La primera causa de muerte en nuestro país está constituida por las denominadas enfermedades cardiovasculares. Se estima que en 2030 morirán cerca de 23,3 millones de personas por enfermedades cardiovasculares y se prevé que siga siendo la principal causa de muerte en todo el mundo. Se determinaron las distintas subfracciones de lipoproteínas mediante el sistema Lipoprint (Quantimetrix Corporation) en una población constituida por 166 pacientes pertenecientes a un centro de salud de la Región de Murcia. Nos planteamos los objetivos enunciados a continuación: Objetivo 1: Evaluar el método Lipoprint (Quantimetrix Corporation) para la cuantificación y separación por tamaño de las principales fracciones y subfracciones de lipoproteínas. Objetivo 2: Comparar las concentraciones y tamaños de las fracciones lipoproteícas en distintos grupos de estudio con riesgo cardiovascular (RCV) y correlacionarlos con marcadores de RCV clásicos. Objetivo 3: Valorar la utilidad de la concentración y el tamaño de las lipoproteínas VLDL e IDL para clasificar pacientes con distinto RCV. Se obtienen las siguientes conclusiones: Conclusión 1: Los valores del diámetro medio de partícula LDL son inferiores en hombres frente a mujeres sugiriendo un predominio de partículas LDL pequeñas y densas en éstos, con un mayor RCV asociado. El diámetro medio de partícula LDL se correlacionan con los niveles de triglicéridos y Apo B positivamente y de forma negativa con los niveles del colesterol HDL. El sistema de determinación de subfracciones de lipoproteínas Lipoprint es un método adecuado para su utilización en la práctica clínica habitual. Conclusión 2: La presencia de obesidad, diabetes tipo 1 e hipertensión arterial no se asocian con ningún perfil lipídico concreto. La diabetes tipo 2 presenta una asociación positiva e independiente de la presencia de otras situaciones clínicas con los niveles del colesterol VLDL, el diámetro medio de partícula IDL y el RCV. La presencia de síndrome metabólico en la población se encuentra asociado a unos mayores niveles de colesterol VLDL. Conclusión 3: El diámetro medio de partícula IDL ha demostrado ser útil en el despistaje de RCV, según tablas de riesgo SCORE, empleando el punto de corte de 309 Å con un VPN de 78,8%. Además este VPN aumenta hasta el 84,6% cuando la población que se evalúa no presenta síndrome metabólico. El diámetro medio de partícula IDL ha demostrado ser útil en el despistaje de RCV, según tablas de riesgo Framingham, empleando el punto de corte de 310 Å con un VPN de 87,7%. Además este VPN aumenta hasta el 89,6% cuando la población que se evalúa no presenta síndrome metabólico. / The first cause of death in our country is due to the so-called cardiovascular diseases. It is estimated that in 2030 will die about 23.3 million people due to cardiovascular diseases and is expected to remain the leading cause of death worldwide. The different lipoproteins subfractions were determined with Lipoprint system (Quantimetrix Corporation) in a population of 166 patients of a health centre in the Region of Murcia. We consider the objectives sketch out below: Objective 1: To assess Lipoprint method (Quantimetrix Corporation) for quantifying and separation by size of lipoprotein subfractions. Objective 2: Compare the concentrations and sizes of fractions lipoprotein in different groups of study with cardiovascular risk (CVR) and correlate them with classic markers of CVR. Objective 3: Rating the usefulness of the IDL and VLDL lipoproteins concentration and size to classify patients with different CVR. The following conclusions were obtained: Conclusion 1: The average LDL particle diameter values are lower in men front women suggesting a small and dense LDL particles prevalence and a greater CVR associated. The average LDL particle diameter is positively correlated with triglycerides and Apo B levels and negatively with HDL cholesterol levels. Determination of lipoproteins subfractions with Lipoprint system is suitable for use in routine clinical practice. Conclusion 2: Obesity, type 1 diabetes and arterial hypertension presence are not associated with any particular lipid profile. Type 2 diabetes presents a positive and independent of the presence of other clinical situations association with VLDL cholesterol levels, the average IDL particle diameter and CVR. The metabolic syndrome presence in the population is associated with increased VLDL cholesterol levels. Conclusion 3: The average IDL particle diameter has proved useful in screening CVR, according to SCORE risk tables, using the cut-off point of 309 Å with a NPV from 78.8%. In addition this NPV increases up to 84.6% in metabolic syndrome absent people. The average IDL particle diameter has proved useful in screening CVR, according to Framingham risk tables, using the cut-off point of 310 Å with a NPV of 87.7%. In addition, this NPV increases to 89.6% in metabolic syndrome absent people.

