Fibrinogen is associated with silent myocardial ischaemia in type 2 diabetes mellitus.

OBJECTIVE: Because traditional risk factors only partially explain coronary events, it is necessary to search for new ones like fibrinogen which has been related with coronary disease in healthy middle-aged adults. We attempted to determine the impact of fibrinogen on silent myocardial ischaemia (SMI) in diabetic patients. METHODS AND RESULTS: In a cross-sectional study, 134 type 2 diabetes patients with no history of cardiovascular disease were assessed for SMI. A personal history and physical evaluation of each patient was conducted as well as evaluation of cholesterol, glucose, fibrinogen, blood cell counts, glycated haemoglobin, urine albumin quantification, and urinalysis. A modified Bruce test was performed on all study participants to evaluate the presence of SMI. RESULTS: Eleven patients had SMI (8.2%) that was associated with systolic, diastolic and mean blood pressure, hypertension, and fibrinogen. The correlation coefficient was obtained for quintiles of fibrinogen with the percentage of patients with SMI in that quintile (r = 0.97; 95% = 0.66-0.99). Fibrinogen levels were associated with SMI. A receiver-operator curve analysis showed that the cutoff value for fibrinogen to predict SMI was 400 mg/dL (82% sensitivity, 81% specificity). A cutoff value of 306 mg/dL of fibrinogen would rule in the diagnosis of SMI (100% sensitivity, 17% specificity), while fibrinogen cutoff of 682 mg/dL would rule out SMI (100% specificity, 9% sensitivity). CONCLUSIONS: Fibrinogen strongly predicts SMI in diabetic patients and may identify individuals with high cardiovascular risk. Fibrinogen should be evaluated in diabetic patients for a more accurate cardiovascular evaluation.

[Economic cost of care at the Dysplasia Clinic of Colima]. / El costo económico de la atención en la clínica de displasias de Colima.

OBJECTIVE: We studied 1,755 patients in dysplasia clinic in Instituto Mexicano del Seguro Social in Colima city in 2000, to know the economic cost of their attention. METHODOLOGY: Descriptive, quantitative study, for the identification and description of the instruments and human resources needed in each intervention. We estimated the fixed cost and the variable cost to determinate unitary cost. We made comparative cost analysis for diagnoses, treatment, and for sick evolution and we estimated the proportion of the total economic resources devoted to attention in this service. RESULTS: We found variation in unitary cost. The median cost was $227.67 pesos for each intervention. Colposcopy has the lower cost with $134.25, the upper cost was the treatment for vaginal infection $372.15, followed for the diatermic therapy $354.40. p = 0.2. The patients with advanced stage needed more large and expensive treatment. The proportion of the total economics resources devoted for the dysplasia clinic was 0.25%. CONCLUSION: All dysplasia clinic: 1. Should know the real unitary cost for every action done. And incorporate it to the planning of the economic resources. 2. Should have an automatic system for estimation of cost in order to know the unitary cost for each action.

[Efficiency of ambulatory services for female adolescent]. / Eficiencia de los servicios de atención ambulatoria de la adolescente.

OBJECTIVE: To evaluate effectiveness conditions of ambulatory services for female adolescent within Instituto Mexicano del Seguro Social, (Mexican Institute of Social Security) in Colima State, Mexico. METHODOLOGY: A cross-sectional study was conducted in 10 medical units of Instituto Mexicano del Seguro Social, Colima District, from June 2001 to June 2002. Data were collected using applied questionnaire Evaluation of ambulatory services for adolescents: effectiveness conditions of the Pan American Health Organization, the information collected included eight divisions with the mayor importance areas for the function services. We estimated frequencies and percentages. RESULTS: By 14 possible activities, 1 of the 10 units does not achieve anything, 3 achieved one to tree, and 6 achieved four to nine activities. CONCLUSIONS. The conditions of effectiveness of ambulatory services for female adolescent were under of the minor limit in seven of the eight evaluated areas.