Invasive pneumococcal disease (IPD) is a serious problem in some risk groups: patients with stage 4 and 5 chronic kidney disease, stage 3 CKD undergoing immunosuppressive treatment, nephrotic ...syndrome or diabetes. These individuals are more susceptible to infections and more prone to suffering more severe and worsening symptoms. Vaccination is one of the strategies for preventing IPD, although vaccination coverage in this group at present is lower than desired. Currently, there are two vaccinations for adults. The polysaccharide vaccine (PPSV23), used for decades in patients over the age of 2, includes most serotypes (23), but it does not generate immune memory, causing the immune tolerance phenomenon and it does not act on nasopharyngeal colonisation. The conjugate vaccine (VNC13) can be used from infancy until adulthood (advice in patients over 18 years old received approval from the European Medicines Agency in July 2013) and generates a more powerful immune response than PPSV23 against the majority of the 13 serotypes that it includes. The 16 scientific societies most directly associated with the groups at risk of IPD have discussed and drafted a series of vaccination recommendations based on scientific evidence related to pneumococcal vaccination in adults with underlying conditions and pathologies, which are the subject of the document "
Pneumococcal vaccination in adults with underlying pathology". This text sets out the vaccination recommendations for the chronic kidney disease population.
Previous studies have shown an increased effect of proton pump inhibitors on intragastric pH in Helicobacter pylori (HP)-infected patients suffering from gastroesophageal reflux disease (GERD). We ...evaluated the effect of HP infection on healing and symptom relief in GERD patients with erosive esophagitis treated with pantoprazole. Two hundred twenty-seven patients with endoscopically proven reflux esophagitis were treated for 8 weeks with pantoprazole, 40 mg daily. Patients achieving endoscopic healing at that time were treated for 16 weeks more with pantoprazole, 20 mg daily. Healing and symptom relief rates for HP infection were compared. We found complete relief of heartburn in 72.3% of the HP-positive versus 58.8% of the HP-negative group (P < 0.05). Overall prevalence of heartburn at 8 weeks was higher in the HP-negative group (40.3 vs. 25.8%; P < 0.05), with no significant differences in endoscopic healing (overall 80.4%). At 24 weeks of treatment, the symptomatic relapse rate was higher in the HP-negative group (25.9 vs. 10.2%; P < 0.020). At 8 weeks, patients with erosive esophagitis and HP infection exhibited a significantly better response to pantoprazole through complete heartburn relief, with no differences in endoscopic healing rates between the groups. After 24 weeks, the relapse rate was significantly higher in the HP-negative group.
La insuficiencia cardiaca (IC) es un importante problema de salud en nuestro medio. Pretendemos conocer las características de estos pacientes en Galicia.
Estudio descriptivo, transversal, ...multicéntrico con la participación de 149 médicos de atención primaria, en el que se registraron las características de 1.195 pacientes diagnosticados de IC.
Un 48% de los pacientes eran varones con una edad media de 76 años, mayor en mujeres (p
<
0,001). Presentaba antecedentes de hipertensión el 82%, de dislipidemia el 47%, de diabetes el 31%, de fibrilación auricular el 49%, de valvulopatía el 35% y de cardiopatía isquémica el 32%. Los valores medios de presión arterial sistólica y diastólica fueron, respectivamente, 131 y 76 mmHg, y estaban controlados (≤ 130/80
mmHg) en el 43% de pacientes. El 67% tiene un ecocardiograma, el 61% de ellos con una función sistólica preservada. Al 47% de los pacientes con IC se les realizó una coronariografía, porcentaje superior (p
<
0,001) en varones. Los fármacos más prescritos fueron diuréticos (82%), inhibidores de la enzima de conversión de la angiotensina (IECA) (48%), antagonistas de los receptores de la angiotensina II (29%) y bloqueadores beta (27%). En los pacientes con función sistólica deprimida se prescriben más bloqueadores beta (p
<
0,001), IECA (p
<
0,01) y antialdosterónicos (p
<
0,05). Durante el último año, el 57% de los pacientes estuvieron ingresados, el 45% de ellos por causa cardiovascular.
