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Introduction Insomnia is the most common sleep disorder, and it adversely impacts daily living and increases the risk of chronic and acute health problems. Of the few individuals who seek treatment for insomnia, most pursue help in primary care settings. The management of insomnia most commonly focuses on the prescription of hypnotics and sleep hygiene recommendations, although these are not the most effective treatments. Conversely, cognitive–behavioural therapy for insomnia (CBT-i), which is considered to be the first-line treatment for persistent insomnia, is seldom prescribed by primary care physicians (PCPs) or primary care nurses (PCNs). The hesitancy of these professionals to provide CBT-i is mainly attributed to their heavy workloads and the difficulties in acquiring the skills needed to administer this intervention.Methods and analysis A two-arm cluster-randomised study (in which patients are assigned to a PCP or PCN) will be conducted in primary health centres of Majorca Island (Spain). A total of 206 patients will be recruited. Healthcare professionals will be allocated to the intervention or control group in a 1:1 ratio. The intervention group will receive CBT-i and the control group will receive usual care. We will include patients with Insomnia Severity Index scores of 8 or more who also report that insomnia interferes with daily functioning or is noticeable to others. The CBT-i will consist of four individual structured sessions, three in person (20 min each) and one by telephone (10 min) that are administered at intervals of 2–3 weeks. An additional session will be provided for patients taking hypnotic medications. The primary outcome measure is the decrease in sleep latency, which will be measured with the Pittsburg Sleep Quality index at 6 months and 12 months.Ethics and dissemination This project was approved by the Ethical Committee of the Balearic Islands (IB 4604/21 PI) and the Primary Care Research Committee of the Department of Majorca Primary Care (PI19/24). All participants are required to provide written informed consent and no study-related procedures will be performed until consent is obtained. The trial results will be published in peer-reviewed journals and presented at conferences.Trial registration number ISRCTN10144646.

Introduction: Insulin resistance (IR) is a highly prevalent pathophysiological entity implicated in the development of a wide variety of metabolic, cardiovascular, and endocrine disorders. The aim of this study is to assess the association between sociodemographic variables and healthy habits with IR risk scales. Methodology: This dual study, incorporating both longitudinal-retrospective and cross-sectional designs, analyzed healthcare workers across four professional categories (physicians, nurses, healthcare technicians, and auxiliary personnel). It examined the association of age, sex, professional category, smoking status, physical activity, and adherence to the Mediterranean diet with elevated scores on insulin resistance risk scales. Results: All the variables analyzed were associated with the presence of elevated values of the IR scales, with age, sex, and physical activity showing the strongest association (reflected in the odds ratio values). Conclusions: The profile of an individual with a higher risk of presenting elevated values of the IR risk scales would be an elderly male auxiliary health worker who is a smoker and is physically inactive, with a low adherence to the Mediterranean diet.

Introduction: Metabolic syndrome (MetS) and hypertriglyceridemic waist (HTW) are two multifactorial pathological conditions that have been increasing in prevalence worldwide. The objective of this study was to evaluate how various sociodemographic variables and healthy habits are associated with the presence or absence of MetS and HTW. Methodology: This study employed a mixed-methods approach, consisting of a retrospective longitudinal study and a cross-sectional descriptive study, analyzing 44,939 healthcare workers with MS and HTW across four professional categories to evaluate the relationship between age, sex, smoking, physical activity, and adherence to the Mediterranean diet using three diagnostic criteria. Descriptive analysis included categorical and quantitative variables, which were assessed through frequencies, Student’s t-test, chi-square, and binary logistic regression models. Logistic regression and Cohen’s kappa were used to evaluate associations and concordances. Age, sex, and lack of physical activity showed the strongest associations with MetS (OR: 2.65–2.84). The results highlight the importance of physical activity and other factors in metabolic prevention. Results: Age, sex, and physical activity were the variables most strongly associated with MetS and HTW across the three evaluated diagnostic criteria. The odds ratios revealed significant values: age (9.07–13.71 for MetS and 13.42 for HTW), sex (2.82–3.31 for MetS and 3.72 for HTW), and physical activity (2.65–2.84 for MetS and 2.40 for HTW). Conclusions: The risk of developing MetS and HTW among healthcare personnel is influenced by lifestyle habits, sex, and age, with the highest ORs observed in nursing assistants and orderlies. Future research that delves deeper into the causal relationship between lifestyle factors and the severity of MetS and HTW in healthcare personnel will improve understanding and facilitate the development of preventive activities to reduce their incidence.

Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most common cause of chronic liver disease worldwide, with a multifactorial etiology. This study aims to evaluate the associations between various sociodemographic variables, healthy habits, and stress with risk scale values for MAFLD. Materials and Methods: A descriptive, cross-sectional study was conducted on 16,708 Spanish workers to assess how sociodemographic variables (age, gender, and socioeconomic status), healthy habits (smoking, Mediterranean diet adherence, and physical activity), and stress correlate with values from three MAFLD risk scales: fatty liver index (FLI), hepatic steatosis index (HSI), and lipid accumulation product (LAP). Results: All analyzed variables were associated with the values of the three MAFLD risk scales. Among them, the variables showing the strongest associations (represented by odds ratio values) were age and physical activity. Conclusions: The profile of an individual at higher risk of elevated MAFLD risk scale values is a male, aged 50 or older, belonging to lower socioeconomic levels (manual laborers), a smoker, sedentary, with low adherence to the Mediterranean diet, and with high stress scale scores.

Background and Objectives: The accumulation of fat in the body, especially visceral fat, is associated with various cardiometabolic conditions such as diabetes mellitus and fatty liver. The reasons for the accumulation of this fat are diverse. Some studies, also in the working population, have shown a clear association between sociodemographic variables and health habits with scales that assess overweight and obesity. This study aims to determine how certain sociodemographic variables, such as age, gender, and socioeconomic level, as well as certain healthy habits like physical activity and tobacco consumption, affect the levels of body and visceral fat. Materials and Methods: We conducted a descriptive and cross-sectional study involving 8590 Spanish workers. The percentage of body and visceral fat was measured using a bioimpedance analysis with a Tanita DC 430MA device. Results: Both the average values and the prevalence of elevated body and visceral fat increase with age and decrease with social class and lower levels of physical activity. These values are higher in smokers. A multivariate analysis shows that the variables most influential in increasing the risk of high levels of both body and visceral fat are age and low levels of physical activity. Conclusions: The profile of a person at high risk of having elevated body and visceral fat levels is an older male with a low socioeconomic status who smokes and leads a sedentary lifestyle.

Background: Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide, accounting for one-third of all global deaths. The World Health Organization (WHO) asserts that prevention is the most effective strategy to combat CVD, emphasizing the need for non-invasive, low-cost tools to identify individuals at high risk of CVD. Atherogenic indices and heart age (HA) are valuable tools for assessing cardiovascular risk (CVR). The aim of our study was to evaluate the association between atherogenic indices and HA. Methods: A cross-sectional study was conducted involving 139,634 Spanish workers to determine the association between three atherogenic indices and HA. ROC curves were employed to identify the cut-off values for the various atherogenic indices used to estimate high HA. The cut-off points, along with their sensitivity, specificity, and Youden index, were determined, and the area under the curve (AUC) was calculated. Results: As the values of the atherogenic indices increased, so did the risk of having elevated avoidable lost life years (ALLY) HA. In the ROC curve analysis, the AUC with the best results corresponded to the total cholesterol/HDL-c atherogenic index, with an AUC of 0.803 in females and 0.790 in males. The LDL-c/HDL-c atherogenic index showed an AUC of 0.780 in women and 0.750 in men, with Youden indices around 0.4. When analyzing the AUC of the atherogenic index for triglycerides/HDL-c, the results were 0.760 in women and 0.746 in men. Conclusions: Atherogenic indices and HA show a close relationship, with an increase in these indices leading to a rise in HA values. Raising patient awareness that as their CVR levels increase, so does their HA may be useful in achieving some benefit in reducing CVR.

Introducción: La fístula arteriovenosa para hemodiálisis repercute negativamente sobre la hemodinamia, la morfología y las funciones cardíacas. Objetivo: Determinar la repercusión del cierre del acceso vascular sobre variables clínicas, humorales, morfológicas y funcionales del corazón derecho en receptores de trasplante renal. Material y Métodos: Estudio cuasi-experimental longitudinal que incluyó 92 pacientes divididos en dos grupos, experimental (n=46): con cierre del acceso vascular y de comparación (n=46): sin cierre del angioacceso. Se determinan variables; clínicas, de laboratorio, y ecocardiográficas en dos tiempos: inicial y seis meses posteriores. Resultados: La media de edad en ambos grupos fue de 46,87 ±12,04 y 45,50 ±12,47 años respectivamente. Prevaleció el sexo masculino; 26 (56,52%) y el color de piel blanca; 34 (73,91%). Las palpitaciones fueron la manifestación clínica más frecuente con mejoría a la segunda observación en el grupo experimental, al igual que las presiones sistólica y diastólica, así como la creatinina sérica; de 108,24 ±24,53 a 100,00 ±22,35 μMol/L (p=0,004). Las variables mensuradas por ecocardiografía mejoraron en el grupo intervenido respecto al de comparación. Las diferencias final – inicial para las presiones sistólica y media de la arteria pulmonar mostraron relaciones muy significativas (p

