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Cinza-Sanjurjo S, Micó-Pérez RM, Velilla-Zancada S, Prieto-Díaz MA, Rodríguez-Roca GC, Barquilla García A, Polo García J, Martín Sánchez V, Llisterri Caro JL. [Factors associated with cardiovascular risk and cardiovascular and renal disease in the IBERICAN study: Final results]. Semergen 2020; 46:368-378. [PMID: 32873502 DOI: 10.1016/j.semerg.2020.06.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 06/19/2020] [Accepted: 06/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyse the prevalence in clinical practice of cardiovascular risk factors (CVRF) and cardiovascular disease (CVD), as well as their causal relationship, in the study inclusion visit. MATERIAL AND METHODS Cross-sectional analysis of the study inclusion visit of 8,066 patients of 18 to 85years of age included in the IBERICAN study. By reviewing the medical history, analytics and medical visits, the patient's physician has collected socio-demographic information, personal and family history and prevalence of CVRF and CVD and renal disease. A multivariate analysis was carried out using a logistic regression that included the autonomous region variable as a random effect variable, in order to analyse the impact of certain variables on the development of each CVRF, metabolic syndrome, subclinical organ damage, renal disease, and CVD. RESULTS Dyslipidaemia was 2.4 times more frequent in diabetics, and the risk was increased by 59% in hypertensive patients. Arterial hypertension was twice as frequent in diabetics, and increased 94% in hyperuricaemic patients and 62.1% in dyslipidaemia patients. Diabetes mellitus was 2.5 times higher in dyslipidaemia patients, and 2.2 times higher in hypertensive patients. CVD was four times more frequent in patients with a family history, and the risk in women was increased by 90.8% and by 53.8% in patients with renal disease. CONCLUSIONS The Spanish population seen in Primary Care that were analysed in the IBERICAN study had a high prevalence of CVRF and CVD, which gives it a high CVR. The multivariate analysis performed shows a close causal relationship between the CVRF with each other, and with renal disease and CVD.
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Affiliation(s)
- S Cinza-Sanjurjo
- Centro de Salud de Porto do Son, AS Santiago de Compostela, Porto do Son, A Coruña, España
| | - R M Micó-Pérez
- Centro de Salud de Fontanars dels Alforins, EAP Ontinyent, Fontanars dels Alforins, Valencia, España
| | | | | | - G C Rodríguez-Roca
- Centro de Salud de Puebla de Montalbán, La Puebla de Montalbán, Toledo, España
| | | | - J Polo García
- Centro de Salud Casar de Cáceres, Casar de Cáceres, Cáceres, España
| | - V Martín Sánchez
- Instituto de Biomedicina (IBIOMED), Universidad de León, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), León, España
| | - J L Llisterri Caro
- Fundación Sociedad Española de Médicos de Atención Primaria, Semergen, Madrid, España
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Cinza Sanjurjo S, Llisterri Caro J, Barquilla García A, Polo García J, Velilla Zancada S, Rodríguez Roca G, Micó Pérez R, Martín Sánchez V, Prieto Díaz M. Descripción de la muestra, diseño y métodos del estudio para la identificación de la población española de riesgo cardiovascular y renal (IBERICAN). Semergen 2020; 46:4-15. [DOI: 10.1016/j.semerg.2019.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 11/29/2022]
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Ripoll T, García AB, Gomila I, Heine D, Poncela JL, Sánchez N, Pérez C, García E, Hernández E, Barceló A, Busardo FP, Barceló B. Post-mortem toxicology in the diagnosis of sudden death in young and middle-aged victims. Eur Rev Med Pharmacol Sci 2019; 23:9135-9149. [PMID: 31773664 DOI: 10.26355/eurrev_201911_19404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We aimed to investigate the impact of the toxicological results found in cases of sudden death (SD) and to correlate the clinical, autopsy and genetic findings with the toxicology results. MATERIALS AND METHODS Consecutive SD in people aged between 16 and 50 years with medico-legal autopsies and toxicology studies were included over a 3-year period. The comparison between the toxicological data and demographic characteristics, clinical circumstances, autopsy, and genetic results were taken into account. RESULTS 101 cases were finally included. They were predominately males (84%) and the mean age was 39.8 years. 52 (51.5%) cases had positive toxicological findings and in 25 cases (24.8%), toxic compounds were considered the first cause of death. Ethanol was the most frequently identified agent (69%), following by licit drugs (56%) and drugs of abuse (39%). Cases with positive toxicology were younger than those with negative results (37.9±9.1 vs. 41.9±7.8; p=0.02). Patients with more than 3 comorbidities showed an association with positive toxicological results (n=14 vs. n=3; p=0.017). The genetic study was performed in 70 (69.3%) SD cases. We identified pathogenic or likely pathogenic variants in 17.1% cases and uncertain significance variants in 42.8% cases. 58% of these variants were probably related to the cause of death. CONCLUSIONS A large fraction of SD victims had positive toxicological findings and a quarter of deaths were directly caused by toxic substances. The identification of the factors that trigger SD provides a good approach to contribute in avoiding future episodes.
