Nonalcoholic steatohepatitis and cardiovascular risk factors in primary care

Varias circunstancias motivan el creciente interés por la esteatosis hepática no alcohólica (EHNA): la elevada prevalencia de la enfermedad en el mundo occidental, su capacidad de progresión a formas histológicas más agresivas y su asociación con enfermedades que incrementan el riesgo cardiovascular. Objetivo: analizar la relación de la esteatosis hepática no alcohólica con los factores de riesgo cardiovascular en pacientes con criterios de síndrome metabólico. Método: fue realizado un estudio descriptivo transversal con una muestra de 100 pacientes, con 2 o más factores de riesgo cardiovascular, con nula o baja ingesta de alcohol, que acudían a consulta de atención primaria. A los seleccionados se les solicitó analítica completa e interconsulta para ecografía de abdomen completo. Se evaluó si tenían esteatosis hepática; en caso de ser afirmativo, se estratificaba en 3 grados. Se recogieron las siguientes variables tanto cualitativas (sexo, antecedentes personales y familiares de diabetes, hipertensión arterial, dislipidemia, entre otros) y cuantitativas (edad, peso, talla, índice de masa corporal, tratamiento farmacológico, cifras de distintos parámetros analíticos, cifras de tensión arterial y perímetro abdominal). Resultados: participaron 100 pacientes, 56% de los cuales eran mujeres, con una edad media de 61,84 DE ± 9,5 años. Del total de sujetos del estudio, el 23 % no tenía esteatosis hepática no alcohólica; un 29% tenía esteatosis hepática leve; otro 29%, esteatosis hepática moderada; y el 19% restante, esteatosis hepática severa. En los hombres, el 82% presentó esteatosis hepática. De las mujeres, el 28,57% no presentó hígado graso. Un 22% tenía sobrepeso y un 38% de los pacientes eran obesos. Solo un 22% y un 18% tenían alteradas las cifras tensionales sistólica y diastólica, respectivamente. El 60% tenía una glucemia basal alterada. En cuanto a los parámetros lipídicos, el 36% tenía hipertrigliceridemia; el 41%, hipercolesterolemia, con un 65% de colesterol LDL alto y un 16% de colesterol HDL bajo. El 83% de los pacientes tenía 2 o más criterios de síndrome metabólico. Conclusiones: hay una estrecha relación entre la aparición de esteatosis hepática no alcohólica y los factores de riesgo cardiovascular en pacientes con síndrome metabólico, por lo que se recomienda que, ante la aparición de estos, se analice el hígadoSeveral factors motivate the growing interest in this disease. They include the high prevalence of the disease in the Western world, its ability to progress to more aggressive histological forms, and its association with diseases that increase cardiovascular risk. Objective: The objective of this study was to analyze the relationship of nonalcoholic steatohepatitis (NASH) with cardiovascular risk factors in patients with criteria for metabolic syndrome. Method: This is a descriptive cross-sectional study of 100 patients who had two or more cardiovascular risk factors, who did not consume alcohol or consumed only small amounts of alcohol, and who came to the primary care clinic. The patients selected underwent complete analyses including abdominal ultrasound. They were evaluated for hepatic steatosis, and, if they tested positive, it was stratified into three degrees. Among the qualitative variables used were sex, personal and family history of diabetes, hypertension, dyslipidemia, and the quantitative variables included age, weight, height, body mass index, pharmacological treatment, numbers of different analytical parameters, blood pressure and abdominal perimeter. Results: There were 100 patients, 56% of whom were women. Patients’ mean age was 61.84 SD ± 9.5 years. Of the total number of subjects in the study, 23% did not have NASH, 29% had mild hepatic steatosis, 29% had moderate hepatic steatosis and 19% had severe hepatic steatosis. Of the men in the study, 82% had hepatic steatosis. Of the women, 28.57% did not have fatty livers. 22% were overweight and 38% obese. Only 22% had altered the systolic blood pressure and and 18% had altered diastolic blood pressure. 60% had altered basal glycemia. 36% had hypertriglyceremia, 41% had hypercholesterolemia including 65% with high LDL cholesterol and 16% with low HDL cholesterol. 83% of the patients had two or more criteria for metabolic syndrome.Conclusions: There is a close relationship between the occurrence of NASH and cardiovascular risk factors in patients with metabolic syndrome, and it is advisable that the liver be analyzedEstudio financiado en parte por la Comisión de Investigación de la Gerencia Integrada de Albacet

Active interventions in hypercholeteroloemia patiens with high cardiovascular risk in primary care

