fasting glucose – 13.6% (12.1-15), low HDL-cholesterol – 27.6% (25.7-29.5), hypertriglyceridemia – 24.1% (22.3-25.9), MetS – 32.2% (30.2-34.2). MetS was more prevalent in the highest QTSH (34.9%, 30.9-38.9) than the lowest (27%, 23.3-30.9), p < 0.001, as were low HDL-C (32%, 28-35.9 vs. 25%, 21.3-28.7, p < 0.001) and hypertriglyceridemia (26.8%, 23-30.5 vs. 20.4%, 17-23.8, p = 0.015). Each QTSH increased the risk of MetS by 14%, p < 0.001, of hypertriglyceridemia by 20%, p = 0.001 and of low LDL-C by 9%, p = 0.042. Other significant factors for MetS were age, male gender and obesity. Conclusion The prevalence of MetS increased with higher QTSH within the euthyroid range, mostly by an increase in the dyslipidemia. Arq ...

Objetivo O objetivo deste estudo foi avaliar a prevalência e características da síndrome metabólica (MetS) e seus elementos em relação ao TSH em sujeitos eutireoides. Materiais e métodos Foram analisados, em um estudo transversal, 2.153 adultos eutiroides, de 47,2 ± 14,5 anos (20-94) sem terapia antitiroidiana ou de reposição. Todos os participantes preencheram um questionário sobre doenças atuais e passadas, medicações e tabagismo. O peso corporal, altura, circunferência da cintura, TSH, glicose e lipídios séricos foram medidos. Os sujeitos foram estratificados em quartis de TSH (QTSH) e a prevalência dos elementos da MetS foram calculados. Os critérios da MetS foram determinados pela IDF 2005. Resultados A prevalência de sobrepeso foi de 37,2% (35,2-39,2), de obesidade – 25,1% (23,3-26,9), obesidade abdominal – 61,4% (59,3-63,5), hipertensão – 42,1% (38,9-43,1), diabetes/aumento da glicose de jejum – 13,6% (12,1-15), baixo colesterol HDL – 27,6% (25,7-29,5), hipertrigliceridemia – 24,1% (22,3-25,9), MetS – 32,2% (30,2-34,2). A MetS foi mais prevalente no QTSH mais alto (34,9%; 30,9-38,9) do que no mais baixo (27%; 23,3-30,9), p < 0,001, assim como o baixo HDL-C (32%, 28-35,9 contra 25%, 21,3-28,7; p < 0,001) e hipertrigliceridemia (26,8%; 23-30,5 contra 20,4%, 17-23,8; p = 0,015). Cada QTSH aumentou o risco MetS em 14%, p < 0,001, de hipertrigliceridemia em 20%, p = 0,001 e de baixo LDL-C em 9%, p = 0,042. Outros fatores significativos para a MetS foram idade, sexo masculino e obesidade. ...

The hypertriglyceridemic waist phenotype in young adults from the Southern Region of Brazil / Cintura hipertrigliceridêmica em adultos jovens no Sul do Brasil / Cintura hipertrigliceridémica en adultos jóvenes en el sur de Brasil

The present study aimed to assess the prevalence of the hypertriglyceridemic waist phenotype and its associated factors among subjects that have been followed up from birth. In 1982, all maternity hospitals in the city of Pelotas, in the Southern Region of Brazil, were visited and all births were recorded. Babies whose parents lived in the urban area of Pelotas were subsequently followed up on several occasions. A 22 to 23-year follow-up of this birth cohort was carried out in 2004 and 2005. The presence of the hypertriglyceridemic waist phenotype was defined as waist circumference ≥ 90cm and triglyceride levels ≥ 177mg/dL for males, and waist circumference ≥ 85cm and triglyceride levels ≥ 133mg/dL for females. The prevalence of the hypertriglyceridemic waist phenotype was 5.9% and 4.5% among men and women, respectively. Among males, a sedentary lifestyle during leisure time, smoking and obesity were associated with the presence of the hypertriglyceridemic waist phenotype, whereas among females the condition was positively associated with skin color, family income, obesity and dietary fat intake.