Los objetivos generales del presente estudio son los siguientes: a) Valorar el estado de salud a través de medidas antropométricas, clínicas y de competencia motriz de una muestra de adolescentes del término municipal de Moratalla (Murcia). b) Valorar su estado nutricional. c) Y los objetivos específicos: 1. Conocer los hábitos alimentarios del colectivo, detección de posibles hábitos inadecuados e intentar mejorarlos. 2. Detectar las carencias nutricionales, tanto de macro como de micronutrientes. 3. Determinar la incidencia de obesidad aplicando diferentes criterios antropométricos. 4. Mejorar la competencia motriz en forma de aptitud física 5. Mejorar los conocimientos cardiovasculares y de salud. 6. Promover hábitos de vida más saludables con el fin de controlar el estrés y abandonar hábitos de tabaco y alcohol. 7. Detectar en la muestra poblacional los diferentes factores de riesgo cardiovascular en relación con la edad. 8. Valorar la posible influencia que la aplicación del programa Physical Activity and Teenage Health (PATH) tiene sobre el estado de salud. 9. Confeccionar un informe antropométrico, clínico, de conocimientos y de condición física individualizado para cada adolescente del estudio. 10. Difundir la información. METODOLOGÍA Basado en un programa titulado “Physical Activity and Teenage Health” (PATH). Se han evaluado la ingesta dietética, hábitos alimentarios, hábitos de vida, conocimientos cardiovasculares y de salud, parámetros antropométricos, marcadores bioquímicos, actividad física, nivel de rendimiento físico, estrés y valoración del riesgo cardiovascular global en una etapa inicial y otra final. Los cinco temas teórico-prácticos que integran el Programa PATH se incluyeron a modo de introducción de las sesiones de Educación Física donde se ha desarrollado el estudio, y son: Un corazón sano; Actividad física y el corazón; Nutrición; Estrés y Fumar y el corazón. CONCLUSIONES. 1. Los hábitos alimentarios se alejan de la dieta mediterránea. 2. Los adolescentes del colectivo estudiado muestran una ingesta de energía, hidratos de carbono, fibra y ácidos grasos ω-3 inferior a las recomendaciones, y superior en proteínas y lípidos. Por todo esto, tras el estudio nutricional se debería recomendar a dicha población una disminución de ingesta proteica y lipídica y un aumento de fibra, ácidos grasos ω-3 y micronutrientes, sobre todo en mujeres. 3. La impedancia bioeléctrica parece mejor instrumento para valorar el sobrepeso y obesidad adolescente. La valoración del porcentaje de grasa corporal es alto en mujeres y óptimo en varones, y los valores de referencia de McCarthy et al. (2006) parece el mejor criterio para evaluar obesidad en según porcentaje de grasa, que presentan el 22,6% de los adolescentes, mucho más acentuado en mujeres. 4. El programa ha mejorado la condición física del colectivo adolescente y los conocimientos cardiovasculares y de salud. 5. El 25% de los adolescentes consume alcohol por lo menos 1 vez a la semana, preferentemente en fin de semana. El tabaco es el segundo FRCV hallado en el presente estudio, a favor de las mujeres. 6. E 33% de los adolescentes de la población presenta más de 1 FRCV. El sedentarismo es el FRCV más prevalente, con mucha mayor incidencia en mujeres, y mientras en ellas los FRCV más importantes son sedentarismo, tabaquismo y estrés, en los varones es tabaquismo, sedentarismo e HTA. 7. La prevalencia de síndrome metabólico es muy inferior a los estudios de adolescentes consultados. 8. Este programa ha generado una gran participación e implicación de toda la Comunidad Educativa, sobre todo de los padres y madres. CONCLUSIÓN FINAL: en base a todo lo anterior, se pone de manifiesto el interés de incorporar a la educación secundaria, si no antes, un programa como el considerado en el presente estudio para evitar la incidencia de los factores de riesgo cardiovascular desde la adolescencia. / The general objectives of this study are the following: a) To assess the health status through anthropometric, clinical and motor competence of a sample of adolescents in the municipality of Moratalla (Murcia). b) To assess their nutritional. And the specific objectives: 1. Know the eating habits of the group, detection of possible inadequate habits and try to improve. 2. Detect nutritional deficiencies, both macro and micronutrients. 3. To determine the incidence of obesity using different anthropometric criteria. 4. Improve the driving competition in the form of physical fitness 5. Improve cardiovascular and health knowledge. 6. To promote healthier living habits in order to manage stress and give up tobacco and alcohol habits. 7. Identify the sample population in different cardiovascular risk factors in relation to age. 8. To assess the possible impact that application of the Physical Activity and Teenage Health (PATH) program has on health. 9. To develop a report anthropometric, clinical, knowledge and individualized for each adolescent fitness studio. 10. Disseminate information. METHODOLOGY Based on a program entitled "Physical Activity and Teenage Health" (PATH). We have evaluated the dietary intake, eating habits, lifestyle, knowledge and cardiovascular health, anthropometric, biochemical, physical activity, level of physical performance, stress and assessment of global cardiovascular risk at an early and final stage. The five theoretic and practical themes that compose the PATH program included by way of introduction of physical education sessions that have developed the study are: A healthy heart; Physical activity and heart; Nutrition; Stress and smoking and heart. CONCLUSIONS. 1. Dietary habits go away from the Mediterranean diet. 2. Adolescents studied show a collective intake of energy, carbohydrates, fiber and ω-3 fatty acids lower than the recommendations, and higher in proteins and lipids. For all this, after the nutritional study it should recommend that population decreased protein and fat intake and increase fiber, ω-3 fatty acids and micronutrients, especially in women. 3. The bioelectrical impedance seems best instrument to assess adolescent overweight and obesity. The assessment of body fat percentage is higher in women and optimal in men and the reference valuesof McCarthy et al. (2006) seems the best approach to evaluate obesity as body fat percentage, which have 22.6% of adolescents, more prominent in women. 4. The program has improved the physical condition of the teenage group and cardiovascular health and knowledge. 5. 25% of adolescents consume alcohol at least 1 time a week, preferably on weekends. The snuff is the second CVRF found in this study, for women. 6. 33% of adolescents in the population has more than one cardiovascular risk factors. Physical inactivity is the most prevalent cardiovascular risk factors, with much higher incidence in women, while in them the most important cardiovascular risk factors are physical inactivity, smoking and stress, in men is smoking, physical inactivity and hypertension. 7. The prevalence of metabolic syndrome is much lower than studies of adolescents surveyed. 8. This program has generated a great participation and involvement of the entire education community, especially parents. FINAL CONCLUSION: Based on the above, it shows the interest of including secondary education, if not before, a program like the one considered in the present study to avoid the incidence of cardiovascular risk factors since adolescence.