Introduction, objectives: Obesity is a global health problem with a great negative impact on health. Among the pathologies caused by obesity are insulin resistance and metabolic syndrome, which constitute an increasingly common health problem in both developed and developing countries. The aim of this study was to examine the relationship between two scales that assess obesity—based on hip circumference—and metabolic syndrome (MetS) and insulin resistance risk scales as predictors of these alterations. Materials, methods: A descriptive, cross-sectional study was carried out on 193,462 workers from different Spanish regions and work groups between January 2019 and September 2021. Abdominal volume index (AVI) and body adiposity index (BAI) were evaluated to assess obesity and its association with insulin resistance using three risk scales (TyG index, Triglycerides/HDL, and METS-IR), while their association with metabolic syndrome was determined using the NCEP ATP III, IDF, and JIS models. Results: The results of the ROC curves to determine the predictive value of BAI and AVI in relation to the three criteria evaluated to calculate MetS in all instances presented a higher area under the curve (AUC) for AVI. The high values of AVI stand out for predicting MetS when applying the IDF criteria. The cut-off point in women was 13.70 with a Youden index of 0.802, whereas in men, the cut-off point was set at 17.59 with a Youden index of 0.672. Regarding the relationship of BAI and AVI with insulin resistance risk scales for both sexes, the AUC only revealed high values when using the METS-IR formula for both AVI and BAI. The AVI cut-off points to predict high values of insulin resistance risk scales in women were established at 13.12 with a Youden index of 0.722. In men, the cut-off point was 17.59, with a Youden index of 0.626. The BAI cut-off points in women were set at 33.88 with a Youden index of 0.748. In men, the cut-off point was 27.91, with a Youden index of 0.598. Conclusions: AVI demonstrated its value as a predictor of metabolic syndrome while exclusively applying the IDF criteria. AVI and BAI demonstrated their value as predictors of high values of insulin resistance risk scales only in the case of METS-IR. This predictive value is also higher in women.

Insulin resistance is a pathological entity that can lead to alterations in lipid metabolism and can increase cardiovascular risk. Objective. The aim of this study was to assess the influence of different sociodemographic variables such as age, sex and social class and healthy habits such as smoking, physical activity and adherence to the Mediterranean diet on the cardiometabolic profile of Spanish workers. Material and methods. A descriptive, cross-sectional study was carried out in 1457 Spanish workers in an attempt to evaluate the effect of healthy habits (physical exercise determined with the IPAQ questionnaire, Mediterranean diet and tobacco consumption) and sociodemographic variables (age, sex and social class) on the values of different insulin resistance scales. Results. The progressive increase in the level of physical activity and high adherence to the Mediterranean diet achieved an improvement in the mean values and in the prevalence of elevated values in all the insulin resistance scales analyzed in this study. Age over 50 years and belonging to the least favored social classes (social classes II-III) were the variables that increased the risk of presenting insulin resistance. Male sex also increased the risk of presenting insulin resistance. Conclusions. The different healthy habits such as vigorous physical exercise and high adherence to the Mediterranean diet improve the values of the different scales that assess insulin resistance.

Resumen: Se presentan las recomendaciones del Programa de Actividades Preventivas y Promoción de la Salud (PAPPS) de la Sociedad Española de Medicina Familiar y Comunitaria (semFYC), para la promoción de un estilo de vida saludable mediante la metodología de intervención y las actuaciones preventivas en consumo de tabaco, consumo de alcohol, alimentación saludable, actividad física en el tiempo libre y prevención de accidentes de tráfico y sistemas de retención infantil. Se actualizan las recomendaciones, se señalan aspectos novedosos como la definición de consumo de alcohol de bajo riesgo y se pone al día la bibliografía. Para las principales recomendaciones se incluyen tablas específicas que recogen la calidad de la evidencia y la fuerza de la recomendación. Abstract: We present the recommendations of the Preventive Activities and Health Promotion Programme (PAPPS) of the semFYC (Spanish Society of Family and Community Medicine) to promote healthy lifestyles using intervention methodology, and preventive actions against tobacco and alcohol use, healthy eating, physical activity in leisure time, prevention of traffic accidents, and child restraint systems. The recommendations have been updated, and new aspects highlighted, such as the definition of low-risk alcohol consumption, and the references have been updated. For the main recommendations, we include specific tables showing the quality of the evidence and the strength of the recommendation.