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Affiliation(s)
- T Ripoll
- Cardiology Department, Hospital Universitari Son Llàtzer, MUSIB Research Group, Research Institute of Health Sciences (IdISBa), Palma de Mallorca, Spain.
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Pallarés-Carratalá V, Divisón Garrote JA, Prieto Díaz MA, García Matarín L, Seoane Vicente MC, Molina Escribano F, Velilla Zancada S, Rey Aldana D, Cinza Sanjurjo S, Santos Altozano C, Górriz JL, Alonso Moreno FJ, Polo García J, Barquilla García A, Beato Fernández P, Escobar Cervantes C. [Positioning for the management of arterial hypertension in Primary Care from the critical analysis of the American (2017) and European (2018) guidelines. Spanish Society of Primary Care Physicians (SEMERGEN)]. Semergen 2019; 45:251-272. [PMID: 31005506 DOI: 10.1016/j.semerg.2019.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/04/2019] [Indexed: 11/30/2022]
Abstract
The Scientific Societies of Primary Care, being the area in which there is a considerable prevalence of Arterial Hypertension (AHT), need to periodically evaluate the international guidelines for its management. This is particularly relevant when disparate guidelines make it difficult to make decisions in daily clinical practice. The present document has as its aim to analyse the changes and new developments proposed in the guidelines of the American College of Cardiology and the American Heart Association (ACC/AHA 2017), as well as in the guidelines of the European Society of Cardiology and European Society of Hypertension (ESC/ESH 2018). An analysis will be made of any differences, limitations, and their applicability to Primary Care in Spain. Finally, the most relevant available and appropriate information is extracted and integrated in order to homogenise the care of the hypertensive patient, from a critical, but also a reasoned, perspective. The discrepancies between the recommendations in such essential aspects as the management of the disease, require the compiling and critical analysis of the information that enables us as scientific society, interested in providing all PC physicians with the most relevant, and at the same time, sensible, recommendations of all the guidelines.
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Affiliation(s)
- V Pallarés-Carratalá
- Unidad de Vigilancia de la Salud, Unión de Mutuas, Castellón, España; Departamento de Medicina, Universitat Jaume I, Castellón, España.
| | - J A Divisón Garrote
- Centro de Salud Casas Ibañez, Casas Ibáñez, Albacete, España; Cátedra de Medicina de Familia SEMERGEN, Universidad Católica San Antonio de Murcia, Murcia, España.
| | | | | | | | - F Molina Escribano
- Centro de Salud Casas Ibañez, Consultorio Balsa de Ves, Balsa de Ves, Albacete, España
| | | | - D Rey Aldana
- Centro de Salud A Estrada, A Estrada, Pontevedra, España
| | - S Cinza Sanjurjo
- Cátedra SEMERGEN, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España; Centro de Salud Porto do Son, Porto de Son, A Coruña, España
| | | | - J L Górriz
- Servicio de Nefrología, Hospital Clínico de Valencia, Valencia, España; Departamento de Medicina, Facultad de Medicina, Universidad de Valencia, Valencia, España
| | | | - J Polo García
- Centro de Salud Casar de Cáceres, Casar de Cáceres, Cáceres, España
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López-González L, Candel FJ, Viñuela-Prieto JM, González-Del Castillo J, García AB, Pena I, Rodríguez-Avial I. Useful independent factors for distinguish infection and colonization in patients with urinary carbapenemase-producing Enterobacteriaceae isolation. Rev Esp Quimioter 2017; 30:450-457. [PMID: 29115369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of this study is to know epidemiologic and clinical differences among those patients colonized or infected by carbapenemase-producing Enterobacteriaceae (CPE) and develop a predictive model to facilitate the clinical approach concerning to start antimicrobial therapy. METHODS Observational retrospective cohort study was performed involving all patients with Urine carbapenemase-producing Enterobacteriaceae isolation (UCPEI) between November 2013 and July 2015. Patients were classifieds as colonized or infected considering Center for Disease Control and Prevention (CDC) definition for urinary tract infection (UTI). RESULTS A total of 72 patients were included, mean age 76.4 (IQR 23-99) years and 40 (55.6%) were women. Thirty-four (47.2%) were colonized and 38 (52.8%) met the criteria of UTI and were considered infected. The independent variables associated to infection were female sex, peripheral vascular disease, admission in medical ward, permanent urinary catheter carrier, previous antimicrobial therapy, and length of stay. Isolation of OXA-48 carbapenemase-producing Enterobacteriaceae behaved as a non UTI (colonization) factor in comparison with KPC or VIM CPE. The developed predictive model showed an area under the curve (AUC) of 0.901 (95% CI: 0.832-0.970; p < 0.001). CONCLUSIONS The predictive model that includes all this factors has demonstrated a good accuracy for infection diagnosis in these patients, an important issue considering that establishing the diagnosis of infection is not always easy in the profile of patients in which a CPE is isolated.