Las anemias hemolíticas hereditarias se producen por defectos en los genes que codifican la síntesis de las proteínas imprescindibles para la vida del hematíe: hemoglobina (hemoglobinopatías), proteínas de la membrana (membranopatías), enzimas del metabolismo eritrocitario (eritroenzimopatías). Nuestra hipótesis de trabajo se basa en que no existen estudios epidemiológicos ni registros oficiales de estas enfermedades en la región de Murcia y en que es un grupo de patologías cuya importancia está infraestimada desde el punto de vista de Salud Pública. Objetivos: - Analizar el perfil epidemiológico y biológico de los pacientes diagnosticados de anemia hemolítica hereditaria en el área de influencia sanitaria del Hospital Clínico Universitario Virgen de la Arrixaca en un periodo de 19 años. - Descripción de las principales alteraciones moleculares de las talasemias en la Región de Murcia. - Proporcionar datos clínicos y epidemiológicos que permitan establecer la necesidad de un programa de cribado de anemias hemolíticas hereditarias en nuestra Región. Métodos: Se ha realizado un análisis descriptivo sobre un total de 2044 pacientes diagnosticados de anemia hemolítica hereditaria en nuestro centro en un periodo de 19 años (desde enero de 2002 hasta diciembre de 2013) y se ha comparado con los datos existentes en otras regiones y comunidades de España. Conclusiones: - El perfil epidemiológico y biológico de las anemias hemolíticas hereditarias en nuestra Área es similar al descrito en otras regiones de España, en especial de las áreas del litoral mediterráneo. Las talasemias representan las anemias hemolíticas hereditarias más prevalentes en el Área I. Sin embargo, en la población inmigrante la hemoglobinopatía S es la más frecuente. - La alteración más frecuente en los pacientes con -talasemia es la mutación [C>T] que afecta al codon CD39; estos datos son similares a los descritos en otras regiones de España. - El perfil molecular de la α-talasemia en nuestra Región es similar al descrito en otras regiones de España con un 85% de frecuencia de la deleción α-3,7 y un 4% de α-talasemias no deleción. - Nuestros datos justifican la implantación de un programa de cribado neonatal de hemoglobinopatías y déficit de G6PDH, al menos en la población de riesgo, para poder establecer acciones preventivas eficaces para la salud de estos pacientes. - Actualmente nuestros datos constituyen los únicos registros epidemiológicos de anemias hemolíticas hereditarias existentes en la Región de Murcia. Esto puede ayudar a establecer estudios epidemiológicos prospectivos adicionales para definir la frecuencia real de estas patologías y su impacto en la atención sociosanitaria, tanto en la población general como en la población de riesgo. Hereditary hemolytic anemias are caused by defects in genes encoding the synthesis of essential proteins for the life of erythrocyte: hemoglobin (hemoglobinopathies), membrane proteins (membrane erythrocyte disorders ), erythrocyte metabolism enzymes (erythroenzimopaties). / Our working hypothesis is based on the the fact that there are no epidemiological studies and no official records of these diseases in the region of Murcia and that it is a group of diseases whose importance is underestimated from the point of view of Public Health. Goals: - Analyze the epidemiological and biological profile of patients diagnosed with hereditary hemolytic anemia in the area of health influence the University Hospital Virgen de la Arrixaca in a period of 19 years. - Description of the main molecular alterations of thalassemia in the region of Murcia. - Provide clinical and epidemiological data to establish the need for a screening program of hereditary hemolytic anemias in our region. Methods: We performed a descriptive analysis of a total of 2044 patients diagnosed with hereditary hemolytic anemia in our center over a period of 19 years (from January 2002 to December 2013) and compared with existing data in other regions and communities Spain. Conclusions: - The epidemiological and biological profile of hereditary hemolytic anemias in our area is similar to that described in other regions of Spain, especially the areas of the Mediterranean coast. Thalassemias represent the most prevalent hereditary hemolytic anemias in Area I. However, in the immigrant population hemoglobinopathy S is the most common. - The most frequent alteration in patients with β-thalassemia is the mutation [C> T] CD39 affecting codon 39; These data are similar to those described in other regions of Spain. - The molecular profile of α-thalassemia in our region is similar to that described in other regions of Spain with 85% frequency of the deletion α-3,7 and 4% of non-deletion α-thalassemia. - Our data justify the implementation of a program of neonatal screening of hemoglobinopathies and G6PD deficiency, at least in the population at risk in order to establish effective preventive measures for the health of these patients. - Currently our epidemiological data records are the only existing hereditary hemolytic anemias in the Region of Murcia. This can help establish additional prospective epidemiological studies to determine the actual frequency of these diseases and their impact on health and social care, in both the general population and in the population at risk.

Neste estudo avaliou-se a ação da Angiotensina II (Ang II) e do bloqueio dos seus receptores AT1 e AT2 no remodelamento da matriz extracelular (MEC) e traçamos o perfil da sinalização intracelular envolvida no processo. O estudo foi feito in vivo em camundongos isogênicos C57Bl/6J submetidos a tratamento durante 7 e 14 dias com doses subpressoras de Ang II, bloqueador do receptor AT1 (Losartan) e uma combinação destes. Os animais foram sacrificados e procedeu-se a coleta de tecidos de artérias (aorta, carótida e femoral), coração, rins e pulmão para análise da síntese e degradação de componentes da MEC. Foram feitas avaliações hemodinâmicas, morfológicas em microscopia de luz, morfométricas, imunohistoquímicas para os componentes da matriz extracelular: colágeno (tipos I, III, IV e VI), fibronectina, tenascina-C, elastina, metaloproteinases (tipos 2 e 9), e quantificação de algumas proteínas ligadas à sinalização intracelular da via das Proteínas quinases ativadas por mitógenos (MAPK - Mitogen-activated protein kinases) usando-se Western Blotting. / In this study we evaluated the action of Angiotensin II (Ang II) and the blockade of AT1 and AT2 receptors in the remodeling of extracellular matrix (ECM) and outlines the process involved in intracellular signaling. The study was done in vivo in C57Bl/6J inbred mice undergoing treatment for 7 and 14 days subpressor doses of Ang II, AT1 receptor blocker (Losartan) and a combination thereof. The animals were sacrificed and proceeded to collect tissues of arteries (aorta, carotid and femoral arteries), heart, kidneys and lungs for analysis of the synthesis and degradation of ECM components. We assessed hemodynamic, morphological light microscopy, morphometry, immunohistochemistry for extracellular matrix components: collagen (types I, III, IV and VI), fibronectin, tenascin-C, elastin, metalloproteinases (types 2 and 9) and quantification of some proteins related to intracellular signaling pathways of the mitogen-activated protein kinase (MAPK) using Western Blotting.

