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Aim To determine in the adult population the crude and the sex- and age-adjusted prevalence rates of hypertriglyceridaemia (HTG) and to assess its association with cardiovascular risk factors, chronic kidney disease, cardiovascular and cardiometabolic diseases. Methods Cross-sectional observational study conducted in Primary Care, with 6,588 adult study subjects, randomly selected on base-population. Patients had HTG if the triglyceride level was ≥150 mg/dL (≥1.7 mmol/L), or were on lipid-lowering therapy to lower triglyceride. Associations were assessed by univariate and multivariate analysis, and crude and sex- and age-adjusted prevalence rates were determined. Results The arithmetic and geometric means of triglyceride levels were respectively 120.5 and 104.2 mg/dL in global population, 135.7 and 116.0 mg/dL in men, and 108.6 and 95.7 mg/dL in women. The crude HTG prevalence rates were 29.6% in global population, 36.9% in men and 23.8% in women. The sex- and age-adjusted HTG prevalence rates were 27.0% in global population, 34.6% in men and 21.4% in women. The independent variables that were most associated with HTG were hypercholesterolemia (OR: 4.6), low HDL-C (OR: 4.1), hepatic steatosis (OR: 2.8), diabetes (OR: 2.0), and obesity. (OR: 1.9). Conclusions The means of triglyceride levels and HTG prevalence rates are intermediate between those of other national and international studies. A fifth of the female adult population and more than a third of the male population had HTG. The independent factors associated with HTG were hypercholesterolemia and low HDL-C, and the cardiometabolic variables diabetes, hepatic steatosis and obesity.

Resumen Objetivo Determinar en la poblacion adulta las tasas de prevalencia brutas y ajustadas por edad y sexo de hipertrigliceridemia (HTG) y valorar su asociacion con factores de riesgo cardiovascular, enfermedad renal cronica y enfermedades cardiovasculares y cardiometabolicas. Metodos Estudio observacional transversal realizado en Atencion Primaria, con 6.588 sujetos de estudio adultos, seleccionados aleatoriamente con base poblacional. Los pacientes tenian HTG si la concentracion de trigliceridos era ≥ 150 mg/dL (≥ 1,7 mmol/L) o estaban en tratamiento hipolipidemiante para reducir los trigliceridos. Se valoraron las asociaciones mediante analisis univariado y multivariante, y se determinaron las prevalencias brutas y ajustadas por edad y sexo. Resultados Las medias aritmeticas y geometricas de las concentraciones de trigliceridos fueron respectivamente 120,5 y 104,2 mg/dL en la poblacion global, 135,7 y 116,0 mg/dL en hombres, y 108,6 y 95,7 mg/dL en mujeres. Las prevalencias brutas de HTG fueron 29,6% en poblacion global, 36,9% en hombres y 23,8% en mujeres. Las prevalencias ajustadas por edad y sexo de HTG fueron 27,0% en poblacion global, 34,6% en hombres y 21,4% en mujeres. Las variables independientes que mas se asociaban con la HTG fueron hipercolesterolemia (OR: 4,6), c-HDL bajo (OR: 4,1), esteatosis hepatica (OR: 2,8), diabetes (OR: 2,0) y obesidad (OR: 1,9). Conclusiones Las medias de trigliceridos y las prevalencias de HTG se encuentran intermedias entre las de otros estudios nacionales e internacionales. La quinta parte de la poblacion adulta femenina y mas de un tercio de la masculina presentaba HTG. Los factores independientes asociados con HTG fueron hipercolesterolemia y c-HDL bajo, y las variables cardiometabolicas diabetes, esteatosis hepatica y obesidad.

Objectives In patients with suspected coronavirus disease 2019 (COVID-19) consulting primary care (PC) centers, clinical criteria may not be sensitive enough to detect many cases in which complications first occur. We intended to assess whether lung ultrasound (LUS) examinations performed by PC physicians are a useful tool to detect lung injury and may help in decisions about hospital referral. Methods This study included 61 patients with moderate symptoms suggesting COVID-19 who were evaluated with LUS by PC physicians and then referred to a hospital during the current pandemic peak in Madrid. We analyzed association of a simple self-designed LUS severity scale (grade 0, normal; grade 1, multiple separated B-lines, pleural irregularity, or both; and grade 2, coalescent B-lines, consolidations, pleural effusion, or a combination thereof) with the main outcome indicating adequacy of hospital referral, and also with chest x-ray (CXR) findings. Results The proposed LUS severity scale was significantly associated with the main outcome of appropriate referral (P = 0.001): the higher the scale, the higher the percentage of adequate referrals. The LUS scale was also associated with a CXR severity scale (P = 0.034). The presence of coalescent B-lines was the only independent LUS finding significantly associated with the appropriate-referral outcome (P =0 .008) and also with a higher probability of hospital admission (P = 0.02) and with several CXR findings. Conclusions This study supports the use of LUS in PC as a tool to assess patients with suspected COVID-19. Its use can reduce uncertainty during clinical evaluations of moderate patients, facilitate early detection of lung involvement, allow early appropriate referral, and avoid unnecessary referral.