Introduction, objectives: Although cardiovascular events have been traditionally associated mainly with men, some data reflect an increase in women, which may even exceed their male counterparts, constituting the leading cause of death in working women in Spain. The objective of this present study was to analyze the level of cardiovascular risk in Spanish working women by assessing the influence of age, type of work, and tobacco consumption. Material, methods: A descriptive cross-sectional study was carried out in 172,282 working women from different Spanish geographical areas and from different companies between January 2018 and June 2020. A range of variables and risk factors were assessed and various cardiovascular risk scales were used to analyze the data. Results: An increase in cardiovascular risk was observed in the least qualified work groups, mainly corresponding to blue-collar workers, when using the SCORE or REGICOR risk equation. The prevalence of altered values for all the parameters analyzed (overweight and obesity, hypertension, dyslipidemia, diabetes, fatty liver, hepatic fibrosis, atherogenic indexes, and cardiovascular risk scales) was higher among blue-collar women. Age was the only factor that influenced all the cardiovascular risk scales studied, increasing risk when comparing the group of women aged 50 years and older with the others. Conclusions: Aging and belonging to the blue-collar job category meant worse results in the cardiovascular risk scales and in all the parameters analyzed. This is in line with numerous studies that argue that age and zip code are more influential than genetic code.

Obesity induces alterations in lipid biochemistry, evolving toward dyslipidaemia atherogenesis, a critical factor in the development of cardiovascular events. Two relevant forms of lipid abnormalities are atherogenic dyslipidaemia (AD) and lipid triad (LT), which involve alterations in triglyceride levels, HDL-c, and LDL-c. The aim of this study was to assess the linkage of atherogenic AD and LT with different scales of overweight and obesity. We carried out a cross-sectional study including 418,343 Spanish adult workers, recruited from workplace health assessments. Atherogenic dyslipidaemia was defined as triglyceride levels ≥ 150 mg/dL, HDL values 160 mg/dL, LT was considered. Subjects affected by AD and LT in the study exhibited significantly higher mean values than those without AD and LT in all overweight, obesity, and body fat related scales studied. VAI (visceral adiposity index) was the strongest predictor of AD (AUC = 0.934, 95% CI: 0.933 to 0.936) and LT (AUC = 0.926, 95% CI: 0.923 to 0.928). Atherogenic dyslipidaemia and LT positively correlate with different scales of overweight and obesity. Further studies should aim to identify other contributory factors. Our obtained data might be useful in laying the groundwork for future works on AD and LT.

Insulin resistance (IR) has been identified as a key factor in the appearance of non-alcoholic fatty liver disease (NAFLD) as it is related through a complex molecular biochemical and immunological mechanism. Our aim was to evaluate the relationship between different scales that estimate the risk of IR and scales that determine the risk of NAFLD. This descriptive and cross-sectional study was performed in 219,477 Spanish workers from different sectors and Spanish regions. The prevalence of high values of all the IR scales increases as the values of the NAFLD and liver fibrosis scales increase. In the multivariate analysis, the risk of presenting high values in the IR scales increases greatly as the values of the NAFLD and hepatic fibrosis scales increase, with particularly high OR values when using the Metabolic Score for Insulin Resistance (METS-IR) scale (LAP high OR 42.20 (95% CI (39.10–45.56) and FLI high OR 32.35 (95% CI 31.10–33.61)). We can conclude that there is a direct relationship between the values of the IR scales and the NAFLD and liver fibrosis scales in our population.

RESUMEN Introducción: Las complicaciones cardiovasculares constituyen la primera causa de morbilidad y mortalidad en el receptor de trasplante renal. Objetivo: Caracterizar la repercusión de la fístula arteriovenosa sobre variables hemodinámicas del corazón derecho en trasplante renal. Métodos: Estudio prospectivo, longitudinal. Se incluyeron 52 pacientes, evaluados clínica y ecocardiográficamente. Se compararon cinco variables hemodinámicas en el corazón derecho, previos y seis meses posteriores al cierre de la fístula arteriovenosa. Resultados: La edad promedio 46,02 años, 29 masculinos (55,8 %). El diámetro de la aurícula derecha en las fístulas cerradas en la muñeca izquierda ≥ 6 años disminuyó (p=0,044), al igual que en el ventrículo derecho

