Luis Isidoro Romero García

Importancia del síndrome metabólico en el control de la presión arterial y de la dislipemia

Fundamento y objetivo: Valorar la importancia del sindrome metabolico (SM) en el tratamiento y control de la hipertension y dislipemia. Pacientes y metodo: Estudio transversal de 1.320 pacientes hipertensos no diabeticos (634 mujeres y 686 varones) con una edad media (DE) de 58,1 (13,3) anos y con un indice de masa corporal de 29,8 (4,7) (kg/m2). El diagnostico de SM se establecio segun los criterios del NCEP-ATP III. Se considero con buen control de la presion arterial los que presentaban valores inferiores a 140/90 mmHg. Se calculo el riesgo coronario segun los criterios de Framingham y se clasifico en 3 grupos (bajo: inferior al 10%; intermedio: 10-20%; alto: superior al 20%). Se consideraron objetivos del tratamiento hipolipemiante los del ATP III, segun su grupo de riesgo. Resultados: Tenian SM 461 pacientes (35%), 246 varones (36%) y 215 mujeres (34%). Los pacientes con SM requerian mayor numero de farmacos que los pacientes sin SM para el tratamiento de la presion arterial (2,1 [1,3] frente a 1,7 [1,3]; p < 0,001), pero el grado de control de la hipertension fue similar en ambos grupos (el 53 frente al 52%; p = ns). Los pacientes con SM tenian mayor riesgo coronario global que los pacientes hipertensos sin SM (10,7 [8,3] frente a 7,9 [6,8]; p < 0,001) y cumplian menos los objetivos terapeuticos del colesterol ligado a lipoproteinas de baja densidad (el 57 frente al 74%; p < 0,001). En un analisis de regresion logistica, la presencia de SM se asocio de forma independiente, y controlando por la edad, a un 26% menos probabilidades de cumplir el doble objetivo (p < 0,001). Conclusiones: La existencia de un SM se asocia a mayor riesgo coronario, requerir mas farmacos antihipertensivos para el control de la presion arterial, menor control de los valores de colesterol ligado a lipoproteinas de baja densidad y un 26% menos posibilidades de cumplir ambos objetivos. Los pacientes con SM constituyen un objetivo prioritario en la prevencion cardiovascular.

Uso clínico de las estatinas y objetivos terapéuticos en relación con el riesgo cardiovascular

Fundamento y objetivo: El National Cholesterol Education program (NCEP) ha publicado las ultimas guias de tratamiento hipolipemiante, que amplian el numero de tratamientos farmacologicos respecto a anteriores guias. El objetivo de nuestro estudio es establecer el grado de cumplimiento de los objetivos terapeuticos establecidos por las guias terapeuticas recientemente publicadas. Pacientes y metodo: Estudio descriptivo transversal de pacientes que acudieron a una unidad de hipertension y riesgo cardiovascular. Se calculo el colesterol unido a lipoproteinas de baja densidad (cLDL) de cada uno y se definieron los valores considerados objetivos terapeuticos acordes con su riesgo coronario, siguiendo las indicaciones del NCEP-ATP III. Resultados: Se estudio a 1.811 pacientes (el 46% varones y el 54% mujeres), pertenecientes a tres categorias de riesgo definidas por el ATP III. El 35% de los pacientes pertenecia al grupo de mayor riesgo (grupo 1: riesgo coronario a los 10 anos superior al 20%). El 19% tenia un riesgo del 10-20% (grupo 2) y en el 46% el riesgo era inferior a 10% (grupo 3). El 58% de los pacientes cumplia los objetivos terapeuticos de cLDL: un 26% en el grupo 1, un 51% en el grupo 2 y el 86% del grupo 3 (p = 0,001). En el analisis de los factores que intervienen por conseguir el objetivo terapeutico, el tratamiento con estatinas obtuvo un resultado estadisticamente significativo solo en el grupo 1 de mayor riesgo coronario (odds ratio = 1,7; intervalo de confianza del 95%, 1,2-2,4; p = 0,007), pero no en los grupos de riesgo intermedio o bajo. El 41% de los pacientes del grupo 1 tenia valores de cLDL que requerian intervencion farmacologica (cLDL superior a 130 mg/dl) y no tomaba tratamiento. Conclusiones: En nuestro estudio, aunque el 58% de los pacientes alcanza los objetivos terapeuticos previstos, solo uno de cada 4 pacientes con alto riesgo coronario tiene valores de cLDL inferiores a 100 mg/dl. Estos datos indican que es necesario implementar el uso correcto de estatinas a las dosis eficaces en prevencion secundaria.