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Affiliation(s)
| | - F J Candel
- Dr Francisco Javier Candel González, Department of Clinical Microbiology and Infectious Diseases. Hospital Clínico San Carlos. IDISSC. Universidad Complutense. Avda Profesor Martín Lagos s/n, 28040. Madrid, Spain.
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Barquilla García A. Brief update on diabetes for general practitioners. Rev Esp Sanid Penit 2017; 19:57-65. [PMID: 28748985 DOI: 10.4321/s1575-06202017000200004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/21/2017] [Indexed: 06/07/2023]
Abstract
Diabetes includes a group of metabolic disorders in which there is hyperglycemia. This can be due to impaired insulin secretion, insulin action or both. Chronic hyperglycemia is associated with serious long-term complications in several organs, especially in the eyes, kidneys, nerves, heart and blood vessels. In our country this disorder affects 13.8% of the population. There are several types of diabetes although most patients suffer type 2 diabetes. We set out to review the diagnostic process, screening recommendations, prevention strategies, initial assessment upon diagnosis, therapeutic targets regarding both blood glucose levels and the other vascular risk factors while also considering healthy lifestyles and brief references to medications recommended in each section.
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Affiliation(s)
- A Barquilla García
- Medical Centre of Herguijuela and Conquista de la Sierra, Equipo de Atención Primaria (EAP) de Trujillo
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Polo García J, Barrios Alonso V, Escobar Cervantes C, Prieto Valiente L, Lobos Bejarano J, Vargas Ortega D, Prieto Díaz M, Alonso Moreno F, Barquilla García A. Control de la anticoagulación en pacientes con fibrilación auricular no valvular en práctica clínica de atención primaria en las diferentes comunidades autónomas. Estudio PAULA. Semergen 2017; 43:207-215. [DOI: 10.1016/j.semerg.2016.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/10/2016] [Indexed: 11/24/2022]
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Barquilla García A, Llisterri Caro JL, Prieto Díaz MA, Alonso Moreno FJ, García Matarín L, Galgo Nafría A, Mediavilla Bravo JJ. [Blood pressure control in a population of hypertensive diabetic patients treated in primary care: PRESCAP-Diabetes Study 2010]. Semergen 2014; 41:13-23. [PMID: 24703582 DOI: 10.1016/j.semerg.2014.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/12/2014] [Accepted: 02/12/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the level of blood pressure (BP) control in hypertensive diabetic patients treated in primary care and to determine the factors associated with poor control. MATERIAL AND METHODS A cross-sectional, multicentre study that enrolled hypertensive diabetics recruited by consecutive sampling by family doctors in Spain in June 2010. A mean BP of less than 140/90mmHg was considered as good control of arterial hypertension. The percentages of patients with<130/80mmHg PA, 140/80mmHg, and 140/85mmHg, respectively, were also determined. Sociodemographic, clinical, cardiovascular risk factors, and pharmacological treatments were recorded. RESULTS A total of 3,993 patients were enrolled (50.1% female) with a mean age (standard deviation) of 68.2 (10.2) years, of whom 73.9% received combination therapy. The figures showed good control of both blood pressure values (<140/90mmHg) in 56.4% (95% CI: 54.3 to 58.4) of the cases, with 58.5% (95% CI: 57.0-60.0) only in systolic BP, and 84.6% (95% CI, 83.2 to 85.8) only in diastolic BP. The variables with strongest association with poor control were the presence of albuminuria, elevated total cholesterol, physical inactivity, and not taking the medication on the day of the interview. CONCLUSIONS The PRESCAP-Diabetes 2010 study results indicate that 43.6% of diabetics with hypertension seen in primary care have a poorly controlled BP, in particular, systolic BP.
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Affiliation(s)
- A Barquilla García
- Medicina de Familia y Comunitaria, Centro de Salud de Trujillo, Cáceres, España.
| | - J L Llisterri Caro
- Medicina de Familia y Comunitaria, Centro de Salud Ingeniero Joaquín Benlloch, Valencia, España
| | - M A Prieto Díaz
- Medicina de Familia y Comunitaria, Centro de Salud de Vallobín-La Florida, Oviedo, España
| | - F J Alonso Moreno
- Medicina de Familia y Comunitaria, Centro de Salud Sillería, Toledo, España
| | - L García Matarín
- Medicina de Familia y Comunitaria, Unidad de Gestión Clínica de Vicar, Almería, España
| | - A Galgo Nafría
- Medicina de Familia y Comunitaria, Centro de Salud Espronceda, Madrid, España
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Barquilla García A, Mediavilla Bravo J, Comas Samper J, Seguí Díaz M, Carramiñana Barrera F, Zaballos Sánchez F. Recomendaciones de la Sociedad Americana de Diabetes para el manejo de la diabetes mellitus. Semergen 2010. [DOI: 10.1016/j.semerg.2010.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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