Receptores ativados por protease (PARs) pertencem à família de GPCRs. Desses, PAR-1, PAR-3 e PAR-4 são ativados por trombina, e PAR-2 por tripsina. Como as proteases, peptídeos sintéticos (PARs-AP) também ativam esses receptores. Estudamos o papel dos PARs na reatividade vascular de Wistar e SHR. In vitro, PAR-1 AP, promoveu maior vasoconstrição em aorta com endotélio (E+) de SHR vs Wistar. PAR-2 AP promoveu vasodilatação similar em aorta E+ de SHR e Wistar, enquanto PAR-4 AP e peptídeos reversos não causaram efeito. In vivo/in situ PAR-1 e PAR-2 AP mostraram intensa vasomotilidade em arteríolas mesentéricas. A expressão gênica de PAR-1 está aumentada em aorta e arteríolas de SHR, mas a expressão protéica está aumentada apenas em arteríolas. Demonstramos ainda que a vasoconstrição induzida por PAR-1 AP, é dependente de Ca++ e da liberação de Ang II, ET-1 e O2- pelo endotélio. Assim, sugerimos que PAR-1 pode ser um alvo terapêutico para novos antihipertensivos com efeito antitrombótico, já que este receptor também tem sido envolvido em eventos romboembólicos. / Protease activated receptors are a new GPCRs family. The PAR-1, PAR-3 and PAR-4 are activated by thrombin and PAR-2 by tripsin. Like proteases, synthetic peptides (PARs-AP) can also activate those receptors. We studied the role of PARs in vascular reactivity of Wistar and SHR. In vitro, PAR-1 promoted higher vasoconstriction to PAR-1 AP in SHR aorta with endothelium (E+) than the Wistar ones. PAR-2 AP produced similar vasodilation in Wistar and SHR aorta E+, while neither PAR-4 nor reverse peptides presented any effect. In vivo/in situ PAR-1 and PAR-2 showed an intensive vasomotion in mesenteric vessels. PAR-1 gene expression was increased in SHR aorta and arterioles, while the protein expression was increased only in the arterioles. We have also shown that the vasoconstriction induced by PAR-1 AP, is Ca++-dependent and Ang II, ET-1 and O2- release from endothelium. Thus, we suggest that PAR-1 might represent a therapeutic target to new antihypertensive drugs with antithrombotic effect, since this receptor has been involved in thromboembolics events.

Introdução: Até o presente momento, há escassez de estudos que avaliem os níveis séricos de citocinas angiogênicas em pacientes com dermatomiosite (DM), uma miosite autoimune sistêmica que tem como fisiopatogênese a vasculopatia. Portanto, os objetivos do presente estudo foram: (a) analisar sistematica e simultaneamente os níveis séricos de angiogenin (ANG), angiopoietin (ANGPT) -1, vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF) -1 e -2 e platelet derived growth factor (PDGF) -AA e -BB em pacientes com DM; (b) correlacionar o nível sérico destas citocinas com as características clínico-laboratoriais, alterações metabólicas e atividade da DM. Pacientes e métodos: Estudo transversal, único centro, no qual foram incluídos, no período de 2012 a 2014, 48 pacientes consecutivos com DM definida (Bohan e Peter, 1975), entre 18 e 45 anos de idade, e em seguimento regular na nossa Instituição. Foram excluídos pacientes com condições clínicas relacionadas à DM (como sequelas de doença e tratamento prolongado) ou secundárias a outras causas que poderiam influenciar na interpretação dos resultados das citocinas avaliadas, seja por apresentarem variações hormonais ou por estarem relacionados ao mecanismo de inflamação e/ou angiogênese. Os pacientes foram pareados por sexo, idade e etnia com 48 indivíduos saudáveis (grupo controle). A análise das citocinas séricas foi realizada por imunoensaio multiplex. Os parâmetros da atividade da DM foram baseados nos escores estabelecidos por International Myositis Assessment & Clinical Studies Group (IMACS). Resultados: A distribuição de sexo e a etnia foram comparáveis entre os grupos DM e controle assim como a média de idade (33,3±7,6 vs. 35,8±8,2 anos, respectivamente), e a mediana de duração de doença foi de 1 ano. No grupo DM, os níveis séricos de FGF-1 e FGF-2 (P < 0,001, P < 0,001, respectivamente) estavam elevados, enquanto os níveis de VEGF e PDGF-AA (P=0,009 e P=0,022, respectivamente) estavam reduzidos. Os níveis de ANG, ANGPT-1 e PDGFBB foram semelhantes em ambos os grupos. Houve uma tendência para correlação positiva entre as citocinas (com exceção de VEGF e PDGF-BB) e os parâmetros de atividade da DM, enquanto FGF-2 apresentou correlação negativa. Além disso, o FGF-1 correlacionou-se fortemente com manifestações cutâneas da dermatomiosite. Conclusões: Os dados atuais reforçam a importância das citocinas angiogênicas nos mecanismos de vasculopatia da DM, especialmente em condições de atividade cutânea e adequado tratamento medicamentoso. Estudos adicionais serão necessários para validar os dados obtidos no presente trabalho / Introduction: Until now, there are few studies evaluating serum levels of angiogenic cytokines in patients with dermatomyositis (DM), a systemic autoimmune myositis that has vasculopathy as its physiopathogenesis. Therefore, the aims of the present study were: (a) to analyze systematically and simultaneously serum levels of angiogenin (ANG), angiopoietin (ANGPT) -1, vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF) -1 and -2, and platelet derived growth factor (PDGF) -AA and -BB in patients with DM; (b) to correlate the serum level of these cytokines with the clinical and laboratory features, metabolic alterations and DM activity. Patients and methods: This is an one-center cross sectional study, in which 48 consecutive patients with defined DM (Bohan and Peter, 1975) aged 18 to 45 years and regularly followed up at our Institution were included from 2012 to 2014. Patients with clinical conditions related to DM (as sequelae of disease and