[Integral control of cardiovascular risk factors in type 2 diabetes in the Pallars Jussà and Sobirà regions (area of influence of the regional hospital of Pallars-Lleida)]. / Control integral de los factores de riesgo cardiovascular en diabetes tipo 2 en dos comarcas rurales.

UNLABELLED: FUNDAMENTALS AND OBJECTIVES: Control of cardiovascular risk factors is especially important in type 2 diabetes (DM2). The degree of control has not been studied specifically in rural population and how it affects quality of life. We have assessed the degree of accomplishment of the main control objectives in the area assigned to a regional hospital and evaluated their quality of life. MATERIAL AND METHODS: Cross-sectional study, in DM2 patients seen in Primary Care Centers on the Pallars Jussà y Sobirà (Lleida) regions. Smoking, body mass index (BMI), blood pressure (BP), HbA1c, total cholesterol, LDLc, HDL-c and triglycerides were evaluated. Quality of life was assessed with a health questionnaire (EQ-5D). RESULTS: 109 subjects (55% male) were recruited, with a medium age (standard deviation) of 70 (7.7) years old. 25% of cases had BMI <27kg/m(2) and 92% were non-current smokers. Systolic and diastolic BP were under control on the 36% and 53%, and HbA1c, on the 41%. Total Cholesterol was found optimal on the 54%, LDL-c on the 30%, HDL-c on the 64% and triglycerides on the 75%. 1.8% of patients achieved all the goals. The medium global subjective assessment of health status was 69 points. CONCLUSIONS: A very small percentage of patients with DM2 are in the recommended target. The most difficult to achieve were BMI and BP and the highest achievement were triglycerides and smoking abstinence. Subjective perception of health status was not associated with degree of objectives' control.

Risk indicators for periodontal diseases in Guatemalan adolescents.

A random sample of sixty-two 11-15-year-old adolescents from 17 different locations in Guatemala were selected for this study. Pocket depth, Plaque Index, and bleeding upon probing were recorded from 6 randomly selected sites in each subject (a total of 372 sites). Subgingival plaque samples were subsequently collected from these sites and processed by several assays. For cost reasons, in each pair of sites different assays were performed as follows: sites #1, #2--BANA test for T. denticola, P. gingivalis, B. forsythus and screening of plaque samples with polyclonal antibodies (ELISA system) for A. actinomycetemcomitans; sites #3, #4--detection of yeasts by SAB agar; sites #5, #6--detection of Entamoeba gingivalis by the Heidenhain iron hematoxylin modified technique. A total of 66% of the children had at least one site that bled upon probing, 42% exhibited at least one site with pocket depth > 3 mm, and 79% exhibited a high Plaque Index, with the percent of sites affected being 30%, 12% and 41%, respectively. In sites #1, #2 (N = 124), the BANA test assay and A. actinomycetemcomitans tested positive in 77% and 47% of the children accounting for 59% and 31% of the sites, respectively. In sites #3, #4 (N = 124), yeasts were detected in 43% of the children and 29% of the sites. In sites #5, #6 (N = 124), Entamoeba gingivalis was detected in 21% of the children and in 11% of the sites. The risk for severe gingival inflammation and/or increased probing depth was 1.5 and 5.2 times higher if a positive BANA test or A. actinomycetemcomitans test was found in a particular site. No associations could be found for yeasts and Entamoeba gingivalis.

[Plasma lipoprotein (a) values in familial defective ligand apo B 100 in a South European population]. / Estudio de los valores plasmáticos de Lp(a) en el defecto familiar de unión de la apo B 100 en una población mediterránea del sur de Europa.

AIMS: 1) to study lipoprotein (a) (Lp(a)) plasma values in subjects with familial ligand-defective apo B 100 (FDB). METHODS: We studied 19 heterozygous FDB subjects (8 males) from 12 families, carriers of R3500Q mutation on apo B gene and 90 controls (34 males). The genetic diagnosis was established with PCR-SSCP analysis and automatic sequencing. In all subjects plasma lipids, apolipoprotein B and Lp(a) levels were determined with standard procedures. RESULTS: Subjects carriers of R3500Q mutation on apo B gene have significantly higher plasma Lp(a) and log transformed Lp(a) values and prevalence of Lp(a) > 30 cut point for coronary heart disease than controls. CONCLUSIONS: Subjects with FDB showed higher Lp(a) plasma values than controls, although the mechanism and the clinical consequences of these result are not known.

Differential clinical treatment outcome after systemic metronidazole and amoxicillin in patients harboring Actinobacillus actinomycetemcomitans and/or Porphyromonas gingivalis.