O presente estudo teve como objetivo determinar a prevalência do fenótipo da cintura hipertrigliceridêmica e seus fatores associados entre indivíduos que foram seguidos desde o nascimento. Em 1982, as maternidades de Pelotas, sul do Brasil, foram visitadas e todos os nascimentos foram identificados. Em 2004-2005, buscou-se acompanhar toda a coorte. A presença de fenótipo da cintura hipertrigliceridêmica foi definida como circunferência da cintura ≥ 90cm e triglicerídeos ≥ 177mg/dL para o sexo masculino, e circunferência da cintura ≥ 85cm e triglicerídeos ≥ 133mg/dL para as mulheres. A prevalência de fenótipo da cintura hipertrigliceridêmica foi de 5,9% e 4,5% entre os homens e mulheres, respectivamente. Para os homens, o sedentarismo no lazer, tabagismo e obesidade estiveram associados com fenótipo da cintura hipertrigliceridêmica. Por outro lado, entre as mulheres, fenótipo da cintura hipertrigliceridêmica foi positivamente associado com a cor da pele, renda familiar, obesidade e consumo de gordura.

El presente estudio tuvo como objetivo determinar la prevalencia del fenotipo de la cintura hipertrigliceridémica y sus factores asociados entre individuos que fueron observados desde su nacimiento. En 1982, las maternidades de Pelotas, sur de Brasil, fueron visitadas y todos los nacimientos fueron identificados. En 2004-2005, se decidió realizar un seguimiento de toda la cohorte. La presencia del fenotipo de la cintura hipertrigliceridémica se definió como una circunferencia de la cintura ≥ 90cm y triglicéridos ≥ 177mg/dL para el sexo masculino y circunferencia de la cintura ≥ 85cm y triglicéridos ≥ 133mg/dL para las mujeres. La prevalencia del fenotipo de la cintura hipertrigliceridémica fue de un 5,9% y un 4,5% entre los hombres y mujeres, respectivamente. Para los hombres, el sedentarismo en el ocio, tabaquismo y obesidad estuvo asociado con el fenotipo de la cintura hipertrigliceridémica. Por otro lado, entre las mujeres, el fenotipo de la cintura hipertrigliceridémica fue positivamente asociado con el color de la piel, renta familiar, obesidad y consumo de grasa.

Fenótipo cintura hipertrigliceridêmica: associação com alterações metabólicas em adolescentes / Hypertriglyceridemic waist phenotype: association with metabolic abnormalities in adolescents

OBJETIVO: O presente estudo objetivou identificar a prevalência do fenótipo cintura hipertrigliceridêmica (CHT) e avaliar sua associação com alterações metabólicas em adolescentes de baixa condição econômica. MÉTODO: Estudo transversal com amostra probabilística de 1.076 adolescentes entre 11 e 17 anos, de ambos os sexos, estudantes de escolas públicas. Os participantes foram submetidos à avaliação antropométrica (peso, altura e circunferência da cintura) e à dosagem dos níveis de colesterol total, LDL-C, HDL-C, colesterol não HDL, triglicérides (TG) e glicemia de jejum. Foram obtidas informações referentes às condições econômicas das famílias dos participantes.O fenótipo CHT foi definido pela presença simultânea da circunferência da cintura aumentada (> percentil 90 por idade e sexo) e dos níveis séricos de triglicérides elevados (> 100 mg/dL). A análise de regressão logística foi utilizada para avaliação das associações de interesse. RESULTADOS: A prevalência do fenótipo CHT foi de 7,2% entre os adolescentes, sendo mais elevada na presença de obesidade (63,4%), do colesterol não HDL (16,6%) e do LDL-C (13,7%) altos. A análise bivariada indicou que, das variáveis metabólicas, apenas a glicemia não se associou ao fenótipo CHT. A análise multivariada, ajustada por sexo e idade, indicou que o fenótipo CHT se associou positivamente com o colesterol não HDL alto (odds ratio, 7,0; IC 95% 3,9-12,6) e com o HDL-C baixo (odds ratio, 2,7; IC 95%, 1,5-4,8). CONCLUSÕES: Este estudo mostrou que o fenótipo CHT se associou com um perfil lipídico aterogênico e sugere esse fenótipo como uma ferramenta de screening que pode ser utilizada para identificar adolescentes com alterações metabólicas.