prolonged treatment) or secondary to other causes that could influence the results interpretation of the evaluated cytokines were excluded, either because of hormonal variations or relationship with inflammation mechanism and/or angiogenesis. Patients were gender-, age- and ethnicity-matched with 48 healthy individuals (control group). The serum levels of cytokines analyses were performed by multiplex immunoassay. The parameters of DM activity were based on the scores established by the International Myositis Assessment & Clinical Studies Group (IMACS). Results: The gender and ethnicity were comparable between DM and control groups as soon as the mean age (33.3±7.6 vs. 35.8±8.2 years, respectively), and the median disease duration was 1 year. The serum levels of FGF-1 and FGF-2 (P < 0.001 and P < 0.001, respectively) were higher in DM group, whereas the levels of VEGF and PDGF-AA (P=0.009 and P=0.022, respectively) were lower in DM group. The levels of ANG, ANGPT-1 and PDGF-BB were similar in both groups. There was a tendency for cytokines (with the exceptions of VEGF and PDGF-BB) to correlate positively with DM activity parameters, whereas FGF-2 correlated inversely. Moreover, FGF-1 strongly correlated with the cutaneous manifestations of DM. Conclusion: The current data reinforce the importance of angiogenic cytokines in DM vasculopathy mechanisms, especially in conditions of cutaneous activity and adequate drug treatment. Additional studies will be needed to validate the data obtained in this work

Introdução: Até o presente momento, há escassez de estudos que avaliem os níveis séricos de citocinas angiogênicas em pacientes com dermatomiosite (DM), uma miosite autoimune sistêmica que tem como fisiopatogênese a vasculopatia. Portanto, os objetivos do presente estudo foram: (a) analisar sistematica e simultaneamente os níveis séricos de angiogenin (ANG), angiopoietin (ANGPT) -1, vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF) -1 e -2 e platelet derived growth factor (PDGF) -AA e -BB em pacientes com DM; (b) correlacionar o nível sérico destas citocinas com as características clínico-laboratoriais, alterações metabólicas e atividade da DM. Pacientes e métodos: Estudo transversal, único centro, no qual foram incluídos, no período de 2012 a 2014, 48 pacientes consecutivos com DM definida (Bohan e Peter, 1975), entre 18 e 45 anos de idade, e em seguimento regular na nossa Instituição. Foram excluídos pacientes com condições clínicas relacionadas à DM (como sequelas de doença e tratamento prolongado) ou secundárias a outras causas que poderiam influenciar na interpretação dos resultados das citocinas avaliadas, seja por apresentarem variações hormonais ou por estarem relacionados ao mecanismo de inflamação e/ou angiogênese. Os pacientes foram pareados por sexo, idade e etnia com 48 indivíduos saudáveis (grupo controle). A análise das citocinas séricas foi realizada por imunoensaio multiplex. Os parâmetros da atividade da DM foram baseados nos escores estabelecidos por International Myositis Assessment & Clinical Studies Group (IMACS). Resultados: A distribuição de sexo e a etnia foram comparáveis entre os grupos DM e controle assim como a média de idade (33,3±7,6 vs. 35,8±8,2 anos, respectivamente), e a mediana de duração de doença foi de 1 ano. No grupo DM, os níveis séricos de FGF-1 e FGF-2 (P < 0,001, P < 0,001, respectivamente) estavam elevados, enquanto os níveis de VEGF e PDGF-AA (P=0,009 e P=0,022, respectivamente) estavam reduzidos. Os níveis de ANG, ANGPT-1 e PDGFBB foram semelhantes em ambos os grupos. Houve uma tendência para correlação positiva entre as citocinas (com exceção de VEGF e PDGF-BB) e os parâmetros de atividade da DM, enquanto FGF-2 apresentou correlação negativa. Além disso, o FGF-1 correlacionou-se fortemente com manifestações cutâneas da dermatomiosite. Conclusões: Os dados atuais reforçam a importância das citocinas angiogênicas nos mecanismos de vasculopatia da DM, especialmente em condições de atividade cutânea e adequado tratamento medicamentoso. Estudos adicionais serão necessários para validar os dados obtidos no presente trabalho / Introduction: Until now, there are few studies evaluating serum levels of angiogenic cytokines in patients with dermatomyositis (DM), a systemic autoimmune myositis that has vasculopathy as its physiopathogenesis. Therefore, the aims of the present study were: (a) to analyze systematically and simultaneously serum levels of angiogenin (ANG), angiopoietin (ANGPT) -1, vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF) -1 and -2, and platelet derived growth factor (PDGF) -AA and -BB in patients with DM; (b) to correlate the serum level of these cytokines with the clinical and laboratory features, metabolic alterations and DM activity. Patients and methods: This is an one-center cross sectional study, in which 48 consecutive patients with defined DM (Bohan and Peter, 1975) aged 18 to 45 years and regularly followed up at our Institution were included from 2012 to 2014. Patients with clinical conditions related to DM (as sequelae of disease and prolonged treatment) or secondary to other causes that could influence the results interpretation of the evaluated cytokines were excluded, either because of hormonal variations or relationship with inflammation mechanism and/or angiogenesis. Patients were gender-, age- and ethnicity-matched with 48 healthy individuals (control group). The serum levels of cytokines analyses were performed by multiplex immunoassay. The parameters of DM activity were based on the scores established by the International Myositis Assessment & Clinical Studies Group (IMACS). Results: The gender and ethnicity were comparable between DM and