An experimental realization of a pulsed control method for the KSS chaotic circuit

In this work, a method for controlling chaotic systems by means of pulses, with four variants, is presented, and its real time application to a particular electronic chaotic circuit (Kiers-Schmidt-Sprott, KSS) is analyzed. Periodic behavior (periodic orbit, PO) is obtained from chaotic dynamics, with a control law depended on a variable event condition, which is automatically adjusted for each particular chaotic process. No previous knowledge of the mathematical model of the system to control is needed, which is considered as a black-box process. Sample data of only one measurement variable and three tuning parameters (proportional gain, pulse width, and hold-off time) are used. Satisfactory real time experimentation results have been obtained using dSPACE 1104 target for the KSS circuit.

Thermochemical Pretreatments of Organic Fraction of Municipal Solid Waste from a Mechanical-Biological Treatment Plant

The organic fraction of municipal solid waste (OFMSW) usually contains high lignocellulosic and fatty fractions. These fractions are well-known to be a hard biodegradable substrate for biological treatments and its presence involves limitations on the performance of anaerobic processes. To avoid this, thermochemical pretreatments have been applied on the OFMSW coming from a full-scale mechanical-biological treatment (MBT) plant, in order to pre-hydrolyze the waste and improve the organic matter solubilisation. To study the solubilisation yield, the increments of soluble organic matter have been measured in terms of dissolved organic carbon (DOC), soluble chemical oxygen demand (sCOD), total volatile fatty acids (TVFA) and acidogenic substrate as carbon (ASC). The process variables analyzed were temperature, pressure and NaOH dosage. The levels of work for each variable were three: 160–180–200 °C, 3.5–5.0–6.5 bar and 2–3–4 g NaOH/L. In addition, the pretreatment time was also modified among 15 and 120 min. The best conditions for organic matter solubilisation were 160 °C, 3 g NaOH/L, 6.5 bar and 30 min, with yields in terms of DOC, sCOD, TVFA and ASC of 176%, 123%, 119% and 178% respectively. Thus, predictably the application of this pretreatment in these optimum conditions could improve the H2 production during the subsequent Dark Fermentation process.

Genetic algorithm for LQG/LTR design parameters. a flight control system application

Abstract In this paper we propose a method for tuning Linear Quadratic Gaussian/Loop-Transfer Recovery (LQG/LTR) controller based on genetic algorithms. Suitable time responses as well as satisfactory robustness properties are obtained using two optimisation loops, where genetic algorithms are employed to satisfy design specifications for a flight control system.

Variable Structure H∞ Controller for Aircraft

This paper proposes a new synthesis method and tuning procedure for a variable structure H∞ multivariable controller for fixed wing aircrafts attitude control, which consists in switching from one-degree of freedom controller (1-DOF) to two degrees of freedom controller (2-DOF), and vice versa, with a method for bump-less transfer in switching transitions. The proposed method is tested using robustness analysis based on frequency domain and time analysis computer simulations based on a nonlinear mathematical model of the F-16 aircraft published by the NASA, from which satisfactory results are obtained.

Estudio de seroprevalencia de hepatitis B en deportistas de orientación

BACKGROUND AND OBJECTIVE Our objectives were to detect asymptomatic cases involved in an outbreak of hepatitis B, to assess the seroprevalence of hepatitis B (HB) in orienteers and to establish recommendations. PATIENTS AND METHOD One hundred sixteen orienteers who had competed in the categories involved in the previous outbreak as well as a stratified random sample of 166 of the remaining orienteers in other competition categories were included in a cross-sectional serological prevalence study. HB surface antigen (anti-HBs); total antibody to HB core antigen (total anti-HBc); HB surface antigen (Ag HBs); and antibody IgM to HB core antigen (anti-HBcIgM) along with the history of vaccination for hepatitis B were analyzed. The results were weighted. RESULTS The seroprevalence of HB (total anti-HBc positive) was 6.7% (n=12, 95% CI 0.6-12.9). No case of acute HB or chronic infection was observed. All the serological markers were negative for 61.1% (n=64, 95% CI 46.3-75.6), and 31.5% (n=29, 95% CI 18.2-46.4) had markers of immunity due to vaccination. Among individuals under 25 years of age, 28.4% were unvaccinated, although they were covered by vaccination programs. CONCLUSION Our results suggest that the seroprevalence of HB among orienteers is not different from the general population in Spain. However, it is necessary to reinforce the vaccination among adolescents and young adults. General recommendations for the prevention of HB were made to orienteering federations.