La IC con función sistólica preservada es la forma más prevalente en Galicia, que está mayoritariamente asociada con una presión arterial elevada siendo, su control limitado. En pacientes con cardiopatía isquémica, el sexo influye en la realización de coronariografía. La prescripción de fármacos no es óptima. Es necesario promover estrategias para mejorar el cuidado de estos pacientes.
Heart failure (HF) is an important public health concern. Our aim was to evaluate the characteristics of HF patients in Galicia, Spain.
This descriptive, cross-sectional, multicenter study involved 149 primary care physicians and recorded the characteristics of 1195 patients diagnosed with HF.
Some 48% of patients were male, and their mean age was 76 years, though women were older (
P<.001). Disease history included hypertension in 82%, hyperlipidemia in 47%, diabetes in 31%, atrial fibrillation in 49%, valvular disease in 35%, and ischemic heart disease in 32%. Mean systolic and diastolic blood pressures were 131 mm Hg and 76 mm Hg, respectively. Pressure was controlled (≤ 130/80 mm Hg) in 43% of patients. Overall, 67% underwent echocardiography, of whom 61% had preserved systolic function. Coronary angiography was performed in 47% of patients with ischemic heart disease, more frequently in males than females (
P<.001). The most commonly prescribed drugs were diuretics (82%), angiotensin-converting enzyme (ACE) inhibitors (48%), angiotensin II receptor antagonists (29%), and beta-blockers (27%). Patients with depressed systolic function were more frequently prescribed beta-blockers (
P<.001), ACE inhibitors (
P<.01), and antialdosterones (
P<.05). During the last year, 57% of patients had been admitted to hospital, of whom 45% were admitted for cardiovascular reasons.
The most prevalent form of HF in Galicia was HF with preserved systolic function, which was mostly associated with high blood pressure due to poor control. In patients with ischemic heart disease, the use of coronary angiography was influenced by sex. Drug treatment was suboptimal. Intervention programs are required to improve care in these patients.
Las alteraciones de la diferenciación sexual (ADS) son patologías originadas por trastornos en una de las tres etapas sucesivas de dicha diferenciación: cromosómica (XX, XY), gonadal (testículo, ...ovario) o fenotípica. El objetivo del trabajo fue dar a conocer la forma de presentación de las ADS en pacientes provenientes de las regiones Capital y Centro Occidental de Venezuela. Se incluyeron diecisiete pacientes y se elaboraron los árboles genealógicos, se realizó evaluación clínica, estudios hormonales, citogenéticos, imagenología y determinación de marcadores del gen SRY y microsatélites del cromosoma Y. En función de la evaluación clínica y los datos obtenidos de los exámenes practicados, se efectuaron los diagnósticos siguientes: a) Doce corresponden a ADS 46,XX , de los cuales siete pacientes tienen ADS por exceso de andrógenos, un caso con reversión sexual, un ADS ovotesticular, un caso con síndrome malformativo, uno con disgenesia gonadal y uno con hipogonadismo, b) Cuatro presentan ADS 46,XY (un paciente con síndrome de Smith-Lemli-Opitz II, uno con síndrome malformativo y dos casos con hipogonadísmo), c) Un caso de ADS por alteración cromosómica 46,XXY (síndrome de Klinefelter). En relación a la edad de la primera consulta, la mayor parte (47,1%) se realizó en menores de 5 años, referidos por ambigüedad sexual con necesidad de resolver la identificación del sexo; en la pubertad los pacientes consultan por alteraciones en los caracteres sexuales secundarios y amenorrea (adolescentes); en la adultez por infertilidad. Los resultados permitieron realizar un mejor asesoramiento genético y contribuir a mejorar la calidad de vida de los pacientes y sus grupos familiares.
Itinerarios didácticos de Ciencias Naturales Fernández Alvarez, María Teresa; Franco Sánchez, Andrés; Martínez Perea, Francisco Jesús ...
Isla de Arriarán: revista cultural y científica,
1995
5
Magazine Article
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