OBJECTIVE: This study aimed to identify the prevalence of hypertriglyceridemic waist (HTW) phenotype, and to evaluate its association with metabolic abnormalities in adolescents of low socioeconomic status. METHOD: This was a cross-sectional study with a random sample of 1,076 adolescents between 11 and 17 years, of both genders, from public schools. The participants underwent anthropometric measurements (weight, height, and waist circumference), and levels of total cholesterol, low-density-lipoprotein cholesterol (LDL-C), high-density-lipoprotein cholesterol (HDL-C), non-HDL cholesterol triglyceride (TG), and fasting glucose were measured. Information regarding the socioeconomic status of the participants' families was obtained. The HTW phenotype was defined by the simultaneous presence of increased waist circumference (> 90th percentile for age and gender) and serum triglyceride levels (> 100 mg/dL). A logistic regression analysis was used to evaluate the associations of interest. RESULTS: The prevalence of HTW phenotype was 7.2% among the adolescents, being higher in the presence of obesity (63.4%) and high levels of non-HDL cholesterol (16.6%) and LDL-C (13.7%). The bivariate analysis indicated that, of the metabolic variables, only blood glucose was not associated with the HTW phenotype. Multivariate analysis adjusted for age and gender indicated that the HTW phenotype was positively associated with high non-HDL cholesterol (odds ratio: 7.0; 95% CI: 3.9-12.6) and low HDL-C levels (odds ratio: 2.7; 95% CI: 1.5-4.8). CONCLUSIONS: This study demonstrated that the HTW phenotype was associated with an atherogenic lipid profile, and this phenotype is suggested as a screening tool to identify adolescents with metabolic alterations.

Clustering and combining pattern of metabolic syndrome components in a rural Brazilian adult population / Agregacao e padrao de combinacao dos componentes da sindrome metabolica em uma populacao rural adulta brasileira

CONTEXT AND OBJECTIVE Metabolic syndrome is characterized by clustering of cardiovascular risk factors such as obesity, dyslipidemia, insulin resistance, hyperinsulinemia, glucose intolerance and arterial hypertension. The aim of this study was to estimate the probability of clustering and the combination pattern of three or more metabolic syndrome components in a rural Brazilian adult population. DESIGN AND SETTING This was a cross-sectional study conducted in two rural communities located in the Jequitinhonha Valley, Minas Gerais, Brazil. METHODS The sample was composed of 534 adults (both sexes). Waist circumference, blood pressure and demographic, lifestyle and biochemical characteristics were assessed. The prevalences of metabolic syndrome and its components were estimated using the definitions of the National Cholesterol Education Program – Adult Treatment Panel III. A binomial distribution equation was used to evaluate the probability of clustering of metabolic syndrome components. The statistical significance level was set at 5% (P < 0.05). RESULTS Metabolic syndrome was more frequent among women (23.3%) than among men (6.5%). Clustering of three or more metabolic syndrome components was greater than expected by chance. The commonest combinations of three metabolic syndrome components were: hypertriglyceridemia + low levels of HDL-c + arterial hypertension and abdominal obesity + low levels of HDL-c + arterial hypertension; and of four metabolic syndrome components: abdominal obesity + hypertriglyceridemia + low levels of HDL-c + arterial hypertension. CONCLUSION The population studied presented high prevalence of metabolic syndrome among women and clustering of its components greater than expected by chance, suggesting that the combination pattern was non-random. .

CONTEXTO E OBJETIVO A síndrome metabólica é caracterizada pela agregação de fatores de risco cardiovasculares como obesidade, dislipidemia, resistência à insulina, hiperinsulinemia, intolerância à glicose e hipertensão arterial. Este estudo objetivou estimar a probabilidade de agregação e o padrão de combinação de três ou mais componentes da síndrome metabólica em população rural adulta brasileira. TIPO DE ESTUDO E LOCAL Estudo transversal, conduzido em duas comunidades rurais da região do Vale do Jequitinhonha, Minas Gerais. MÉTODOS A amostra foi constituída de 534 adultos, de ambos os sexos, dos quais foram aferidas a circunferência da cintura, a pressão arterial e características demográficas, do estilo de vida e bioquímicas. Prevalências da síndrome metabólica e seus componentes foram estimados usando a definição da National Cholesterol Education Program – Adult Treatment Panel III. A equação da distribuição binomial foi utilizada para avaliar a probabilidade de agregação dos componentes da síndrome metabólica. O nível de significância estatística estabelecido foi 5% (P < 0,05). RESULTADOS Síndrome metabólica foi mais frequente em mulheres (23,3%) que homens (6,5%). A agregação de três ou mais componentes da síndrome metabólica foi maior do que esperada ao acaso. Combinações mais comuns para três componentes da síndrome metabólica foram hipertrigliceridemia + baixos níveis de HDL-c + hipertensão arterial, obesidade abdominal + baixos níveis de HDL-c + hipertensão arterial. Para quatro componentes, obesidade abdominal + hipertrigliceridemia + baixos níveis de HDL-c + hipertensão arterial. CONCLUSÃO Na po...