48 adult patients with untreated periodontitis harboring subgingival Actinobacillus actinomycetemcomitans and/or Porphyromonas gingivalis as assessed by PCR were randomly assigned to receive full-mouth scaling alone (control) or scaling with systemic metronidazole plus amoxicillin and supragingival irrigation with chlorhexidine digluconate (test). In patients harboring A. actinomycetemcomitans intraorally at baseline, the adjunctive antimicrobial therapy resulted in a significantly higher incidence of probing attachment level (PAL) gain of 2 mm or more compared to scaling alone over 12 months (p<0.05). In addition, suppression of A. actinomycetemcomitans in subgingival plaque below detectable levels was associated with an increased incidence of PAL gain. In contrast, patients initially harboring P. gingivalis but not A. actinomycetemcomitans in the oral cavity showed a significantly higher incidence of PAL loss following adjunctive antimicrobial therapy compared to scaling alone (p<0.05). When the presence of pathogens at baseline was disregarded in the analysis, adjunctive antimicrobial therapy did not significantly enhance clinical treatment outcome. The results indicated that adults with untreated periodontitis harboring A. actinomycetemcomitans may benefit from the adjunctive antimicrobial therapy for a minimum of 12 months, whereas, the regimen may adversely affect the clinical treatment outcome of patients harboring P. gingivalis but not A. actinomycetemcomitans.

Differential effects of systemic metronidazole and amoxicillin on Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis in intraoral habitats.

48 adult patients with untreated periodontitis harboring subgingival Actinobacillus actinomycetemcomitans and/or Porphyromonas gingivalis were randomly assigned to receive full mouth scaling alone (control) or scaling with systemic metronidazole plus amoxicillin and supragingivai irrigation with chlorhexidine digluconate (test). Subgingival plaque and swab samples from tongue, tonsils, and buccal mucosa were taken at baseline, 10 days and 3, 6, 9, and 12 months. A. actinomycetemcomitans was detected in the oral cavity, i.e., subgingival plaque and/or mucous membranes, less frequently in test patients compared to controls at 9 and 12 months (p<0.01), whereas, the intraoral detection frequency of P. gingivalis was significantly reduced only 10 days following therapy (p<0.001). At any time after therapy, A. actinomycetemcomitans was not detected intraorally in 5 of 10 (50%) test and 1 of 13 (8%) control patients harboring this pathogen at baseline; P. gingivalis was not detected in only 1 of 18 (6%) test and none of the 17 control patients harboring this pathogen at baseline. Although the data indicated that the assessed antimicrobial therapy may suppress A. actinomycetemcomitans from the entire oral cavity below detectable levels over a minimum of 12 months, P. gingivalis persisted or reoccurred.

[The clinical efficacy and complications of the transjugular intrahepatic portosystemic shunt-stent]. / Eficacia clínica y complicaciones del shunt-stent portosistémico intrahepático transyugular.

TIPSS is a new therapeutic modality for decompressing the portal tree and its use has broadened in the last five years. From February 1993 to August 1994 a prospective study was performed to evaluate its efficacy and safety. Nineteen cirrhotic patients (Child A-5, B-10, and C-4) with a TIPSS placed were included. The mean follow-up was 7.2 months. The indication was therapy of esophageal variceal bleeding in 18 patients (acutely in 8 and elective in 10 patients) and refractory ascites in one. In all cases could the "stent" be placed and the portocaval gradient decreased from 22.8 +/- 3.71 to 9.3 +/- 2.27 mmHg. In the first thirty days the mortality rate was 10.5%, with the following complications: two portal thromboses, two acute non-lithiasic cholecystitis, one hemoperitoneum, one spontaneous bacterial peritonitis, and one hepatic encephalopathy. During the follow-up period two patients developed hemorrhagic relapses and two additional patients subclinical encephalopathy. TIPSS dysfunction was observed in 57.8%.

Control integral de los factores de riesgo cardiovascular en diabetes tipo 2 en dos comarcas rurales / Integral control of cardiovascular risk factors in type 2 diabetes in the Pallars Jussà and Sobirà regions (area of influence of the regional hospital of Pallars-Lleida)

Fundamento y objetivos. El control de los factores de riesgo cardiovascular es especialmente importante en diabetes tipo 2 (DM-2). El grado de control no se ha estudiado específicamente en población rural ni cómo afecta a la calidad de vida. Hemos valorado el grado de consecución de los principales objetivos de control en el área adscrita a un hospital comarcal y evaluado la calidad de vida. Material y métodos. Estudio transversal, en pacientes DM-2 atendidos en atención primaria de las comarcas Pallars Jussà y Sobirà (Lleida). Se evaluaron el tabaquismo, IMC, PA, HbA1c, colesterol total, c-LDL, c-HDL y triglicéridos. La calidad de vida se valoró con cuestionario de salud (EQ-5D). Resultados. Se incluyeron 109 sujetos (55% hombres) con edad media (desviación estándar) de 70 (7,7) años. El 25% de los casos tenía IMC <27kg/m2 y 92% no fumaba. La PA sistólica y diastólica se hallaron controladas en el 36% y 53%, y la HbA1c, en 41%. Se halló control óptimo del colesterol total en el 54%, c-LDL en el 30%, c-HDL en el 64% y triglicéridos en el 75%. Un 1,8% alcanzaban todos los objetivos. La media de la valoración subjetiva global del estado de salud fue 69 puntos. Conclusiones. Una proporción muy pequeña de los pacientes con DM-2 se encuentran en los objetivos recomendados. Los más difíciles de conseguir fueron IMC y PA y los de mayor consecución fueron el nivel de triglicéridos y abstinencia tabáquica. La percepción subjetiva del estado de salud no se asoció al grado de control de objetivos(AU)

