Optimización del control telemático de la presión arterial en atención primaria en España (Iniciativa Óptima): resultados de un estudio Delphi

ObjetivoRepresentantes de los grupos de trabajo de hipertensión o enfermedad cardiovascular de las Sociedades Españolas de Médicos de Atención Primaria (MAP) [SEMERGEN], de Medicina Familiar y Comunitaria [semFYC] y de Médicos Generales y de Familia [SEMG] realizaron un estudio Delphi para validar con un panel de MAP expertos en hipertensión una propuesta de recomendaciones para optimizar la teleconsulta en pacientes hipertensos.Materiales y métodosEstudio Delphi basado en un cuestionario online con 59 recomendaciones, elaborado en base a la bibliografía relacionada disponible y a la experiencia clínica aportada por los autores.ResultadosUn total de 118 MAP participaron en dos rondas del cuestionario (98,3% de los invitados), alcanzándose el consenso en 53/62 sentencias (85%). El equipo de Atención Primaria debe seleccionar a los pacientes hipertensos candidatos a realizar la consulta telemática proactivamente, informando de la cita con antelación. Al iniciar la consulta telemática, se recomienda explicar el motivo y los objetivos de la misma, y realizar la anamnesis preguntando por signos y síntomas de empeoramiento de la enfermedad, tratamientos actuales y adherencia a los mismos. En pacientes con una automedida de la presión arterial (AMPA) ≤ 135/85 mmHg se recomienda pautar una nueva cita telemática en 3-6 meses. Por el contrario, en pacientes asintomáticos que reporten una AMPA ≥ 135/85 mmHg se recomienda la monitorización ambulatoria de la presión arterial, modificar el tratamiento, o derivar al paciente a visita presencial o al hospital en caso de signos o síntomas de alarma.ConclusionesLa teleconsulta puede complementar la consulta presencial, constituyendo un elemento más a tener en cuenta para el adecuado control de los pacientes hipertensos.Palabras clave: Telemedicina, Hipertensión, Atención primaria, Consenso     

Reliability analysis on ductus venosus assessment at 11-14 weeks' gestation in a high-risk population

OBJECTIVE: To assess the intra- and interobserver reliability of the fetal ductus venosus (DV) blood flow measurements at 11-14 weeks' gestation in a high-risk population for chromosomal defects. METHODS: Thirty-five consecutive singleton pregnancies at high risk for chromosomal or genetic anomalies were included. DV end-diastolic velocity (EDV) and the pulsatility index for veins (PIV) were determined by manual tracing in three sets of waveforms by a single sonographist to assess intraobserver reliability using transvaginal ultrasound. Subsequently, the EDV and the PIV were also determined in a further set by a second sonographist to assess interobserver reliability. Reliability was evaluated by means of the Intraclass Correlation Coefficient (ICC). The degree of agreement was also examined using the limits of agreement method. RESULTS: The intraobserver reliability was 0.81 (95% C.I. 0.69-0.89) for EDV and 0.91 (95% C.I. 0.85-0.95) for the PIV, both corresponding to almost perfect reliability. The interobserver reliability was 0.50 (95% C.I. 0.20-0.70) for EDV, and 0.74 (95% C.I. 0.54-0.86) for PIV, corresponding respectively to moderate and substantial reliabilities. The 95% interval of the EDV differences (cm/s) within and between observers were (+6.1, - 4.6) and (+13.6, - 9.7), respectively. The 95% interval of the PIV differences within and between observers were (+0.32, - 0.36) and (+0.7, - 0.67), respectively. CONCLUSIONS: Interobserver reliability for EDV is only moderate, whereas for the PIV is substantial, allowing its use for clinical purposes in a high-risk population.     

The ductus venosus in early pregnancy and congenital anomalies

The ductus venosus (DV) is a tiny vessel leading oxygenated blood from the placenta to the fetal heart and its flow assessment has been used as an indicator of fetal acidemia. At 11 to 14 weeks, the fetuses with increased nuchal translucency also showing an abnormal DV blood flow were consistently found to be aneuploid. Early cardiac dysfunction, signaled by abnormal DV blood flow, was suggested as the underlying cause of increased nuchal translucency. Detection rates for aneuploidy with the use of DV blood flow studies range from 59 to 93% with 2 to 21% false-positive rates. In fetuses with normal karyotype, an abnormal DV flow pattern signals cardiac defects or adverse perinatal outcome.     

Effects of major ozonated autohemotherapy in the treatment of dry age related macular degeneration: a randomized controlled clinical study

AIM: To evaluate the effect of systemic ozonated major autohaemotherapy (O₃-AHT) in patients affected by dry age related macular degeneration (AMD). METHODS: This study was a randomized, controlled clinical study. One hundred and forty patients with the diagnosis of AMD in both eyes, with the study eye presenting dry AMD and soft drusen, were randomly assigned in a 1:1 ratio to either receive 27 major ozonated autohemotherapy treatments during 12-month period, or a standardized multi-vitamin therapy. Primary outcome was the change in best corrected visual acuity (mean logMar change) between the baseline and 6 and 12 months, end point of the study. In addition, to investigate the safety of prolonged ozonated autohaemotherapy, we measured the routine haematochemical parameters and biochemical oxidative stress values at baseline and after 12 months treatment time. RESULTS: The mean baseline best corrected visual acuity in study eyes was 0.36 in the treatment group and 0.38 in the control group (difference not statistically significant). At the primary endpoint, 6 months post-baseline, the mean logMAR change in the treated group improved by 0.1 and the values of the control group at the same time impaired by 0.2 respect to the baseline. Four percent and twenty-five percent of eyes in the group treated with O3-AHT gained 1 or more lines after 6 and 12 months respectively compared to 0% in the eyes which received no treatment (P<0.05 at 12 months). None of the treated patients experienced a loss in visual acuity in their study eye at 6 and 12 months, compared to 16% and 40 % of patients in the control group who lost 2 lines or more at 6 months and 12 months respectively (P<0.05 treated vs control group)). Major ozonated autohemotherapy was shown to be safe and well- tolerated by the patients. Moreover, the haematochemical parameters showed a decrease in the Reactive Oxygen Metabolites (300±10.1 UCARR at 12 months compared to a baseline value of 380±10.4 UCARR, P<0.05) and an increase in Biological Antioxidant Potential plasma values (2100±34.8 micromoles/ C vitamin after 12 months compared to the baseline value of 1610±36.2, P<0.05) in the treated patients when compared to the control group. This data suggests that major ozonated autohaemotherapy may exert a role in reducing oxidative stress by endogenously stimulating the production of antioxidant molecules. CONCLUSION: The results of this study suggests that major ozonated autohaemotherapy could be a safe and effective therapeutic option for high-risk patients with dry AMD, and that a series of such treatments could improve the natural course of AMD.