Disección aórtica tipo B aguda complicada: Estrategias diagnóstico-terapéuticas. Reporte de un caso.

La disección aórtica es el síndrome aórtico agudo más común (80%), constituyendo una emergencia vital debido a su alta morbi-mortalidad. La disección aórtica tipo B de Stanford /tipo 3 DeBakey (35%) es aquella que no afecta a la aorta ascendente, con un mejor pronóstico que la disección aórtica tipo A. Debido a la inespecificidad de sus síntomas es esencial un alto índice de sospecha clínica para su correcto enfoque diagnóstico y tratamiento precoz. Tradicionalmente, las formas no complicadas (80%) se han tratado con tratamiento médico, mientras que las complicadas requieren tratamiento quirúrgico urgente (endovascular o cirugía abierta). El objetivo de este trabajo, basado en la exposición de un caso clínico, es realizar una revisión bibliográfica en referencia al manejo óptimo de la disección aórtica tipo B aguda complic ada, para así conseguir un diagnóstico precoz y establecer un algoritmo terapéutico eficaz que facilite su abordaje en el área de urgencias hospitalarias

Erectile Dysfunction Associated with Cardiovascular Risk Factors

Objectives: (1) Determine erectile dysfunction (ED) prevalence in patients with cardiovascular risk factors (CVRF). (2) Assess ED incidence in relation to the extent of controlling CVRF. Methodology: Patients: Enrolled participants came to the health centres in the study area. In accordance with the incidence of diseases with cardiovascular risks (CVR) in the Basic Health Regions of the study area, sample size was calculated with a 95% confidence interval and an alpha error of 0.005, resulting in a sample of 210 people, of which 30 could not complete the study for various reasons (change of address, death, refused to complete questionnaire, etc.). A full awareness and diffusion campaign was organized with talks and leaflets. Letters: A standard letter was given to patients which explained the importance of sexual health, offering them an appointment with a DUE (Diploma in Nursing) survey taker. The questionnaire was devised by the research group and was given by a fully trained DUE survey taker. Previously, contact was made with all the health centres, physicians and nursing staff to give them information on ED and CVRF and to inform them about the work to be done in their health region. Those patients who did not come to the appointment were telephoned to insist on the importance of attending and completing the questionnaire. Variables analysis: We analysed age, level of education, civil status, height, weight and body mass index (BMI), SBP, DBP, smoking habit, number cigarettes/day, year smoking began, ex‐smoker, year smoking stopped, alcohol consumption, grams alcohol/week, as well as consumption of other drugs, frequency and type. Blood test: glucose, haemoglobin glycated haemoglobin, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, artherogenic index, creatinine, urea, GOT, GPT, gamma‐GT and PSA. Urine test: micro‐albuminuria, proteinuria and creatinine clearance. ECG: Diabetes diagnosed at least 1 year ago and prescribed drugs to treat it. High blood pressure diagnosed at least 1 year ago and prescribed drugs to treat it. Dyslipidaemia (hypercholesterolaemia) diagnosed at least 1 year ago and prescribed drugs to treat it. Concomitant diseases of at least 1 year and drugs (up to 3) SHIM questionnaire and ED according to SHIM. Statistical analysis: an observational, descriptive, analytical, cross‐sectional study. Qualitative variables are presented as exact values and a percentage; quantitative variables as the mean and standard deviation (SD). A means comparison was done with the Student’s t‐test for independent groups, or the Mann‐Whitney U test if normality conditions (using the Kolmogorov‐Smirnoff or Shapiro‐Wilks test) were not fulfilled. The chi‐squared test was used for qualitative variables. Results: Of the 210 selected people, 179 completed the questionnaire (85.2%). The mean age was 64.5 ± 11.6 years. When analysing all the study variables in relation to the main variable, presence or absence of ED, age played an important role in ED appearing as ED incidence rises with age. Blood pressure had no significant relationship with the studied variable, and the same hold for BMI and its subdivision into normal weight and obesity. As regards toxic habits, neither cigarette smoking nor alcohol consumption influenced the presence of ED. The same hold for the sociological‐type variables (civil states, level of education). Regarding the biochemical variables from blood tests, a significant relationship with the atherogenic index and its recoded variable at high and low atherogenic risk (p < 0.04) was noted. In the glycaemic profile, a glycaemia mean of 126 mg/dl was obtained in the ED presence group, which is the cut‐off point proposed by ADA117 (American Diabetes Association) to consider a subject diabetic. Likewise, glycated haemoglobin presented figures in the two groups can be considered an alternation of a practically diabetic glucose metabolism. In our study, the presence of diabetic disease, high blood pressure (HBP) and dyslipidaemia showed no significant relationship with ED presence for each disease. However, in the combination of these diseases, a statistically significant relationship was seen when CVR increases, according to the Framinghan tables. Neither did each disease’s duration show a significant relationship with ED presence nor significant differences for the drugs used to treat the three pathologies were found. The coronary risk calculated according to the Framinghan tables indicated a statistically significant result, as did excessive risk (the difference between the coronary risk and the average assigned per age) for ED presence. The LISAT 8 test suggested that ED affected health‐associated quality of life and was statistically significant in two items of sex life and economic situation and was borderline statistically significant in the general life and working life items. Conclusions: There is a high ED prevalence in patients with high CVR. When ED improves, the better CVRFs are controlled. These patients’ pluripathology implies aggressive polymedication which doctors must consider as it increases the risk of ED

Effects of the Mediterranean diet on the cardiovascular risk factors

Background: Eating habits have been modified, which together with a more sedentary lifestyle has contributed to a significant increase in cardiovascular risk factors and consequently in cardiovascular disease. It is believed that this epidemic could be reduced with a change to a healthier lifestyle and diet, such as the Mediterranean diet. Objetive: To demonstrate the benefit of the Mediterranean diet as a valid dietary pattern for the primary prevention of cardiovascular disease Methods: study of the articles found in bibliographic review of different databases through systematic technique Results: In interventions with Mediterranean diet, a global beneficial effect on blood pressure has been observed with significant reductions in systolic, diastolic or both depending on the study. There is also a positive effect on glucose levels, HbA1c and incidence of type 2 diabetes mellitus with a significant level of significance. Regarding the lipid profile, the results are more variable, although generally it is considered that there is a reduction of total cholesterol, triglycerides, concentration and oxidation of LDL and ApoB and an increase of HDL. Inflammatory markers such as CRP, IL6, IL8, TNF alpha, ICAM, P-selectin, are also reduced in several of the studies analyzed. Likewise, the Mediterranean diet has proven to be an useful tool in the reversal of the metabolic syndrome. Conclusions: After a few decades in which prevention and treatment of cardiovascular diseases focused on the use of low-fat diets, the Mediterranean diet is currently emerging as a healthier alternative since it has shown a greater reduction in blood pressure, glycaemia, lipid profile, markers of inflammation and endothelial damage