control groups as soon as the mean age (33.3±7.6 vs. 35.8±8.2 years, respectively), and the median disease duration was 1 year. The serum levels of FGF-1 and FGF-2 (P < 0.001 and P < 0.001, respectively) were higher in DM group, whereas the levels of VEGF and PDGF-AA (P=0.009 and P=0.022, respectively) were lower in DM group. The levels of ANG, ANGPT-1 and PDGF-BB were similar in both groups. There was a tendency for cytokines (with the exceptions of VEGF and PDGF-BB) to correlate positively with DM activity parameters, whereas FGF-2 correlated inversely. Moreover, FGF-1 strongly correlated with the cutaneous manifestations of DM. Conclusion: The current data reinforce the importance of angiogenic cytokines in DM vasculopathy mechanisms, especially in conditions of cutaneous activity and adequate drug treatment. Additional studies will be needed to validate the data obtained in this work

Objetivos: Avaliar as características do canal da artéria alveolar superior posterior (AASP) em exames de tomografia de feixe conico (TCFC) em indivíduos com fissura labiopalatina (FI) e comparar com indivíduos não fissurados (NF). Material e Métodos: Foram analisados 150 exames de TCFC de FI e 150 TCFC de NF. Os critérios de exclusão foram: exames de pacientes sindrômicos, presença de lesões intraósseas, desdentados totais, outras alterações que interferem a visivilidade do canal da AASP, presença de artefatos, idade abaixo de 20 anos e exames que não incluíam toda a maxila. As características avaliadas foram à presença/ausência, localização em relação ao seio maxilar, diâmetro, distancia em relação ao rebordo alveolar e assoalho do seio maxilar e término presença/ausência de anastomose com a artéria alveolar superior anterior (AASA).Os testes estatísticos aplicados foram Kappa, Dahlberg Fischers, test t. Resultados: O grupo de FI foi constituído de 75 homens e 75 mulheres, com idade média de 29,8 anos. O grupo de NF foi composto por 75 homens 75 mulheres com idade média de 40,3 anos. O Kappa para a concordância da presença e ausência do canal da AASP foi: intra-avaliador 0,8 substancial e inter-avaliador de 0,7 subtancial. O Dahlberg intra-avaliador foi de 0, 75 excelente e inter-avaliador de 0,7 satisfatório. No ponto de ingresso o canal AASP esteve presente em 100% em FI e em 100% em NF, em todos os casos o canal da AASP era bilateral. Os diâmetros, do canal da AASP, foram significativamente diferentes entre os dois grupos, sendo maior para os FI (Test t P < 0,0001). A localização em relação ao ponto de ingresso no seio maxilar foi estatisticamente significante entre ambos os grupos, nos FI a maior frequência foi no terço médio (Fisher\' s P <0,0001) e superior do seio maxilar (Fisher\' s P < 0,0071 lado esquerdo), e os NF apresentaram maior frequência foi no terço inferior (Fisher\' s P < 0,0001). Em relação à distância da AASP ao rebordo alveolar e ao assoalho do seio maxilar, não houve resultados estatisticamente significantes. Em relação aos tipos de términos não houve diferença estatisticamente significante entre os grupos. Conclusões: De acordo com material e métodos realizados, o canal da AASP apresentou maior diâmetro e localização mais superior no seio maxilar em FI quando comparado com NF. Esses resultados podem indicar um maior risco de sangramento durante cirurgias para os portadores de fissura labiopalatina. / Objectives: This study evaluates the characteristics of the posterior superior alveolar artery canal (AASP) in individuals with cleft lip and palate (FI) and compares with individuals without cleft lip and palate (NF). Material and Methods: 150 Cone-Beam Computed Tomography (TCFC) were evaluated from both FI and NF 150 TCFC according to the criteria outlined above. Exclusion criteria were: Sindromic patients, exams with alteration introsseous, edentulous maxilla, artifacts, people below 20 years of age, exams that did not include all maxilla. The characteristics evaluated include presence/absence, location in to maxillary sinus, diameter, distance in relation to the alveolar crest and maxillary sinus floor and presence/absence of anastomosis with the anterior superior alveolar artery canal (AASA). The statistical tests used were Kappa, Dahlberg, Fisher\'s and test t. Results: The group of FI was composed of 75 men and 75 women, with an average age of 29.8. The NF group was composed of 75 men and 75 women with average of age 40.3. In relation to the presence/absence of the AASP canal, result from an evaluation by the intra-rater was 0,8 substancial and inter-rater showed 0.7substantial. O Dahlberg intra-rater was 0.75 excelent and inter-rater 0.7 satisfactory. The prevalence of the AASP canal was100% in the FI group and NF. Regarding the diameters of the AASP canal there were significant differences between the two groups, and was considerably greater for the FI group (Test t p < 0.0001). With respect to location in relation to the point of entry in the maxillary sinus results showed significant statistical difference between both groups, with the NF group possessing higher frequency in the middle third (Fishers p <0.0001) and upper third of maxillary sinus (Fishers p < 0.0071 left side) and NF had higher frequency was in lower third (Fishers P <0.0001). There was no significant statistical difference in relation to the distance of the AASP to alveolar crest and to the floor maxillary sinus. The same was true in relation to the types of terms. Conclusion: According to the material and methods the AASP canal present larger diameter and more premium location in the maxillary sinus in individuals with FI compared with NF. The results indicate a higher risk of bleeding during surgery for patients with cleft lip and palate.