Introducción: el síndrome coronario agudo incluye un grupo de síntomas y signos atribuibles a una isquemia aguda del miocardio que repercute biológica, social y económicamente en quien lo sufre, por lo que la estratificación del riesgo coronario es de vital importancia. Objetivo: identificar las características epidemiológicas y los factores de riesgo coronario y su relación con las complicaciones más frecuentes en pacientes con síndrome coronario agudo. Métodos: se realizó un estudio descriptivo, transversal en pacientes que requirieron ingreso en el Hospital “Celestino Hernández Robau” con diagnóstico de síndrome coronario agudo durante el período de septiembre de 2015 a diciembre de 2016. De la población de estudio fueron seleccionados 168 pacientes de forma no probabilística. Se estudiaron las variables edad, sexo, peso, talla, factores de riesgos y antecedentes patológicos personales. Se utilizaron distribuciones de frecuencias absolutas y relativas, razón, media, desviación típica y técnicas de la estadística inferencial. Resultados: predominó el sexo masculino (59,52%); los factores de riesgo frecuentes fueron la hipertensión arterial (68,45%), la cardiopatía isquémica (44,64%), el tabaquismo (35,71%), la diabetes mellitus (26,79%) y la obesidad (10,12%) y las complicaciones se presentaron según los factores de riesgo presentes: la obesidad (82,35%), la cardiopatía isquémica (58,67%) y la diabetes mellitus (53,33%). Conclusiones: la aparición del síndrome coronario agudo aumenta hacia la quinta década de la vida, con predominio masculino. Prevalecieron los factores de riesgo como la hipertensión arterial, la cardiopatía isquémica, el tabaquismo, la diabetes mellitus y la obesidad, que estuvo relacionada con las complicaciones más frecuentes.

Cardiovascular complications associated with chemotherapy

RESUMEN Introducción: La hemoglobina glucosilada pudiera convertirse en una herramienta en la estratificación inicial de pacientes infartados según el balance metabólico previo. Objetivo: Determinar el valor pronóstico de la hemoglobina glucosilada para muerte y complicaciones cardíacas mayores en el período intrahospitalario en pacientes con diagnóstico de infarto agudo del miocardio con elevación del segmento ST. Métodos: Se realizó un estudio observacional analítico de cohorte prospectivo en pacientes atendidos en la Unidad de Cuidados Coronarios del Hospital Universitario “Arnaldo Milián Castro” entre noviembre de 2018 y marzo de 2019 por presentar diagnóstico de infarto del miocardio agudo con elevación del segmento ST (N=73), de los cuales se seleccionó una muestra de 62 pacientes. Se realizó un análisis de conglomerados de K-medias y se valoró el área bajo la curva ROC de la hemoglobina glucosilada para predecir mortalidad y complicaciones mayores. Resultados: Existieron diferencias estadísticamente significativas entre los diferentes cluster en las variables estado al egreso (p=0,001; V=0,489) y ocurrencia de complicaciones cardíacas mayores (p=0,050; V=0,307). El análisis del estadístico C de la hemoglobina glucosilada demostró su capacidad predictiva para mortalidad tanto en diabéticos (C=0,810; p=0,014) como en no diabéticos (C=0,817; p=0,006), así como para complicaciones cardíacas mayores en diabéticos (C=0,799; p=0,015) y no diabéticos (C=0,683; p=0,052). Se estableció el punto de corte en 7,8 %, por encima del cual la hemoglobina glucosilada constituyó un factor pronóstico de mortalidad y complicaciones cardíacas mayores. Conclusiones: Se determinó que la hemoglobina glucosilada posee capacidad para predecir mortalidad y complicaciones cardíacas mayores en el período intrahospitalario. Su valor por encima del punto de corte constituyó un predictor independiente.

El síndrome hemolítico urémico (SHU) es una entidad clínica caracterizada por la aparición de anemia hemolítica no inmune, trombocitopenia e insuficiencia renal aguda. Se trata de una enfermedad perteneciente al grupo de las microangiopatías trombóticas (MAT) de la que hacen parte también la purpura trombocitopénica trombótica (PTT) y algunas otras MAT asociadas a otras condiciones médicas antes conocidas como MAT secundarias. Por otra parte, la variedad conocida como SHU atípico (SHUa) es una patología ultra-huérfana que frecuentemente evoluciona a insuficiencia renal crónica (IRC) y se asocia con elevada morbimortalidad si no recibe el tratamiento adecuado. Se examina el caso de un paciente que presenta su primera manifestación clínica de síndrome hemolítico urémico atípico después de trasplante renal cadavérico lo cual no solo lo hace un caso aún más exótico, sino que implica mayor complejidad en su manejo.