To determine in the adult population the crude and the sex- and age-adjusted prevalence rates of hypertriglyceridaemia (HTG) and to assess its association with cardiovascular risk factors, chronic kidney disease, cardiovascular and cardiometabolic diseases.Cross-sectional observational study conducted in Primary Care, with 6,588 adult study subjects, randomly selected on base-population. Patients had HTG if the triglyceride level was≥150mg/dL (≥1.7mmol/L), or were on lipid-lowering therapy to lower triglyceride. Associations were assessed by univariate and multivariate analysis, and crude and sex- and age-adjusted prevalence rates were determined.The arithmetic and geometric means of triglyceride levels were respectively 120.5 and 104.2mg/dL in global population, 135.7 and 116.0mg/dL in men, and 108.6 and 95.7mg/dL in women. The crude HTG prevalence rates were 29.6% in global population, 36.9% in men and 23.8% in women. The sex- and age-adjusted HTG prevalence rates were 27.0% in global population, 34.6% in men and 21.4% in women. The independent variables that were most associated with HTG were hypercholesterolemia (OR: 4.6), low HDL-C (OR: 4.1), hepatic steatosis (OR: 2.8), diabetes (OR: 2.0), and obesity (OR: 1.9).The means of triglyceride levels and HTG prevalence rates are intermediate between those of other national and international studies. A fifth of the female adult population and more than a third of the male population had HTG. The independent factors associated with HTG were hypercholesterolemia and low HDL-C, and the cardiometabolic variables diabetes, hepatic steatosis and obesity.

Resumen: Este artículo es continuación de la revisión iniciada en el número anterior sobre la utilidad de la ecografía clínica abdominal en Atención Primaria (AP), y completa los escenarios de grandes vasos abdominales, bazo, nefrourológicos y ginecológicos. Abstract: This article is a continuation of the review initiated in the previous issue about the usefulness of point of care ultrasound in Primary Care, completing the scenarios of large abdominal vessels, spleen, nephrourological and gynecological ultrasound. Palabras clave: Ecografía clínica, Medicina familiar, Utilidad, Fiabilidad, Keywords: Point of care ultrasound, Family practice, Usefulness, Reliability

Resumen: La ecografía es una técnica segura y fiable que aumenta la capacidad diagnóstica, agiliza y mejora la toma de decisiones de los profesionales de la medicina en cualquier ámbito de ejercicio. El médico de familia (MF), que debe ser competente para abordar la práctica totalidad de los problemas de salud de las personas, es un especialista idóneo para incorporar esta herramienta a su actividad, dotándose con ella de una capacidad de manejo hasta ahora desconocida, al ser muy numerosas las situaciones clínicas de la práctica habitual en las cuales se puede beneficiar de ella de modo fiable, eficiente y eficaz. Al tratarse de una tecnología muy dependiente del explorador, se hace necesario asegurar la competencia de quienes la practican, definir los beneficios y los potenciales riesgos que su uso puede generar, así como sus escenarios de aplicación, en aras de evitar exploraciones innecesarias y minimizar el coste oportunidad que puede suponer incorporar esta actividad a una agenda de por sí desbordada. Este trabajo pretende resumir el estado actual de la ecografía clínica abdominal y su utilidad para el MF en aquellos escenarios en los que resulta fiable y eficaz. Abstract: Ultrasound is a safe and reliable way to increase diagnosis capabilities, as well as an improving and speed up method for taking decisions for healthcare professionals of every medical specialty. Family doctor, who must be ready to address all kind of health problems for his patients, is the key person to incorporate this tool to his daily activity, acquiring the best managing skill, unknown nowadays, being quite large the clinical situations in the day by day practice, in which he can obtain benefit in a reliable and effective way.Due to this practice is explorer dependent, it's needed to assure the best competence of the professional who practice it, and define the benefits and potential risks its use can create, as well as its application scenarios, in order to avoid unnecessary explorations and minimize opportunity costs that this activity can add to a currently saturated agenda. This work pretends to summarize the current state of abdominal point of care ultrasound, and its utility for the family doctor, in those scenarios that can be potentially reliable and effective. Palabras clave: Ecografía clínica, Medicina familiar, Utilidad, Fiabilidad, Keywords: Point of care ultrasound, Family practice, Usefulness, Reliability

Resumen Este artículo es continuación de la revisión iniciada en el número anterior sobre la utilidad de la ecografía clínica abdominal en Atención Primaria (AP), y completa los escenarios de grandes vasos abdominales, bazo, nefrourológicos y ginecológicos.