Introduction: Hypercholesterolemia is a major modifiable risk factors for cardiovascular disease (CVD). Its reduction reduces morbidity and mortality from ischemic heart disease and CVD in general, primary prevention and secondary prevention especially. Objective: To determine whether a notarized and intensive clinical practice can overcome inertia and achieve the therapeutic goal (OT) LDL-C &lt;100 mg &lt;dL in high-risk patients attended in Primary Care (PC) in our country. Methodology: epidemiological, prospective, multicenter study conducted in centers of different ACs By AP consecutive sampling 310 patients at high cardiovascular risk (diabetic or established CVD) previously treated with statins, which did not reach the OT included c-LDL. Results: The study subjects had a mean age of 65.2 years, of which 60.32% were male. The 41.64% had a previous EVC, acute myocardial infarction (20.33%), angina (16.07%), stroke /TIA (9.19%), arthropathy (5.25%), diabetes (70 , 87%), hypertension (71.01%), and abdominal obesity (69.62%). The 43.57% (95% CI: 37,21; 50,08) of patients who performed the 2nd visit (241) got the OT. 62.50% (95% CI: 55.68, 68.98) of those who took the 3rd (216) got the OT. Finally, 77.56% (95% CI: 72.13, 83.08) patients who performed the last visit (205) got the OT. Throughout the study there was a reduction in LDL-C levels from 135.6 mg /dL at baseline, 107.4 mg /dL in the 2nd visit, 97.3 mg /dL in the 3rd visit, up to 90.7 mg /dL at the final visit (p &lt;0.0001) The increase in HDL-C from baseline (50.9 mg /dL) and final (53.6 mg /dL) was also significant (p = 0.013). Conclusions: The reassessment and intensification of treatment in patients at high cardiovascular risk treated in primary care, applying the indications of the guides, achieves the OT in more than three quarters of the previously uncontrolled within half a year. These results should encourage us to overcome the therapeutic inertia in the control of CVD by early and energetic performance against hypercholesterolemia.Introducción: La hipercolesterolemia es uno de los principales factores de riesgo modificables de la enfermedad cardiovascular (ECV). Su reducción disminuye la morbimortalidad por cardiopatía isquémica y ECV en general, en prevención primaria y en prevención secundaria especialmente. Objetivo: Comprobar si una práctica clínica protocolizada e intensiva permite vencer la inercia y alcanzar el objetivo terapéutico (OT) de c-LDL < 100 mg/dL en pacientes de alto riesgo asistidos en Atención Primaria (AP) de nuestro país. Metodología: Estudio epidemiológico, prospectivo, multicentrico, realizado en Centros de AP de diferentes CC.AA. Mediante muestreo consecutivo se incluyeron 310 pacientes de alto riesgo cardiovascular (diabéticos o con ECV establecida), tratados previamente con estatinas, que no alcanzaban el OT de c-LDL. Resultados: Los sujetos del estudio tenían una edad media de 65,2 años, de los que el 60,32% eran varones. El 41,64% presentaba un EVC previo, infarto agudo de miocardio (20,33%), angina (16,07%), ictus/AIT (9,19%), artropatía (5,25%), diabetes (70,87%), hipertensión (71,01%), y obesidad abdominal (69,62%). El 43,57% (IC95%: 37,21; 50,08) de los pacientes que realizaron la 2a visita (241) consiguieron el OT. El 62,50% (IC95%: 55,68; 68,98) de los que realizaron la 3a (216) consiguieron el OT. Finalmente, el 77,56% (IC95%: 72,13; 83,08) de los pacientes que realizaron la última visita (205) consiguieron el OT. A lo largo del estudio hubo una reducción de los niveles de c-LDL desde los 135,6 mg/ dL en la visita basal, 107,4 mg/dL en la 2a visita, 97,3 mg/ dL en la 3a visita, hasta los 90,7 mg/dL en la visita final (p < 0,0001) El incremento de c-HDL entre la visita basal (50,9 mg/dL) y la final (53,6 mg/dL) también fue significativo (p = 0,013). Conclusiones: La reevaluación e intensificación del tratamiento en pacientes de alto riesgo cardiovascular atendidos en Atención Primaria, aplicando las indicaciones de las guías, permite alcanzar el OT en más de las tres cuartas partes de los previamente no controlados en el plazo de medio año. Estos resultados nos deben estimular a superar la inercia terapéutica en el control de la ECV mediante una actuación precoz y enérgica ante la hipercolesterolemi

Historia de la RAMSA. 50º aniversario (1971-2021)

Libro conmemorativo de los 50 años de existencia de la Real Academia de Medicina de Salamanca, donde se recogen todas las actividades llevadas a cabo durante ese tiempo, los premios concedidos, los miembros elegidos, etc., así como se gestó su nacimiento en el contexto de la existencia de otras academias médicas.Universidad de Salamanc