El objetivo del presente trabajo fue evaluar el efecto del componente racial y la suplementación energética en novillos en etapa de nalización en pastoreo sobre la ganancia de peso, la calidad de la canal y la fuerza de corte (kg). El periodo de evaluación del estudio fue de 144 días, durante el año 2014. Este se realizó en la nca “La Vega” ubicada en el cantón de San Carlos, Alajuela, Costa Rica. Se utilizaron veintiséis animales distribuidos en dos grupos raciales y tres niveles de suplementación para un total de seis tratamientos experimentales: E-T0 (3,2 Mcal), C-T0 (3,2 Mcal), E-T1 (3,4 Mcal), C-T1 (3,4 Mcal), E-T2 (3,67 Mcal) y C-T2 (3,67 Mcal). Se evaluaron: ganancia diaria de peso (GDP) y peso vivo y de la canal, marmoleo, desarrollo muscular, grasa dorsal, rendimiento en canal, espesor de grasa dorsal (EGD), peso de grasa perirenal, área del ojo del lomo (AOL) y nalmente la fuerza de corte (FC) como parámetro de calidad de carne. No se encontraron diferencias debido al efecto de la ración (P>0,05) para ganancia diaria de peso, peso de la canal, marmoleo, desarrollo muscular y grasa dorsal. Se encontró un efecto del componente racial sobre la calidad de carne (P

Background and Objectives: The treatment of hypertension and its complications are a worldwide problem. In our country nearly 25 % of the population over 15 years old is hypertensive, and this figure nearly doubles in those over 60. This research aims to compare two treatment strategies for controlling hypertension in outpatients with chronic coronary ischemic syndrome. Method: A total of 150 patients was included, 73 were randomized to receive calcium antagonist and non-calcium antagonist respectively, as 4 patients were subsequently excluded. Each was asked to sign consent, underwent clinical examination and a 12-lead, conventional electrocardiogram. Blood pressure and episodes of angina were evaluated at 6 months and one year. All variables were entered into a database and statistical analysis was performed using Student's t and Chi square. Results: The mean age was 61,5 years. Women and white skin color were predominant. At 12 months of treatment, blood pressure normalized in more than 80 % of patients without significant differences between the two treatment strategies. Over 75 % of patients in both groups controlled the angina episodes and more than 85 % said the quality of life was good. Conclusions: Control of blood pressure and angina was achieved and there were no significant differences between the two treatment strategies.

Resumen Introducción y objetivos: En Cuba las estadísticas vitales de la morbi-mortalidad por infarto agudo de miocardio proceden de pequeñas áreas de salud. El objetivo fue identificar las principales características y conducta hospitalaria de los pacientes con infarto a través de un registro hospitalario de infarto. Métodos: Se monitorizaron los casos de infarto ocurridos en pacientes de 45 a 74 años de edad y residentes en Santa Clara, durante los años 2007 y 2008. Las fuentes de información fueron: listados de egresos hospitalarios, registros hospitalarios de infarto de miocardio, certificados de defunción y registros de autopsias nosocomiales. Se utilizó la metodología MONICA (MONItoring Trends and Determinants in CArdiovascular Disease Project). Resultados: Se registraron 297 pacientes con infarto. El 62,7 % de los varones y el 46,8 % de las mujeres recibieron tratamiento de reperfusión. Las letalidades hospitalarias en varones y mujeres fueron de 25,3 % y 45 %. Las variables que se relacionaron con una mayor mortalidad fueron la edad, el sexo femenino, la frecuencia cardíaca alta, el infarto de topografía anterior, la creatinina elevada, así como los antecedentes personales de cardiopatía isquémica previa y diabetes mellitus. Mientras que el tratamiento con fibrinolíticos y/o betabloqueadores se correlacionaron inversamente con la mortalidad. Conclusiones: Existió una elevada prevalencia de dislipidemia desconocida y letalidad hospitalaria a 28 días; así como una baja utilización de las estrategias cruentas. La hipertensión sistólica al ingreso se relacionó con un mejor pronóstico. / Abstract Introduction and objectives: In Cuba, the vital statistics of morbi-mortality due to acute myocardial infarction come from small health areas. The objective of this study was to identify the main characteristics and hospital management of patients with myocardial infarction, through a hospital registry of infarctions. Methods: The cases of acute myocardial infarction in patients between 45 and 74 years of age, from Santa Clara, during 2007 and 2008, were monitored. The information sources were: hospital discharge records, hospital registry of myocardial infarction, death certificates and nosocomial autopsy records. The MONICA methodology was used (Monitoring Trends and Determinants in Cardiovascular Disease Project). Results: a total of 297 patients with acute myocardial infarction were registered; 62,7 percent of males and 46,8 percent of women received reperfusion treatment. The hospital deaths in males and women were 25,3 percent and 45 percent respectively. The variables related to a higher mortality were: age, female sex, a high cardiac frequency, anterior-wall infarction, a high creatinine level, as well as individual antecedents of ischemic heart disease and diabetes mellitus. On the other hand, the treatments with fibrinolitics and/or beta-blockers were inversely proportional to mortality. Conclusions: There was a high prevalence of unknown dyslipidemia and hospital death within 28 days; as well as little use of invasive strategies. Systolic hypertension at the time of admission was related with a better prognosis.