Resumen La ecografía es una técnica segura y fiable que aumenta la capacidad diagnóstica, agiliza y mejora la toma de decisiones de los profesionales de la medicina en cualquier ámbito de ejercicio. El médico de familia (MF), que debe ser competente para abordar la práctica totalidad de los problemas de salud de las personas, es un especialista idóneo para incorporar esta herramienta a su actividad, dotándose con ella de una capacidad de manejo hasta ahora desconocida, al ser muy numerosas las situaciones clínicas de la práctica habitual en las cuales se puede beneficiar de ella de modo fiable, eficiente y eficaz. Al tratarse de una tecnología muy dependiente del explorador, se hace necesario asegurar la competencia de quienes la practican, definir los beneficios y los potenciales riesgos que su uso puede generar, así como sus escenarios de aplicación, en aras de evitar exploraciones innecesarias y minimizar el coste oportunidad que puede suponer incorporar esta actividad a una agenda de por sí desbordada. Este trabajo pretende resumir el estado actual de la ecografía clínica abdominal y su utilidad para el MF en aquellos escenarios en los que resulta fiable y eficaz.

Resumen Objetivos Conocer el grado de control de los pacientes en tratamiento con anticoagulantes orales atendidos en Atencion Primaria (AP) estimando el tiempo en rango terapeutico (TRT) segun el metodo de Rosendaal, y compararlo con el porcentaje de international normalized ratio (INR, «razon normalizada internacional») en rango y el analisis transversal (ultima INR). Material y metodo Estudio observacional retrospectivo con datos de la historia clinica electronica de todos los centros de AP (n = 262) de la Comunidad de Madrid. Se incluyeron todos los pacientes en tratamiento con acenocumarol con rango terapeutico de INR entre 2 y 3. Se excluyeron los pacientes con valvulopatias y aquellos con seguimiento discontinuo ( 90 dias o ≥ 3 periodos de > 60 dias entre 2 determinaciones). La poblacion final fue de 49.312. Las variables consideradas fueron todos los valores de INR y sus fechas respectivas. Se calculo el TRT por los 3 metodos referidos, considerando «rango terapeutico» valores de INR entre 2-3, y rango «ajustado» valores de INR entre 1,8-3,2. Consideramos «control optimo» en cada paciente si el TRT > 60%. Resultados El TRT por el metodo de Rosendaal fue del 66,8% (81,7% ajustado), el porcentaje de INR en rango, del 58,8% (66,5% ajustado), y el analisis transversal, del 70,5% (76,8% ajustado). La media (desviacion estandar) de los TRT por paciente fue del 65% (20,3), y el porcentaje de pacientes con un TRT > 60% fue del 63,3% (88,1% ajustado). Conclusion El grado de control de los pacientes anticoagulados en AP es aceptable, similar o superior respecto a otros estudios y a los ensayos pivotales de nuevos anticoagulantes. Comparados con el metodo de Rosendaal, el porcentaje total de INR infraestima el grado de control, y el analisis transversal lo sobrestima ligeramente.

Objectives To determine quality control of patients with oral anticoagulant treatment recruited in Primary Care (PC) using the Rosendaal method to estimate time in therapeutic range (TTR) and comparing it with fraction of international normalized ratio (INR) in range and cross-sectional analysis (last INR registred). Material and method A retrospective observational study based on electronic medical record in routine clinical practice. Setting: PC centers (262) in Madrid. We included all patients with acenocumarol treatment, with an INR therapeutic range established between 2 and 3. We excluded patients with valvular pathology and disrupted clinical follow up in PC ( 90 days or ≥3 periods of >60 days between 2 determinations). The final population was 49,312 patients. The variables considered were all INR values and their respective dates. TTR was calculated by the 3 methods above mentioned. We considered “therapeutic range” INR between 2 and 3 and “adjusted range” INR between 1.8 and 3.2. Optimal control for each patient was considered TTR > 60%. Results By using Rosendaal method, TTR was 66.8% (81.7% adjusted), with a percentage of total INR in range was 58.8% (66.5% adjusted), and, with the cross-sectional analysis, it was 70.5% (76.8% adjusted). Mean TTR was 65% (standard deviation 20.3), and the percentage of patients with TTR > 60% was 63.3% (88.1% adjusted). Conclusion The quality control of patients with oral anticoagulants in PC in Madrid is acceptable, similar or higher to other studies and pivotal trials of new anticoagulants. Compared to the Rosendaal method, total fraction of INR underestimates quality control, and cross-sectional analysis slightly overestimates it.