La reperfusión en caso de oclusión de una arteria coronaria se puede realizar con agentes fibrinolíticos que recanalizan de forma farmacológica la oclusión trombótica asociada a SCACEST o mediante la eliminación de forma mecánica de la obstrucción con una angioplastia primaria (ICPp). La ICP primaria es la estrategia de reperfusión, pero desgraciadamente muchos de los pacientes acuden inicialmente a hospitales sin ICP, siendo su principal limitación la imposibilidad de ofertarla al total de la población por su limitada disponibilidad geográfica y el retraso que supone el traslado desde centros sin disponibilidad de ICPp a centros de referencia. Se han puesto en marcha programas regionales de asistencia al SCACEST en los que se integran ambos tratamientos de reperfusión, en función del tiempo de evolución de los síntomas y la demora a la angioplastia primaria, utilizando en casos indicados la trombolisis para lograr una rápida recanalización de la arteria ocluida, seguido de un estudio angiográfico de forma rutinaria. En la Región de Murcia existe un programa de atención al SCACEST, cuyos resultados no han sido evaluados. Objetivos: Analizar los resultados del tratamiento del SCACEST en la Región de Murcia. Para ello nos planteamos los siguientes objetivos: 1. Analizar las características clínicas y evolución de los pacientes en función del área: a. Áreas dependientes de Hospitales comarcales sin disponibilidad de ICPp. b. Área con acceso inmediato a ICPp. 2. Comparar las características y resultados de dos estrategias específicas de reperfusión: pacientes pertenecientes al HUVA tratados con ICPp vs pacientes pertenecientes a hospitales comarcales tratados con trombolisis. 3. Estudiar los pacientes tratados con fibrinolisis, analizando las características clínicas y la evolución de los enfermos con reperfusión exitosa frente a los que precisaron una ICP de rescate. 4. Analizar los predictores de mortalidad a 30 días en pacientes con SCACEST atendidos en nuestro medio. Métodos: Estudio retrospectivo de una cohorte de pacientes, ingresados por SCACEST durante los años 2006 al 2010 en los dos grupos de Hospitales: Grupo 1. Hospital con ICPp: Hospital Universitario Virgen de la Arrixaca (El Palmar, Murcia). Grupo 2. Hospitales comarcales sin ICPp: Hospital Comarcal del Noroeste (Caravaca de la Cruz) y Hospital Virgen del Castillo (Yecla). Criterios de inclusión: Pacientes con diagnóstico de SCACEST. Pacientes remitidos para realización de ICPp a H.C.U.V.Arrixaca, o trombolisados. Duración de los síntomas menor de 24 horas. Se analizaron las siguientes Variables: • Fase Hospitalaria: Variables demográficas; antecedentes cardiovasculares y otras comorbilidades; presentación IAM (tiempos evolución y variables ECG), características ecocardiográficas y angiográficas; empleo de técnicas invasivas; evolución hospitalaria. • Seguimiento: Eventos cardiovasculares a corto (30 días) y largo plazo (1 año): mortalidad total y cardiaca, reIAM, ACV, necesidad de nueva revascularización. Conclusiones: 1. Los pacientes diagnosticados de SCACEST en las áreas sanitarias de la Región de Murcia más alejadas (IV y V) presentan unas características clínicas similares a los del área I. 2. A pesar de una menor accesibilidad a la ICPp inmediata en las poblaciones pertenecientes a estas áreas sanitarias, la red asistencial regional al SCACEST permite lograr unos resultados comparables a los de las poblaciones pertenecientes a áreas sanitarias con disponibilidad de ICPp. 3. La estrategia fármacoinvasiva permite aplicar un tratamiento de reperfusión a las poblaciones pertenecientes a esas áreas sanitarias, sin disponibilidad de ICPp, dentro de los tiempos recomendados por las sociedades científicas, con tasas de supervivencia similares a las de la ICPp, sin un aumento de las complicaciones, y con unos resultados a corto y largo plazo similares. 4. Los pacientes en los que la trombolisis no ha sido efectiva, la ICP de rescate presenta unos resultados similares a corto y largo plazo, sin un aumento significativo de las complicaciones. 5. Los predictores de mortalidad a 30 días fueron una fracción de eyección del ventrículo izquierdo (FEVI) deprimida, la ausencia de flujo coronario TIMI III al final del procedimiento intervencionista y la clase funcional Killip durante el ingreso. / Rapid diagnosis of ST elevation myocardial infarction (STEMI) followed by a quick restoration of a TIMI 3 coronary flow in the occluded artery is associated with a short and long term improvement in survival. Restoration of myocardial perfusion can be done pharmacologically with thrombolitics agents or by a mechanical elimination of a thrombus with a primary angioplasty (pPCI). Several clinical trials have shown that primary angioplasty is the preferred reperfusion strategy in patients with STEMI. However, many patients with STEMI arrive to hospitals without pPCI or it cannot be performed in a timely manner according to clinical guidelines. Regional systems of STEMI care have been developed using both methods of reperfusion depending on the time of symptoms onset and the delays to a pPCI. When thrombolysis is indicated to open the occluded artery routine angiography should be done in the first 24-48 hours (pharmacoinvasive strategy). In Region de Murcia we have had for several years a STEMI attention program with different methods of reperfusion depending on the place where the diagnosis is made. The results of this program have not been evaluated. Objectives: The main aim of the study is to analyze the results of STEMI treatment in Región de Murcia. We propose the following more specific objectives: 1. Analyze clinical characteristics and outcomes of the patients depending on the sanitary area where they were first attended: a. Hospitals without pPCI. b. Hospital with pPCI. 2. Compare clinical characteristics and outcomes of the two different reperfusion strategies: a. Patients treated with primary PCI from sanitary area I (HUVA) b. Patients treated with fibrinolysis from regional hospitals (areas IV and V). 3. Analyze clinical characteristics and outcomes of patients with successful fibrinolysis vs rescue PCI after failed fibrinolysis 4. Analyze Mortality predictors in patients with STEMI treated in our regional network Methods Restrospective cohort study of patients with STEMI from 2006-2010 in two different groups of hospitals. Group 1: Hospital with pPCI (Hospital Universitario Virgen de la Arrixaca). Group 2: regional hospitals without pPCI (Hospital Virgen del Castillo and Comarcal del Noroeste). All of them have the same reference ICU in Hospital Virgen de la Arrixaca. Inclusion criteria: patients with the diagnosis of STEMI based in classical criteria and duration of symptoms less than 24 hours. We analyze the following variables: Hospitalization: Demographic variables, previous cardiac disease and cardiovascular risks factors, other comorbidities; STEMI presentation (time from symptoms onset to reperfusion and EKG), angiographic and echocardiographic features, invasive technics, in-hospital outcomes. Conclusions: 1. STEMI patients in populations further away from hospital with pPCI (areas IV and V) present clinical features similar than area I patients. 2. Despite of less availability of pPCI in regional hospitals, after the organization of a regional network for the treatment of STEMI the results obtained were similar to the patients from a hospital with pPCI. 3. Pharmacoinvasive strategy allows to apply a reperfusion treatment in populations further away from a hospital with pPCI within the time limits recommended by scientific societies. The reperfusion rate and short and long term results were similar to pPCI without an increase in complications. 4. In patients in which thrombolysis has not been effective, rescue PCI, has similar short and long term results than pharmacoinvasive strategy, without a significant increase in complications. 5. Mortality predictors at 30 days were low left ventricle ejection fraction, lack of TIMI III flow at the end of the interventional procedure and killip class during hospitalization.