Come rileggere la sanità locale? Spagna e italia: esperienze a confronto. ¿Cómo impulsar la sanidad local? España e Italia: experiencia a debate

Il volume raccoglie le relazioni rivedute ed aggiornate svolte nell'ambito del convegno webinar "Come rileggere la Sanità locale? Spagna e Italia: esperienze a confronto" tenutosi l'11 marzo 2022, con il patrocinio della Scuola di Medicina e Chirurgia dell'Alma Mater Studiorum - Università di Bologna e della Real Academia de Medicina de Castilla-La Mancha, in collaborazione con CeSDirSan - Centro Interdisciplinare di Studi sul Diritto Sanitario. El volumen recoge las ponencias presentadas en el congreso webinar "¿Cómo impulsar la Sanidad Local? España e Italia: experiencia a debate" realizado el 11 de Marzo de 2022, bajo el patrocinio de la Facultad de Medicina de la Alma Mater Studiorum - Università di Bologna y de la Real Academia de Medicina de Castilla - La Mancha, con la colaboración de CeSDirSan - Centro Interdisciplinare di Studi sul Diritto Sanitario

Mapa de incidencia de cáncer colorrectal en Albacete: influencia de la dieta y estilos de vida

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid. Facultad de Medicina. Departamento de Cirugía. Fecha de lectura: 4 de Octubre de 200

Primary and Secondary Prevention of Colorectal Cancer

Introduction Cancer is a worldwide problem as it will affect one in three men and one in four women during their lifetime. Colorectal cancer (CRC) is the third most frequent cancer in men, after lung and prostate cancer, and is the second most frequent cancer in women after breast cancer. It is also the third cause of death in men and women separately, and is the second most frequent cause of death by cancer if both genders are considered together. CRC represents approximately 10% of deaths by cancer. Modifiable risk factors of CRC include smoking, physical inactivity, being overweight and obesity, eating processed meat, and drinking alcohol excessively. CRC screening programs are possible only in economically developed countries. However, attention should be paid in the future to geographical areas with ageing populations and a western lifestyle. 19 , 20 Sigmoidoscopy screening done with people aged 55-64 years has been demonstrated to reduce the incidence of CRC by 33% and mortality by CRC by 43%. Objective To assess the effect on the incidence and mortality of CRC diet and lifestyle and to determine the effect of secondary prevention through early diagnosis of CRC. Methodology A comprehensive search of Medline and Pubmed articles related to primary and secondary prevention of CRC and subsequently, a meta-analysis of the same blocks are performed. Results 225 articles related to primary or secondary prevention of CRC were retrieved. Of these 145 were considered valid on meta-analysis: 12 on epidemiology, 56 on diet and lifestyle, and over 77 different screenings for early detection of CRC. Cancer is a worldwide problem as it will affect one in three men and one in four women during their lifetime. There is no doubt whatsoever which environmental factors, probably diet, may account for these cancer rates. Excessive alcohol consumption and cholesterol-rich diet are associated with a high risk of colon cancer. A diet poor in folic acid and vitamin B6 is also associated with a higher risk of developing colon cancer with an overexpression of p53. Eating pulses at least three times a week lowers the risk of developing colon cancer by 33%, after eating less meat, while eating brown rice at least once a week cuts the risk of CRC by 40%. These associations suggest a dose–response effect. Frequently eating cooked green vegetables, nuts, dried fruit, pulses, and brown rice has been associated with a lower risk of colorectal polyps. High calcium intake offers a protector effect against distal colon and rectal tumors as compared with the proximal colon. Higher intake of dairy products and calcium reduces the risk of colon cancer. Taking an aspirin (ASA) regularly after being diagnosed with colon cancer is associated with less risk of dying from this cancer, especially among people who have tumors with COX-2 overexpression. 16 Nonetheless, these data do not contradict the data obtained on a possible genetic predisposition, even in sporadic or non-hereditary CRC. CRC is susceptible to screening because it is a serious health problem given its high incidence and its associated high morbidity/mortality. Conclusions (1) Cancer is a worldwide problem. (2) A modification of diet and lifestyle could reduce morbidity and mortality. (3) Early detection through screening improves prognosis and reduces mortality