El síndrome coronario agudo es un conjunto de entidades nosológicas que representan distintos estadios de un proceso fisiopatológico único: la isquemia miocárdica aguda, secundaria en general (pero no exclusivamente) a aterosclerosis coronaria complicada con fenómenos trombóticos que provocará distintos grados de obstrucción al flujo coronario y que en dependencia del grado de obstrucción y del estado previo del miocardio se presentará clínicamente como una angina inestable, infarto agudo del miocardio sin elevación del ST, infarto agudo del miocardio con elevación del ST o muerte súbita de causa isquémica. La presente revisión pretende abordar los principales aspectos fisiopatológicos de dicho proceso: desde la aterogénesis hasta el daño por reperfusión.Acute coronary syndrome is a number of disease entities representing different stages of a unique pathophysiologic process: acute myocardial ischemia generally secondary (but no exclusively) to coronary atherosclerosis complicated with thrombotic phenomena provoking different degrees of coronary flow obstruction and that depending of the obstruction degree and the previous status of myocardium clinically will see as a unstable angina, myocardium acute infarction with rise of ST or sudden death of a ischemic cause. Present review tries to approach the main pathophysiologic features of such process: from the atherogenesis to reperfusion damage.

Introduction and objectives: Coronary artery disease is the main cause of death in the developed world, also affecting young people. This investigation aims at determining the characteristics of suchan illness in people under 45 years of age. Method: A retrospective study was carried out during a two year period in the provincial hospitals of Villa Clara province. Results: 84,0 percent of the patients were male, and 68,0 percent were between the ages of 40 and 45. The infarction of the inferior wall represented 56.0 percent, 31 patients (62,0 %) presented a positive ergometry, 44 patients (88,0 %)had a normal ejection fraction, 34 patients (68,0 %) suffered from alterations of the regional motility, 92,0 percent had normal ventricular diameters and 76,0 percent showed a normal pattern of relaxation of the left ventricle (p = 0,000). Only 7 patients (14,0 %) had normal arteries. In the 43 remaining patients, 46,5 % presented type C lesions, 60,5 percent had the right coronary as the one responsible for the infarction, 60,5 percent had only one vessel affected, and 88.4 percent had stenosis obstructing more than half the diameter of the artery. Conclusions: In the investigation there was a prevalence of male individuals, the group between 40 and 45 years of age, an inferior localization, alterations of the ergonometric test, a normal LVEF, alterations of the regional contractibility, normal ventricular diameter and relaxation pattern, and a positive coronariography with a predominant damage of one vessel, left coronary and type C lesions.

Con la publicación este año de la clasificación de las miocardiopatías según la perspectiva de la Sociedad Europea de Cardiología, se rompió un consenso de más de 13 años acerca del tema, y se ha iniciado un debate acerca de cuál de las clasificaciones vigentes es la más apropiada. Por su parte, la Sociedad Americana del Corazón defiende su propuesta, basada en un enfoque genético-molecular, con ampliación del concepto de miocardiopatía al ámbito eléctrico y manteniendo la división en primarias y secundarias, mientras la perspectiva europea expresa un claro desacuerdo en estos puntos, planteando además que su clasificación tiene más utilidad en la práctica médica diaria. En el presente artículo se describen las principales similitudes y puntos de controversia entre ambos documentos, y se emiten criterios desde el punto de vista de la cardiología clínica, el grupo principal de personales de la salud para quienes fueron realizados.With the present classification of Myocardiopathies according the perspective of European Society of Cardiology, a consensus of more than 13 years on this matter, was broken, starting a debate on which of in use classification is the more appropriate. Heart American society defends its proposal, based on a genetic-molecular approach, with a more broad meaning of myocardiopathy to electric scope and maintaining the division of primaries and secondaries, whereas European perspective express a clear disagreement on these points, proposing also that its classification is more usefulness in daily medical practice. In present paper are described the main similarities and points of controversy between both documents with criteria from the clinical cardiology point of view, the main group of health staff for whom they were made.

