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The article presents several studies related to rheumatological pathology and musculoskeletal disorders. One of the studies compares the results of supervised physical therapy and unsupervised therapy at home after total knee replacement surgery, finding that there are no significant differences in long-term outcomes. Another study analyzes the effect of glucocorticoids on cardiovascular risk in patients with rheumatoid arthritis, concluding that high doses increase the risk of major cardiovascular events. It also mentions a study on the use of effervescent paracetamol, which does not show a significant increase in blood pressure or cardiovascular risk. The article also presents studies on the treatment of bone fractures, supplementation with vitamin D3, and the treatment of chronic pain. It was found that most treatments are beneficial and no major risks were found in any of them. However, it is noted that the reduction of long-term opioid treatment for chronic pain remains limited due to the poor methodology of existing studies. [Extracted from the article]

The article is about a clinical case of transient amaurosis and temporary vision loss in a 57-year-old patient with cardiovascular risk factors. The importance of suspecting transient amaurosis in patients over 50 years old with monocular vision loss lasting 2 to 30 minutes is highlighted. It is recommended to refer the patient to the emergency department to rule out an anterior circulation stroke and perform neuroimaging tests. It is also mentioned that patients with transient amaurosis have a higher risk of suffering an ischemic stroke. The importance of medical history in the diagnosis of transient vision loss (TVL) is discussed, and the main causes of TVL are described. Acronyms such as GCA (giant cell arteritis), stroke (cerebrovascular accident), TIA (transient amaurosis), and TVL (transient vision loss) are mentioned. Different related medical conditions are presented, such as giant cell arteritis, transient amaurosis, vertebrobasilar ischemia, and carotid dissection. General and secondary prevention measures for these conditions are also mentioned. The article concludes with information about the treatment and prognosis of these conditions. Criteria for referral to the emergency department for patients with transient vision loss are established, such as those over 50 years old with cardiovascular risk factors or symptoms associated with giant cell arteritis. [Extracted from the article]

Microalbuminuria is a condition in which an abnormal amount of albumin is excreted in the urine, which can be an early indicator of chronic kidney disease and a cardiovascular risk factor. It is defined as a urinary excretion of albumin between 20 and 200 μg/min or between 30 and 300 mg in overnight or 24-hour urine samples, respectively. Treatment focuses on controlling cardiovascular risk factors and avoiding nephrotoxic drugs. The prevalence of microalbuminuria is 7.8% and increases with age. It is important to measure microalbuminuria as an indicator of risk for complications, especially in patients with diabetes, hypertension, and kidney disease. Screening for microalbuminuria is suggested in patients with specific risk factors. Additionally, recommended drugs for the treatment of hypertension in patients with chronic kidney disease and medications to be avoided in these patients are mentioned. The importance of controlling cardiovascular risk factors and avoiding the use of nephrotoxic drugs, especially nonsteroidal anti-inflammatory drugs (NSAIDs), is also highlighted. [Extracted from the article]

The article "Pharmacotherapy" highlights the importance of evaluating the risks of medication use from different perspectives, especially in an aging society with chronic pathologies. A study is mentioned suggesting that empagliflozin may reduce the risk of cardiovascular death or hospitalization due to heart failure in patients with preserved ejection fraction. The risks of concomitant use of opioids and antidepressants are also mentioned, as well as the cardiovascular risks associated with chronic use of proton pump inhibitors (PPIs). Other studies analyze the efficacy of molnupiravir in patients with COVID-19, the association between the use of paracetamol formulations with sodium and cardiovascular risk, and the use of statins and the risk of diabetes progression in diabetic patients. The association between polypharmacy in frail patients and deterioration in functionality, quality of life, and increased mortality is highlighted. The importance of reviewing and adjusting medication in older patients to improve their health and quality of life is also emphasized. [Extracted from the article]