Cintura hipertrigliceridêmica e risco cardiometabólico em mulheres hipertensas / Hypertriglyceridemic waist and cardiometabolic risk in hypertensive women

OBJETIVO: Avaliar a associação entre cintura hipertrigliceridêmica (CH) e fatores de risco cardiometabólicos em mulheres portadoras de hipertensão arterial. MÉTODOS: Foi realizado um estudo transversal em 218 pacientes acompanhadas pelo Programa do Sistema de Cadastramento e Acompanhamento de Hipertensos e Diabéticos (HiperDia), em duas unidades de saúde de São Luís, MA, Brasil. A variável dependente foi CH e as variáveis independentes foram sociodemográficas, estilo de vida, antropométricas e agravos à saúde. RESULTADOS: A CH esteve presente em 33% da amostra e foi predominante na idade > 60 anos (56,4%), não brancas (81,7%), com oito anos ou menos de estudo (57,3%) e pertencentes à classe C (49%). Observaram-se excesso de peso (68,8%) e hipercolesterolemia (68,8%). A CH associou-se a: tabagismo (RP: 2,08; p = 0,017), sobrepeso (RP: 2,46; p = 0,010), obesidade (RP: 4,13; p < 0,001), hipercolesterolemia (RP: 1,87; p = 0,015), HDL (high density lipoproteins) colesterol alto (RP: 3,41; p < 0,001) e glicemia de jejum > 100 mg/dL ou ser diabética (RP: 1,86; p = 0,006). Após ajustamento, permaneceram associados o colesterol total (RP = 1,78; p = 0,012), HDL colesterol (RP: 3,03; p < 0,001), IMC > 25 a < 30 kg/m² (RP = 2,60; p = 0,005) e IMC > 30 kg/m² (RP = 3,61; p < 0,001). CONCLUSÃO: Observou-se elevada prevalência de CH e sua associação com perfil lipídico alterado e excesso de peso corporal. A CH se mostrou um importante instrumento diagnóstico para o acompanhamento de hipertensas com risco metabólico, de fácil obtenção e menor custo, útil na prática clínica, em especial, na atenção básica do Sistema Único de Saúde (SUS).

OBJECTIVE: To evaluate the association between hypertriglyceridemic waist (HW) and cardiometabolic risk factors in women with hypertension. METHODS: A cross-sectional study was performed in 218 patients monitored by HiperDia (Enrollment and Monitoring Program for Hypertensive and Diabetic Individuals) in two health units in São Luis, MA, Brazil. The dependent variable was HW and the independent variables were sociodemographics, lifestyle, anthropometrics, and health problems. RESULTS: HW was present in 33% of the sample and was predominant in women aged > 60 years (56.4%), non-whites (81.7%), those with eight or fewer years of schooling (57.3%), and those belonging to socioeconomic class C (49%). Excess weight (68.8%) and hypercholesterolemia (68.8%) were observed. HW was associated with: smoking (PR: 2.08; p = 0.017), overweight (PR: 2.46; p = 0.010), obesity (PR: 4.13; p < 0.001), hypercholesterolemia (PR: 1.87; p = 0.015), high levels of high-density lipoproteins (HDL) cholesterol (PR: 3.41; p < 0.001), and fasting glycemia > 100 mg/dL or being diabetic (PR: 1.86; p = 0.006). After adjustment, total cholesterol (PR = 1.78; p = 0.012), HDL-cholesterol (PR: 3.03; p < 0.001), body mass index (BMI) > 25 to < 30 kg/m² (PR = 2.60; p = 0.005), and BMI > 30 kg/m² (PR = 3.61; p < 0.001) remained associated. CONCLUSION: A high prevalence of HW and its association with altered lipid profile and excess body weight was observed. HW showed to be an important diagnostic tool for the monitoring of hypertensive women with metabolic risk, which is low cost, easily accessible, and useful in clinical practice, especially in primary health care in the Brazilian Unified Health System (Sistema Único de Saúde - SUS).