La ecografía, técnica diagnóstica en esteatosis hepática no alcohólica

Objective. To analyze the ultrasound as a diagnostic test for non-alcoholic liver steatosis. Method. Observational, descriptive and analytical study, of cross section. For 12 months, 100 patients were selected, with 2 or more cardiovascular risk factors, with no or low alcohol intake, who attended Primary Care. Determinations made. Demographic and biochemical variables: Age. Gender. Alcohol intake.  History of diabetes, systemic arterial hypertension. Weight, height, body mass index (BMI). Blood  pressure measurement Basal glucose levels, glycosylated hemoglobin. Total cholesterol, HDL cholesterol,  LDL cholesterol, triglycerides, AST, ALT, bilirubins and alkaline phosphatase. Personal and family history of  diabetes, HBP, dyslipidemia, drug treatment, figures of other analytical parameters and abdominal  perimeter were also collected. Hepatic evaluation by ultrasonography. Once they met the selection  criteria, they were cited for the realization of the ultrasound of the entire abdomen, prior information on  the purpose of the technique to be performed and providing the signed informed consent. The ultrasound  was performed with the patient on an empty stomach and, if possible, with a bladder  replenished, in order to perform the technique in the best conditions of preparation of the patient, in  order to reduce the ultrasound devices and to assess all the abdominal structures correctly. Statistical  Analysis with SPSS program 23. The qualitative variables are shown as exact value and in percentage, the  quantitative variables as mean and standard deviation (SD). The comparison between means was made  through the Student t test for independent groups or the Mann-Whitney U test if the normal conditions  (application of the Kolmogorov-Smirnoff or Shapiro Willks test) were not met. In qualitative variables, the  chi-square test. Results. 100 patients participated: 44 men and 56 women, with a mean age of 61.84. 71% of subjects are obese. 23% of the subjects do not have steatosis, and in 58% it is mild and moderate in both genders (p  <0.003). 19% have grade 3 steatosis. The most prevalent risk factors of the patients studied are obesity,  which is presented by 78% of them, hypercholesterolemia 73%, DM 62% and HT 59%. Conclusions. Ultrasound is the modality of choice for the qualitative determination of steatosis, but it is a subjective and operator-dependent test: it only detects moderate to severe fat infiltration.   Objetivo. Analizar le ecografia como prueba diagnostica de la esteatosis hepática no alcohólica. Método. Estudio observacional, descriptivo y analítico, de sección transversal. Durante 12 meses se seleccionaron 100 pacientes, con 2 o más factores de riesgo cardiovascular, con nula o baja ingesta de alcohol, que acudían a consulta de Atención Primaria. Determinaciones efectuadas. Variables demográficas y  bioquímicas: Edad. Género. Ingesta de alcohol. Historia de diabetes, hipertensión arterial sistémica. Peso,  talla, índice de masa corporal (IMC). Medición de presión arterial. Niveles de glucosa basal, hemoglobina  glicosilada. Colesterol total, colesterol HDL, colesterol LDL, Triglicéridos, AST, ALT, bilirrubinas y fosfatasa  alcalina. También se recogieron antecedentes personales y familiares de diabetes, HTA, dislipemia,  tratamiento farmacológico, cifras de otros parámetros analíticos y perímetro abdominal. Evaluación hepática  por ultrasonografía. Una vez cumplían los criterios de selección eran citados para la realización de  la ecografía de abdomen completo, previa información del propósito de la técnica a efectuar y aportando el  consentimiento informado firmado. La ecografía se realizaba con el paciente en ayunas y a ser posible con  vejiga repleccionada, para poder efectuar la técnica en las mejores condiciones de preparación del paciente,  con el fin de disminuir los artefactos ecográficos y poder valorar todas las estructuras abdominales  correctamente. Analisis Estadístico con programa SPSS 23. Las variables cualitativas se exponen como valor  exacto y en porcentaje, las cuantitativas como media y desviación estándar (DE). La comparación entre  medias se realizó a través de la prueba t de Student para grupos independientes o la U de Mann-Whitney si  las condiciones de normalidad (aplicación del test de Kolmogorov- Smirnoff o de Shapiro Willks) no se  cumplían. En las variables cualitativas, la prueba de Ji al cuadrado. Resultados. Han participado 100 pacientes: 44 hombres y 56 mujeres, con una edad media de 61,84. El 71%  de los sujetos tienen obesidad. El 23 % de los sujetos no tiene esteatosis, y en el 58 % es de grado leve y  moderado en ambos géneros (p< 0,003). El 19 % tiene esteatosis grado 3. Los factores de riesgo más  prevalentes de los pacientes estudiados son obesidad, que la presentan el 78 % de ellos, hipercolesterolemia  el 73 %, DM el 62 % e HTA el 59 %. Conclusiones. La ecografía es la modalidad de elección para la determinación cualitativa de esteatosis, pero  es una prueba subjetiva y dependiente del operador: sólo detecta infiltración grasa de moderada a grave.