The article is about physical inactivity and sedentary behavior as important health problems. Examples of non-sedentary activities are mentioned, such as using electronic devices while sitting. It is established that health risks increase when sedentary behavior exceeds 7 hours per day. It is highlighted that both physical inactivity and sedentary behavior have increased in recent years and affect women and the most disadvantaged classes more. Additionally, it is mentioned that people with insufficient physical activity have a higher risk of death and are more likely to suffer from chronic diseases. Different methods for measuring the level of physical activity, both subjective and objective, are presented. The article emphasizes the importance of recording the number of daily steps as a meaningful tool to quantify total daily physical activity and set incremental goals. The use of pedometers is recommended to monitor physical activity and facilitate patient compliance with therapy. There are two types of physical activity interventions: general advice and exercise prescription. General advice aims to inform the patient about the need to increase physical activity following international recommendations. Exercise prescription involves a detailed and individualized program for patients with chronic conditions. A pre-participation evaluation should be conducted to identify the current level of physical activity and cardiovascular risk. Cardiovascular risk factors should be prioritized to design the exercise prescription. World Health Organization guidelines recommend accumulating a minimum of 150 to 300 minutes of moderate to vigorous aerobic physical activity throughout the week, as well as muscle-strengthening activities. The article presents different strategies for designing exercise prescriptions for patients with cardiovascular risk factors (CVRF) or chronic diseases. Strategy A focuses on the most limiting chronic condition or health condition for daily activities and quality of life. Strategy B is based on a more conservative exercise program in terms of intensity, volume, and total time. Strategy C focuses on the CVRF or chronic disease that encompasses the prescription for the other CVRF presented by the patient. Incorporating exercise prescription is recommended to improve levels of physical activity and reduce the burden of chronic diseases. The text presents a series of World Health Organization (WHO) recommendations on physical activity and sedentary behavior. The WHO guidelines for 2020 are mentioned, which include specific recommendations for patients with diabetes mellitus, dyslipidemia, hypertension, and obesity. The importance of strength training and moderate to vigorous aerobic exercise for improving health and reducing the risk of cardiovascular diseases is emphasized. The need to complement these exercises with flexibility and balance exercises is also mentioned. The text refers to other bibliographic sources related to physical inactivity and sedentary behavior. The article is about the association between sedentary behavior and cancer mortality in middle-aged and older American adults. It is highlighted that physical inactivity and sedentary behavior are important public health problems, as they are associated with an increased risk of chronic diseases, disability, poor quality of life, and mortality. Family physicians are mentioned as the appropriate professionals to identify and prescribe exercise to patients, and the use of pedometers is recommended to improve levels of physical activity in patients with chronic diseases. Recommendations for exercise prescription are also mentioned, including type, frequency, intensity, and duration, as well as the importance of regularly evaluating and advising patients to promote adherence to exercise programs. [Extracted from the article]

The article "Clinical Miscellany" presents a selection of ten articles on topics relevant to the clinical practice of the family physician. One of the articles highlights the importance of personal cholesterol level history in relation to cardiovascular disease. Another article analyzes the link between coffee consumption and the occurrence of tachyarrhythmias, concluding that coffee consumption does not increase the risk of arrhythmias, but may decrease it. Furthermore, evidence has been found suggesting that high coffee consumption may decrease the risk of heart failure. On the other hand, it has been shown that raising the head of the bed can reduce symptoms of gastroesophageal reflux. The approval of aducanumab by the FDA does not necessarily mark a new era in Alzheimer's treatment, as Europe has the final say on its effectiveness. Two phase III clinical studies evaluated this monoclonal antibody in patients with cognitive impairment and mild dementia, showing statistically significant improvements in the high-dose group in one study, but not in the other. The decision of the European Medicines Agency will be crucial in determining the future of this treatment. The article also presents two different studies, one on the prevalence of postural hypotension in different healthcare settings and another on the intensive management of cardiovascular risk factors in high-risk individuals with type 2 diabetes and its relationship with cardiovascular autonomic neuropathy. Two other articles review medications that can cause infections as an adverse reaction and best practices regarding the duration of antimicrobial treatment for common infections in primary care. [Extracted from the article]

Intermittent claudication is a manifestation of arteriosclerotic disease that mainly affects older individuals with cardiovascular risk factors. In Spain, it has a prevalence of 8.5% in the general population. The Edinburgh questionnaire is used to diagnose this condition, which has high sensitivity and specificity. Additionally, a prediction rule called the REASON index has been developed to identify patients at higher risk of peripheral artery disease. Physical examination is essential to confirm the diagnosis, and different findings and corresponding values are mentioned, such as the presence or absence of foot pulses, femoral pulse, femoral artery bruit, differences in leg temperature, foot and toe wounds or injuries, and venous filling time. The use of the ankle-brachial index (ABI) for diagnosis is also highlighted, with different cutoff values to classify the severity of the disease. In conclusion, the importance of a thorough medical history and physical examination for the diagnosis of peripheral artery disease is emphasized. [Extracted from the article]

The ankle-brachial index (ABI) is a non-invasive test used to diagnose and monitor peripheral arterial disease (PAD). This test is recommended for patients with clinical suspicion of PAD, lower limb ulcers, cardiovascular risk factors, and diabetic patients over 50 years old. The ABI is performed using the Doppler measurement technique, and a value ≤ 0.90 indicates the presence of PAD. However, in diabetic or chronic kidney disease patients, the sensitivity of the test may be lower due to artery calcification. It is recommended to perform the ABI after exercise or a Doppler ultrasound in case of clinical suspicion, and recommendations for compression therapy are provided based on the ABI results. [Extracted from the article]