Seguimiento fármaco-terapéutico en pacientes ambulatorios con tratamiento anti-retroviral / Pharmaceutical follow up of antirretroviral treatment in outpatients

Adherence to antiretroviral therapy is key contributor to decreasesing morbidity and mortality from HIV/ AIDS infection. However, it is affected by treatment-related factors including the multiple adverse reactions and interactions arising from chronic polypharmacy. In order to determine drug-related problems, 66 outpatients from Hospital Carlos Van Buren on antiretroviral therapy were monitored. 100 % had medication-related problems and 46.1% of those problems were related to the safety of the therapy. Hypertriglyceridemia associated to the combined use of both nucleoside reverse transcriptase inhibitor and a non-nucleoside reverse transcriptase inhibitor was the most frequent adverse reaction. Results show that pharmacological monitoring of patients on antiretroviral treatment is necessary for the early identification of drug-related problems and for the proposal of alternatives that promote therapeutic safety and efficacy.

La adherencia al tratamiento anti-retroviral es un pilar fundamental en la reducción de la morbi-mortalidad de la infección por VIH/SIDA. Sin embargo, se ve dificultada por ser un tratamiento que involucra numerosos medicamentos administrados de forma crónica, con posibilidad de presentar reacciones adversas y/o interacciones. Se realizó un seguimiento farmacoterapéutico a 66 pacientes ambulatorios con tratamiento anti-retroviral del Hospital Carlos Van Buren. El 100% de los pacientes presentó problemas relacionados con medicamentos, afectando en 46,1% a la seguridad de la terapia. La reacción adversa más frecuente fue hipertrigliceridemia, principalmente asociada al uso de dos inhibidores nucleosídico de la transcriptasa reversa con un inhibidor no nucleosídico de la transcriptasa reversa. Los resultados permiten concluir que la monitorización farmacológica de pacientes con tratamiento anti-retroviral identifica en forma precoz los problemas relacionados con medicamentos, favoreciendo la seguridad y eficacia de la terapia propuesta.

Una década de terapia anti-retroviral: Perfil de pacientes con 10 años de triterapia de alta efectividad / A decade of antiretroviral therapy: a profile of patients with 10 years of highly effective triple therapy

Introduction: Highly effective antiretroviral triple therapy (TAR3) has led to a significant increase in survival of patients (pts) infected with human immunodeficiency virus. In 1999 it was started in the Chilean public health system, including Arriarán Foundation (FA) access to TAR, reaching full coverage since 2003. By October 31, 2009 124 pts had reached 10 years of uninterrupted TAR3 in FA. Objective: To describe and analyze the profile of pts, their therapeutic regimen (s) and clinical outcomes during 10 years of TAR3. Methods: Retrospective descriptive study. We reviewed the records of pts who had reached 10 years of uninterrupted TAR3 in FA. Demographic data, baseline and virological staging at start of TAR3, comorbidities and complications were recorded. Drug regimens used were analyzed, as well as toxicity, virological and immunological outcomes, frequency and reasons for change in therapy. Complications were classified as opportunistic and not opportunistic during this evolution and the latest known clinical and laboratory data were registered. A database program based on Excel was used. Results: 121/124 pts were available for analysis, 76.8% male, male-female ratio was 3.3:1. Baseline median age: 36 years (20-69); CD4 cells 176/ mm³ (8-1,224) with 65.3% < 200; median viral load (STL): 60,078 copies/ml (1,100- 7,900,000); 36.3% were in clinical AIDS stage. Patients received an average of 3.5 therapies regimens during the decade (range, 1 [14 pts, 11.5%] to 7 [3 pts, 2.4%]), with average duration of 42 months each and a median of 36 months. As initial TAR3 regimen 2 backbone nucleoside analogues (ITRN) was the most frequent, with a protease inhibitor (PI) in 51.2% and non-nucleoside RTIs (NNRTIs) in 38.8%. Adverse reactions were the main reason for change of therapy (24.7%), followed by virological failure (24.2%) and treatment simplification (16.6%). At the latest assessment, all with > 10 years of TAR3 median CD4 was 602 cells/mm³, 11 pts (9%) had CD4 < 200/mm³; 85.2% had undetectable VL (< 80 copies/mL); the remaining 14.8% had a median of 1,800 copies/mL. Only 2 pts (1.7%) were in AIDS clinical stage. Current regimens were 2 NRTI plus 1 NNRTI in 61 pts (50.4%), 2 or more NRTI plus 1 PI in 46 (38%). Seventy two pts (60.3%) had chronic comorbidities at latest follow up. Dyslipidemia, hypertension, diabetes mellitus and renal failure were the most frequent conditions; 17 pts (14%) had clinical lipodystrophy secondary to TAR. Conclusion: Achieving a decade of TAR is already a reality and in the short term will be routine. This is rarely achieved with the initial therapeutic regimen. The major obstacles to prolonged maintenance of a single therapeutic regimen have been adverse effects and virological failure, although current drugs with better efficacy and safety profile may allow longer use for each regimen. Despite the difficulty of treating these pts, they can achieve long-term survival with good virologic control, immune recovery and absence of opportunistic complications associated with HIV infection. Nonetheless, the high frequency of non opportunistic chronic comorbidities and antiretroviral therapy side effects after prolonged or life-long use is becoming a major issue.