Este artículo presenta un dispositivo para el análisis cinemático de la marcha humana. El dispositivo propuesto se basa en el uso de técnicas de videogrametría y procesamiento de imágenes para registrar el movimiento humano. Con este fin, se utilizó una cámara de video digital, ubicada a 4 metros del paciente, capturando su marcha en el plano sagital. También se desarrolló un modelo cinemático de los miembros inferiores que, a partir del desplazamiento de cierto número de puntos anatómicos, determina los ángulos articulares de la cadera, rodilla y tobillo, además de la inclinación de la pelvis durante un ciclo completo de la marcha. La identificación de dichos puntos fue facilitada mediante el uso de marcadores reflectivos, ubicados en siete posiciones anatómicas diferentes. Después, se diseñó y desarrolló un programa para el registro y procesamiento de los datos obtenidos, por medio de la cámara en el lenguaje de programación C# .NET. La aplicación desarrollada captura y preprocesa el video, detecta cada uno de los marcadores en la imagen, aplica el modelo cinemático y visualiza a modo de gráfica el valor de los ángulos articulares de los miembros inferiores, a lo largo del ciclo de la marcha. Por fin, se diseñó un protocolo y se realizó una prueba experimental con un sujeto, para comparar las curvas entregadas por el software y las curvas teóricas encontradas en la literatura. A pesar de las limitaciones del sistema referentes al análisis bidimensional de la marcha, se lograron obtener curvas articulares muy similares a las teóricas, obtenidas con métodos comerciales para el análisis del movimiento tridimensional.

La medida de la presión plantar es fundamental para conocer la distribución de las fuerzas en la planta del pie. Estos valores son importantes para el diagnóstico y tratamiento de diferentes patologías como úlceras diabéticas en la planta del pie y presencia de deformidades en extremidades inferiores, entre otras. En el presente artículo se describe el desarrollo de un podobarógrafo para el análisis de la huella plantar, cuyo desarrollo incluyó la fabricación de un podoscopio, la selección de un material transductor adecuado y el desarrollo del software para el procesamiento de las imágenes capturadas por una cámara de video. El dispositivo propuesto PodoMED permite realizar un análisis dinámico y estático de la huella, pues aparte de mostrar cómo es la distribución de presiones en la planta del pie durante la marcha, por medio de imágenes en seudocolor, tiene la opción de emitir una valoración de la huella, donde se muestran medidas como el índice de valgo, el ángulo de Clarke, el índice de Hernández Corvo, entre otros. Para el desarrollo de este proyecto se realizaron ensayos experimentales para minimizar el ruido de la imagen, lo cual se logró con la utilización de un filtro físico y otro para la imagen por medio de software. Para una etapa futura, se planea la calibración y validación del sistema, con lo cual se pretende brindar mayor confiabilidad y repetibilidad.

Resumen: Se presentan las recomendaciones del Programa de Actividades Preventivas y Promoción de la Salud (PAPPS) de la semFyC, para la promoción de un estilo de vida saludable mediante la metodología de intervención y las actuaciones preventivas en consumo de tabaco, consumo de alcohol, alimentación saludable, actividad física en el tiempo libre y prevención accidentes de tráfico y sistemas de retención infantil. Se actualizan las recomendaciones, se señalan aspectos novedosos como la definición de consumo de alcohol bajo riesgo y se pone al día la bibliografía. Para las principales recomendaciones se incluyen tablas específicas que recogen la calidad de la evidencia y la fuerza de la recomendación. Abstract: We present the recommendations of the Preventive Activities and Health Promotion Programme (PAPPS) of the semFYC (Spanish Society of Family and Community Medicine) to promote healthy lifestyles using intervention methodology, and preventive actions against tobacco and alcohol use, healthy eating, physical activity in leisure time, prevention of traffic accidents, and child restraint systems. The recommendations have been updated, and new aspects highlighted, such as the definition of low-risk alcohol consumption, and the references have been updated. For the main recommendations, we include specific tables showing the quality of the evidence and the strength of the recommendation.