Actualmente, las enfermedades cardiovasculares, dentro de las que incluimos el Síndrome Coronario Agudo (SCA), se encuentran entre las primeras causas de Incapacidad Temporal (IT). En España se registran cada año 23.000 bajas laborales por enfermedad cardiovascular, siendo la causa más frecuente de IT tras la lumbalgia y la depresión. El objetivo de este estudio es conocer si existen diferencias en la evolución de los pacientes que sufren SCA, dependiendo de si los procesos de IT son considerados accidente laboral o enfermedad común, tanto a nivel de la asistencia sanitaria que reciben los pacientes tratados por el Sistema Público de Salud o por una Mutua, el gasto por prestaciones económicas que generan los procesos de IT en ambas contingencias, la situación funcional final de los pacientes, y su reincorporación al mundo laboral. También analizamos el papel desempeñado por la Rehabilitación Cardíaca en este tipo de procesos. Para ello, hemos estudiado un total de 600 pacientes que iniciaron un proceso de IT tras sufrir SCA, 301 por contingencia común (CC) y 299 por contingencia profesional (CP), y hemos comparado variables demográficas (edad, sexo y Comunidad Autónoma), clínicas (hipertensión arterial, diabetes mellitus, dislipemia y hábito tabáquico), laborales (tipo de trabajo, situación de Pago Directo y secuelas) y funcionales (METS alcanzados en la ergometría y Fracción de eyección medida mediante ecocardiografía) de ambos grupos. Nuestros resultados muestran que el perfil demográfico es similar en ambos grupos, existiendo mayor número de pacientes hipertensos, diabéticos y en situación de Pago Directo en el grupo de CC. El sector ocupacional más frecuente en ambos grupos es el formado por trabajadores de “cuello azul”, existiendo una asociación entre los trabajos calificados como moderados en cuanto al esfuerzo físico que requieren y el grupo de CP, y los calificados como pesados y el grupo de CC. No hemos encontrado diferencias en cuanto a los resultados finales a nivel de secuelas concedidas y valores funcionales obtenidos, pero si en los días de duración; los procesos de CP tienen una duración de 26,1 días menos que los de CC. No hemos encontrado estudios publicados que comparen la duración en días de IT y las secuelas en procesos de contingencia profesional y contingencia común. Más del 80% de los pacientes de ambos grupos, se reincorpora al trabajo que desempeñaba previamente a sufrir en evento cardíaco sin secuelas, y sólo a menos del 20% se les concede una Incapacidad Permanente, siendo la Incapacidad Permanente Total la más frecuente, sin que existan casos de Incapacidad Permanente Parcial ni Gran Invalidez en ninguno de los dos grupos. Estos datos están en consonancia con los estudios sobre Incapacidad Permanente de Valero y col. y Piné y col. (Valero y col., 2004; Piné y col., 2008). En cuanto a la Rehabilitación Cardíaca, los pacientes que la realizan, tanto en contingencia profesional como en contingencia común, mejoran los valores funcionales y tienen menos secuelas al término de la misma, pudiendo incorporase al trabajo que desempeñaban antes de sufrir el evento cardíaco. En conclusión observamos que los procesos de IT por SCA considerados Accidente de Trabajo, tienen una duración en días inferior a aquellos considerados contingencia común. Los pacientes que realizan Rehabilitación Cardíaca, tanto en contingencia profesional como en contingencia común, desarrollan mayor capacidad funcional y tienen menos secuelas que aquellos que no la realizan, de ahí el interés práctico de la realización de este tratamiento en este tipo de pacientes. / Nowadays, cardiovascular diseases, along which we include the Acute Coronary Syndrome (ACS), are among the main causes of Temporary Disability (TD). Every year in Spain there are 23.000 sick leaves registered due to cardiovascular disease, being the most frequent cause of TD after lumbalgia and depression. The main objective this study seeks is to find out if there are differences in the evolution of patients with ACS taking into account both TD processes: occupational accident or common disease To be able to offer a more accurate result, this study also considers the healthcare received by patients in the Public Health System or in Mutual Insurance Companies, the expenditures for economic benefits derived from TD processes in both contingencies and the final functional situation of the patients and their reincorporation to the work market. The role played by heart rehabilitation in this type of processes is also analyzed. To do so, we have studied a total of 600 patients that started a TD process after suffering an ACS, 301 caused by common disease and 299 caused by occupational accident. We have compared different variables like demographics (age, gender and Autonomous Community), clinics (high blood pressure, diabetes mellitus, dyslipidemia and smoke habit), labor (type of work, Direct Payment situation and sequels) and functional (METS achieved in ergometry and Ejection Fraction measured by echocardiography) in both groups. Our results show that the demographic profile is similar in both groups, existing a higher number of high blood pressure, diabetic and in Direct Payment situation patients in the common disease group. The most frequent occupational field involved in both groups is the one formed by “blue neck” workers (operators, officials, mechanics…), existing a link between the jobs qualified as moderate in terms of required physical effort and the occupational accident group and those qualified as heavy and the common disease group. We have not observed differences as far as final results are concerned in terms of sequels granted and functional values obtained. And although we have not found published research on this data, differences exist in terms of days of duration: occupational accidents processes last 26.1 days less than common disease processes. More than 80% of patients in both groups undergo a non-sequel cardiac event and go back to their previously performed job, and only less than 20% are granted a Permanent Disability. This data is similar to the Jiménez et al. research (Jiménez et al., 2008), being the Total Permanent Disability the most frequent, and not existing any Partial Permanent Disability or Severe Disability in neither group. This data is consistent with the researches on Permanent Disability of Valero et al. and Piné et al. (Valero et al., 2004; Piné et al., 2008). When it comes to heart rehabilitation, all patients that conduct it in both groups, occupational accident and common disease, improve their functional values and have less sequels when finishing it, being able to go back to their previously performed job before suffering the cardiac event. In conclusion we have observed that TD processes caused by ACS considered Occupational Accidents have a lesser duration in days than those considered Common Disease. Patients conducting Heart Rehabilitation, both in the occupational accident group and the common disease group, develop a higher functional ability and have less sequels than those not conducting it, hence the practical interest in the performance of this treatment in this kind of patients.