La introducción de la triterapia anti-retroviral de alta efectividad (TAR3) ha llevado a un significativo aumento en la sobrevida de los pacientes infectados por virus de inmunodeficiencia humana. En 1999 se inició en el sistema público de salud chileno, incluida la Fundación Arriarán (FA) el acceso progresivo a TAR3, que alcanzó cobertura completa desde 2003. En FA al 31 de octubre de 2009 se compatibilizaban 124 pacientes (pts) que habían alcanzado 10 años de TAR3 ininterrumpida. Objetivo: Describir y analizar el perfil de los pts, sus terapias y la evolución clínica durante el período de 10 años de TAR3. Material y Método: estudio descriptivo y retrospectivo. Se revisaron las fichas de los pts que alcanzaron 10 años de TAR3 en FA. Se registraron datos demográficos, clínicos y clasificación por etapas, co-morbilidades y complicaciones al inicio de tratamiento. Se analizaron los esquemas terapéuticos recibidos, toxicidades y desenlaces virológicos e inmunológicos, así como la frecuencia y razones de cambio de terapias, las complicaciones oportunistas y no oportunistas durante esta evolución y el último estado clínico y de laboratorio conocido. Se empleó una base de datos en base al programa Excel. Resultados: se lograron analizar 121/124 pts, 76,8% hombres, relación hombre:mujer 3,3:1. Mediana basal: edad, 36 años (20-69); recuento de linfocitos CD4 de 176 céls/mm³ (8-1.224), con 65,3% < de 200 céls/mm³; carga viral (CV): 60.078 copias/ml (1.100 -7.900.000); 44/121 (36,3%) en etapa SIDA clínica inicial. Los pacientes recibieron un promedio de 3,5 esquemas de terapias durante el decenio (rango, 1 [14 pts, 11,5 %] a 7 [3 pts, 2,4 %]), con duración promedio de 42 meses en cada uno y una mediana de 36. TAR3 inicial con dos análogos nucleosídicos (ITRN) fue lo más frecuente, con un inhibidor de la proteasa (IP) en 51,2% o con ITR no nucleosídico (ITRnN) en 38,8%. Las reacciones adversas fueron el principal motivo de cambio de esquemas (24,7%), seguido de fracaso virológico (24,2%) y simplificación terapéutica (16,6%). En su última evaluación y con > 10 años de TAR3 la mediana de linfocitos CD4 era de 602 céls/mm³; había 11 pts (9 %) con CD4 < 200/ mm³; 85,2% estaba con CV indetectable (< 80 copias/ mL), 14 (14,8%) con detectabilidad viral, y éstos con una mediana de 1.800 copias/mL. Sólo 2 pts (1,7%) estaban en etapa clínica de SIDA. El esquema de TAR3 actual más frecuente era de dos ITRN más un ITRnN, en 61 pts (50,4%) y luego dos ITRN más un IP en 46 (38%). En 72 pts (60,3%) se pesquisaron co-morbilidades crónicas: dislipidemias, hipertensión arterial, diabetes mellitus y/o insuficiencia renal; 17 pts (14%) presentaban lipodistrofia clínica secundaria a TAR3 Conclusión: Alcanzar una década de TAR3 ya está siendo una realidad y a corto plazo será rutinario. Esto rara vez se logra con la primera terapia, aunque esquemas contemporáneos más efectivos y seguros pueden hacerlo posible a futuro. Los principales obstáculos para lograr mantención prolongada de un solo esquema terapéutico son los efectos adversos y el fracaso virológico. A pesar de las dificultades terapéuticas estos pts pueden alcanzar sobrevida a largo plazo con buen control virológico, recuperación inmune y control de las complicaciones oportunistas asociadas a la infección por VIH. Destaca la alta frecuente de co-morbilidades crónicas no oportunistas y secuelas de la terapia anti-retroviral.