Fundamentals and objectives. Control of cardiovascular risk factors is especially important in type 2 diabetes (DM2). The degree of control has not been studied specifically in rural population and how it affects quality of life. We have assessed the degree of accomplishment of the main control objectives in the area assigned to a regional hospital and evaluated their quality of life. Material and methods. Cross-sectional study, in DM2 patients seen in Primary Care Centers on the Pallars Jussà y Sobirà (Lleida) regions. Smoking, body mass index (BMI), blood pressure (BP), HbA1c, total cholesterol, LDLc, HDL-c and triglycerides were evaluated. Quality of life was assessed with a health questionnaire (EQ-5D). Results. 109 subjects (55% male) were recruited, with a medium age (standard deviation) of 70 (7.7) years old. 25% of cases had BMI <27kg/m2 and 92% were non-current smokers. Systolic and diastolic BP were under control on the 36% and 53%, and HbA1c, on the 41%. Total Cholesterol was found optimal on the 54%, LDL-c on the 30%, HDL-c on the 64% and triglycerides on the 75%. 1.8% of patients achieved all the goals. The medium global subjective assessment of health status was 69 points. Conclusions. A very small percentage of patients with DM2 are in the recommended target. The most difficult to achieve were BMI and BP and the highest achievement were triglycerides and smoking abstinence. Subjective perception of health status was not associated with degree of objectives’ control(AU)

Estudio de los valores plasmáticos de Lp(a) en el defecto familiar de unión de la apo B 100 en una población mediterránea del sur de Europa / Plasma lipoprotein a values in familial ligand defective apo B 100 in a south European population

Objetivo: Estudiar los valores plasmáticos de Lp(a) en el defecto familiar de unión de apo B 100 (DFB) en poblaciones sur Europea donde no existen datos al respecto. Métodos: Hemos estudiado a 19 heterocigotos DFB (8 varones), portadores de la mutación R3500Q del gen de la apo B y a 90 controles (34 varones). El diagnóstico genético se realizó por técnica de PCR-SSCP y secuenciación automática. En todos los sujetos se determinó de forma estandarizada las concentraciones plasmáticas de lípidos, apolipoproteína B y Lp(a). Resultados: Los valores plasmáticos de Lp(a) y su transformación logarítmica fueron significativamente mayores en el grupo con DFB frente al grupo control. Además, la prevalencia de Lp(a) > de 30 mg/dl, como punto de corte de alto riesgo para cardiopatía isquemia fue significativamente mayor en el grupo portador de la mutación R3500Q. Conclusión: Los sujetos portadores de la mutación R3500Q del gen de apo B mostraron valores plasmáticos superiores de Lp(a) que los controles, sin que conozcamos por el momento el mecanismo y sus implicaciones clínicas (AU)

Allergy to house dust mites and asthma

House dust mites have been shown to be important sources of indoor allergens associated with asthma and other allergic conditions. Asthma is a chronic respiratory disease that affects millions of people worldwide, and numerous scientific studies have shown that the prevalence of asthma is increasing. The most common dust mite species around the world include Dermatophagoides pteronyssinus (Dp), Dermatophagoides farinae (Df), Euroglyphus maynei (Em) and Blomia tropicalis (Bt). Over the past three decades, many important allergens from these species have been identified and characterized at the molecular level. The biological function of several house dust mite allergens has been elucidated, with many of them showing enzymatic activity. However, Bt allergens remain the least studied, even though this mite is very common in tropical and subtropical regions of the world, including Puerto Rico. Therefore, it is very important to include Bt in diagnostic and therapeutic strategies for house dust mite induced allergy and asthma, particularly in areas where Bt exposure and sensitization is high. Recombinant DNA technology, as well as other molecular biology and immunological techniques, have played a fundamental role in advances towards a better understanding of the biology of house dust mites and their role in allergic diseases. This kind of study also contributes to the understanding of the complex immunologic mechanisms involved in allergic reactions. The development of effective diagnostic and therapeutic approaches depends on the continuity of research of house dust mite allergens. The objectives of this review are to describe the most important aspects of house dust mite allergy and to acquaint the scientific community with the latest findings pertaining to house dust mite allergens, particularly those derived from Bt.