La valvulopatía ha de sospecharse ante la auscultación de soplos en pacientes asintomáticos e incluirse en el diagnóstico diferencial de la disnea, la intolerancia al ejercicio, la angina y el síncope. Ante la sospecha de una valvulopatía son imprescindibles la realización de un ECG, una radiografía de tórax y una ECO (prueba complementaria de elección). La EA degenerativa, típica de pacientes de edad avanzada con factores de riesgo cardiovascular, es la valvulopatía más frecuente en los países desarrollados. Presenta un período asintomático muy prolongado (evidente sobre los 70-80 años), siendo su síntoma más frecuente la intolerancia al esfuerzo (cuando aparece debe considerarse grave). La EM suele ser de causa reumática. Los primeros síntomas aparecen a los 35-45 años en forma de disnea o palpitaciones relacionadas con la caída en FA. La IM es la segunda causa en frecuencia. Puede aparecer como consecuencia de una enfermedad valvular degenerativa, en el seno de una enfermedad reumática junto con estenosis, asociada a un prolapso mitral o de forma secundaria a la dilatación del VI. El prolapso mitral es una entidad frecuente (2% de la población general) de origen hereditario o asociada a conectivopatías; en ausencia de insuficiencia el pronóstico es bueno y no requiere tratamiento, seguimiento ni profilaxis de endocarditis. La insuficiencia tricúspide suele ser secundaria a la dilatación del ventrículo derecho. La imposibilidad de incidir médicamente sobre las valvulopatías y la reducción en los índices de mortalidad quirúrgicos, convierten a la cirugía en el tratamiento de elección en la mayoría de los casos. En los pacientes pediátricos y en los adultos jóvenes es de elección la cirugía correctora; pero si la alteración de la válvula no permite la reparación, la técnica de elección es la sustitución por una prótesis. Las prótesis biológicas presentan una menor durabilidad, pero no requieren anticoagulación a largo plazo (de elección en: ancianos con valvulopatía aórtica, contraindicación de la anticoagulación y mujeres con deseo de descendencia); en los adultos, las prótesis de elección son las mecánicas. En las valvulopatías está indicada la anticoagulación en presencia de FA, en caso de embolismo previo o evidencia de trombo auricular y durante 3 meses tras la reparación valvular. La anticoagulación en pacientes con bioprótesis debe durar 3 meses (posteriormente antiagregación indefinida) y en las prótesis mecánicas toda la vida. Los pacientes que vayan a ser sometidos a cualquier manipulación quirúrgica deben recibir profilaxis con antibióticos con una única dosis 2 horas antes del procedimiento. La sospecha de una cardiopatía estructural no conocida obliga, tras la valoración clínica completa, a la confirmación del diagnóstico mediante ecocardiografía (establece el diagnóstico de certeza y su gravedad); además, el seguimiento ecocardiográfico permite valorar la progresión de la enfermedad y establecer la indicación quirúrgica. La aparición de síntomas en una valvulopatía estable es sinónimo de gravedad, por lo que su presencia obliga a la valoración quirúrgica en el menor tiempo posible. La presencia de fiebre sin localidad en un portador de prótesis ha de alertar sobre una posible endocarditis. En ausencia de foco no se deben dar antibióticos y, si la fiebre persiste más de 3 días o el estado general empeora, el paciente ha de ser derivado para la seriación de hemocultivos. [ABSTRACT FROM AUTHOR]

Objetivo. Evaluar si el uso de suplementos de calcio se elaciona con mayor riesgo cardiovascular. Método. Metaanálisis de los artículos más importantes de administración de calcio (superior a 500 mg/día) sin itamina D realizados en mayores de 40 años y con más de 100 participantes de Medline, Embase y Cochrane Central Register of Controlled Trials publicados hasta marzo de 2010. Resultados. Se encontraron 15 estudios válidos, con asi 8.151 sujetos, con una media de seguimiento de entre 3,6 y 4 años. El riesgo de sufrir un infarto de miocardio se ncrementaba de forma significativa en aproximadamente un 31%, y de forma no significativa los accidentes cerebrovasculares (1,20, 0,96 a 1,50) y el riesgo de muerte 1,09, 0,96 a 1,23). El número de pacientes necesario para ratar (NNT) para provocar un infarto de miocardio administrando calcio durante 5 años es de 69, de 100 para un accidente cerebrovascular y de 77 para el riesgo de muere. Ajustando los resultados por edad, sexo, hábito tabáquico y diabetes los resultados no cambiaron. Conclusiones. Los suplementos de calcio solos sin administrar vitamina D se asocian a un incremento del riesgo de infarto de miocardio de casi un 30% y de forma no ignificativa también a un incremento de sufrir un accidente cerebrovascular y de muerte. [ABSTRACT FROM AUTHOR]