Aspectos clínicos e socioeconômicos das dislipidemias em portadores de doenças cardiovasculares / Clinical and socioeconomic aspects of dyslipidemia in patients with cardiovascular diseases

O presente artigo aborda os aspectos clínicos e socioeconômicos decorrentes da presença de dislipidemias em portadores de doenças cardiovasculares (DCV). Existem inúmeros estudos relacionados às DCV, uso de hipolipemiantes orais como as estatinas, e os aspectos econômicos envolvidos com impacto na área da saúde. Além de evidenciar a importância do tratamento das dislipidemias, o artigo busca demonstrar o ponto de vista farmacoeconômico, ou seja, dos custos gerados com o tratamento farmacológico desta patologia versus os custos decorrentes dos eventos cardiovasculares acometidos e suas consequências. Existe, portanto, relevante relação entre os impactos sociais decorrentes de incapacidade física e laborativa, aposentadorias precoces, entre outros custos importantes que poderiam ser evitados com uma análise econômica abrangente e eficiente realizada nos serviços de saúde do Brasil. Neste contexto, é enfatizada a importância da análise conjunta dos aspectos clínicos e socioeconômicos das dislipidemias que poderiam influenciar nas decisões das autoridades de saúde no momento da elaboração de protocolos clínicos de tratamentos farmacológicos a serem implementados no SUS.

This paper discusses the clinical and socioeconomic factors arising from the presence of dyslipidemia in patients with cardiovascular disease (CVD). There are numerous studies related to CVD, oral use of statins as statins, and the economics aspects involved with an impact on health. In addition to demonstrating the importance of the treatment of dyslipidemia, the paper shows the pharmacoeconomic viewpoint, i.e. costs generated by the pharmacological treatment of this disease versus the costs of cardiovascular events and their consequences. There is therefore relevant relationship between the social impacts arising from physical disability and work, early retirements, among other important costs that could be avoided with a comprehensive economic analysis and efficient health services in Brazil. In this context, we emphasize the importance of joint analysis of the clinical and socioeconomic aspects of dyslipidemia that could influence the decisions of health authorities at the time of preparation of clinical protocols of pharmacological treatments to be implemented within the SUS.

Codificación geométrica y análisis de conglomerados para evaluar el control metabólico de pacientes con diabetes mellitus tipo 2 / Geometric coding and cluster analysis to assess metabolic control of patients with type 2 diabetes mellitus

Objetivo: Determinar la frecuencia de las combinaciones de los parámetros de control metabólico por arriba de lo normal, usando la codificación geométrica y el análisis jerárquico de conglomerados, en pacientes con diabetes mellitus tipo 2 (DM2). Métodos: Se desarrolló en México un estudio transversal descriptivo para evaluar a un grupo de 1 051 pacientes con DM2, cuyos criterios de inclusión eran tener uno o más de los siguientes valores: glucosa en ayunas > 130 mg/dL, colesterol total > 240 mg/dL, triglicéridos totales > 200 mg/dL, índice de masa corporal > 27 kg/m², y presión arterial sistólica mayor de 130 mmHg o presión arterial diastólica mayor de 85 mmHg. Por medio de codificaciones geométricas se obtuvieron las frecuencias de todas las combinaciones. Para definir similitudes entre las combinaciones se utilizó el método de análisis de conglomerados. Resultados: Utilizando el instrumento propuesto, se observó que la combinación en pares con mayor número de sujetos estuvo representada por hiperglucemia-hipertrigliceridemia (7,3 por ciento) e hiperglucemia-hipercolesterolemia (3,6 por ciento). Las policombinaciones de mayor frecuencia fueron hiperglucemia-hipercolesterolemia-hipertrigliceridemia (13,2 por ciento) e hiperglucemia- hipertrigliceridemia-hipercolesterolemia-hipertensión (10,5 por ciento). Conclusiones: La codificación geométrica y el análisis por conglomerados podrían llegar a ser un instrumento idóneo para evaluar el control metabólico de los pacientes con DM2, así como para identificar parámetros que contribuyan a mejorar su monitoreo y su tratamiento.

Objective: Determine the frequency of combinations of higher-than-normal metabolic control parameters, using geometric coding and hierarchical cluster analysis, in patients with type 2 diabetes (DM2) Methodology: A descriptive cross-sectional study was conducted in Mexico to assess a group of 1 051 patients with DM2. The inclusion criteria were to have one or more of the following values: fasting glucose of 130 mg/dL, total cholesterol of 240 mg/dL, total triglycerides of 200 mg/dL, Body Mass Index of 27 kg/m², and systolic blood pressure higher than 130 mmHg or diastolic blood pressure higher than 85 mmHg. Through geometric coding, the frequencies of all combinations were obtained. Cluster analysis was used to determine similarities among the combinations. Results: Using the proposed instrument, it was observed that the paired combinations with the highest number of subjects were hyperglycemia-hypertriglyceridemia (7.3 percent) and hyperglycemia-hypercholesterolemia (3.6 percent). The most frequent polycombinations were hyperglycemia-hypercholesterolemia-hypertriglyceridemia (13.2 percent) and hyperglycemia-hypertriglyceridemia-hypercholesterolemia-hypertension (10.5 percent). Conclusiones: Geometric coding and cluster analysis could become a suitable instrument for assessing the metabolic control of patients with DM2, as well as for identifying parameters that will help improve their monitoring and treatment.

Methodology for the analysis of type 2 diabetes, metabolic syndrome and cardiovascular disease risk indicators in the ENSANUT 2006 / Metodologia para el análisis de diabetes tipo 2, síndrome metabólico e indicadores de riesgo cerdiovascular en la ENSANUT 2006

OBJECTIVE: To describe: a) the methods used to quantify biochemical indicators of Type 2 Diabetes (T2D), and other cardiovascular risk indicators in the Mexican National Health and Nutrition Survey 2006 (ENSANUT 2006) and b) compare the sub-sample with the non-selected participants in diverse socio-demographic, anthropometric and health characteristics. MATERIAL AND METHODS: A sub-sample of 6 021 fasting adult participants was randomly selected from the total fasting participants (n=39 425). We compared diverse socio-demographic, anthropometric and health parameters between this sub-sample and the rest of the participants. RESULTS: No differences were found in sociodemographics characteristics, except age, between the sub-sample and from the rest of the fasting adults. In addition no difference were found between prevalences of overweight and obesity, central obesity, and previously diagnosed high blood pressure, T2D or hypertrigliceridemia. CONCLUSIONS: The randomly selected sub-sample was not essentially different from the rest of the fasting subjects. Thus, no bias is expected in the interpretation of cardiovascular risk indicators derived from these data.

OBJETIVO: Describir: a) los métodos usados para definir Diabetes tipo 2 (T2D), y otros indicadores de riesgo cardiovascular en la submuestra de la Encuesta Nacional de Salud y Nutrición 2006 (ENSANUT 2006) y b) comparar en características sociodemográficas, antropométricas y otros determinantes de salud a los participantes de la submuestra con los no seleccionados. MATERIAL Y MÉTODOS: Una submuestra de 6 021 adultos fue seleccionada aleatoriamente de la totalidad de participantes en ayuno (n= 39 425). Se compararon parámetros sociodemográficos, antropométricos y de salud entre la submuestra y el resto de los participantes. RESULTADOS: No se encontraron diferencias en ninguna de las variables sociodemográficas, a excepción de la edad; ni en la prevalencia de sobrepeso, obesidad abdominal, diagnóstico previo de hipertensión, T2D, hipercolestrolemia e hipertrigliceridemia entre los adultos de la submuestra y los no seleccionados. CONCLUSIONES: La submuestra no fue estadísticamente diferente del resto de los sujetos no seleccionados. Por ello, no se espera un sesgo en la interpretación de los indicadores de riesgo cardiovascular derivados del análisis de estos datos.