[Creatinin as predictor value of mortality in patients with acute coronary syndrome]. / Creatinina sérica como pronóstico de mortalidad en pacientes con síndrome coronario agudo.

BACKGROUND: Cardiovascular diseases have become the leading cause of death worldwide. OBJECTIVE: To estimate serum creatinine (Cr) as a prognostic value of mortality in patients with Acute Coronary Syndrome (ACS), which was admitted to the shock room in the emergency department (ED). MATERIAL AND METHODS: A transversal, prospective study, which included 95 patients with ACS who were admitted to the shock room. The following variables were studied: laboratory tests with Cr, cardiovascular risk factors (CVRF), days of hospital stay, service to which it was derived and discharge condition (alive or dead). Statistical analysis was through SPSS v. 23. RESULTS: The diagnosis of admission was ACS without ST elevation (NSTE-ACS), 72.6%; and Acute Myocardial Infarction with ST elevation (STEMI), 27.4%. The 63.2% were discharged alive, 13.7% transferred to a third level hospital and 23.2% died. There was a difference in the level of Cr between living and deceased (p = 0.0001). CONCLUSIONS: CR on admission of the patient with SCA provides prognostic information for mortality, and can be established as a prognostic marker of easy access and available in the ED.

INTRODUCCIÓN: las enfermedades cardiovasculares se han convertido en la principal causa de muerte a nivel mundial. OBJETIVO: estimar la creatinina (Cr), sérica como valor pronóstico de mortalidad en pacientes con síndrome coronario agudo (SCA) que ingresaron a sala de choque en el servicio de urgencias (SU). MATERIAL Y MÉTODOS: estudio prospectivo, transversal, que incluyó a 95 pacientes con SCA ingresados en sala de choque. Se estudiaron las siguientes variables: estudios de laboratorio con Cr, factores de riesgo cardiovascular (FRCV), días de estancia hospitalaria, servicio al que se derivó y condición de egreso (vivo/ muerto). El análisis estadístico fue mediante SPSS v. 23. RESULTADOS: el diagnóstico de ingreso fue de SCA sin elevación del ST (SCASEST), 72.6%; e infarto agudo al miocardio con elevación del segmento ST (IAMCEST), 27.4%. Egresaron vivos el 63.2%, fueron trasladados a hospital de tercer nivel el 13.7% y falleció el 23.2%. Se encontró una diferencia en el nivel de Cr entre vivos y fallecidos (p = 0.0001). CONCLUSIONES: la Cr al ingreso del paciente con SCA proporciona información pronostica para mortalidad, y se puede establecer como un marcador pronóstico de acceso fácil y disponible en el SU.

Homocisteína (HCY), ácido úrico y su relación con c-HDL en pacientes con enfermedad coronaria / Homocysteine (HCY), uric acid and their relationship with HDL in patients with coronary artery disease

Introducción: La enfermedad coronaria (EC) es la principal causa de muerte en México. La homocisteína (HCY), ácido úrico (AU) y el colesterol (c-HDL) se conocen como factores independientes de riesgo para enfermedad cardiovascular. Objetivo: Investigar la relación entre HCY, AU y c-HDL en pacientes con enfermedad coronaria. Material y métodos: Estudio transversal comparativo en 75 pacientes con EC, sin diuréticos, alopurinol, ácido fólico, complejo B y sin enfermedad renal o tiroidea. A cada paciente se le colectó muestra venosa para cuantificación de HCY, AU, glucosa y perfil de lípidos. El análisis estadístico se realizó en SPSS V18. Resultados: Edad promedio: 60.96 ± 16.22 años, 58.45% tuvieron diabetes mellitus tipo 2 (DM2) y/o hipertensión arterial sistémica (HTA). Los pacientes se distribuyeron en dos grupos: AU ≥ 7 mg/dL y AU < 7 mg/dL; se encontraron diferencias en HCY, c-HDL, tensión arterial sistólica y diastólica (p < 0.05). AU correlacionó con c-HDL (r = -0.307; p = 0.010) y HCY con c-HDL (r = -0.283; p = 0.019). Por regresión lineal se encontró HCY como factor predictor del AU (coeficiente estandarizado β: 0.294; t: 2.458; p = 0.017) y de c-HDL (coeficiente estandarizado β: 0.269; t: 2.232; p = 0.029). Conclusiones: Existe relación entre AU y HCY con c-HDL. La HCY es factor predictor de hiperuricemia y de baja c-HDL en pacientes con EC. Se recomienda incluir la HCY como determinación de rutina en pacientes de alto riesgo, historia familiar y/o EC prematura.

Introduction: Coronary heart disease (CHD) is the main cause of death in Mexico. Homocisteine (HCY), uric acid (UA) and cholesterol (c-HDL) are known independent factors for cardiovascular disease. Objective: To investigate the relationship between HCY, UA and c-HDL in patients with Coronary Heart Disease (CHD). Material and methods: Comparative cross-sectional study in 75 patients with CHD, without diuretics, allopurinol, folic acid, B complex and without kidney or thyroid disease. To each patient was collected a fasting blood sample for quantification of HCY, UA, glucose and lipid profile. The statistical analysis was realized in SPSS V18. Results: Mean age was 60.96 ± 16.22 years. 58.45% had type 2 diabetes and/or hypertension. Patients were divides in 2 groups: UA ≥ 7 mg/dL y UA < 7 mg/dL. We found differences in HCY, c-HDL, systolic and diastolic blood pressure (p < 0.005). The UA correlated with c-HDL(r = -0.307, p = 0.010) and HCY with c-HDL (r = -0.283, p = 0.019). In the linear regression analysis was found to HCY as predictor of UA (standardized coefficient β:0.294, t:2.458, p = 0.017) and c-HDL (standardized coefficient β:0.269, t:2.232, p = 0.029). Conclusions: There is relationship between HCY, UA with c-HDL and c-HDL. HCY is a predictor of hyperuricemia, low c-HDL levels in patients with CHD. It is recommended to include the determination of HCY as routine in patients with a family history of CHD.

[Consultation profile and critical points in allergic patient attention at IMSS made by a non-allergologist specialist doctor]. / Perfil de consulta y puntos críticos en la atención del paciente alérgico en el IMSS por médicos especialistas no alergólogos.

BACKGROUND: Allergic diseases represent a serious public health problem all over the world, and they use to be associated with environmental factors as well as with each patient genetic predisposition. OBJECTIVE: To characterize consult profile and critical points of allergic patients attention attended by non-allergologists specialists but referred by allergologists. MATERIAL AND METHOD: Descriptive study since October 2004 until February 2005, with a questionnaire to 255 patients attended by non-allergologists specialists in an IMSS hospital. Skin hypersensibility Prick-tests with standardized commercial extracts were practiced (1:20 p/v). RESULTS: Gender distribution was 41.96% male and 58.04% female, most of them (88.6%) from urban places (the reminder from rural ones); 55.37% with family history of allergy. In 49.02% the disease disturbs family behavior. Annual attention cost to allergic patients was 2,896.74 mexican pesos. Only 35.7% of patients get the disease control. Both work and home control of allergy exacerbation risk factors were poor. CONCLUSIONS: Critical points affecting allergic patients' treatment are attention to risk factors and to those factors exacerbating the disease (environmental and drug scheme choice). Non-allergologists specialists must consider a better control of allergic patients.

[Increased accumulated incidence of allergic rhinitis in adolescents of Morelia, Michoacán, and its relation to satisfaction of vital and affective needs]. / Incremento de la incidencia acumulada de rinitis alérgica en adolescentes de la ciudad de Morelia, Michoacán, y su relación con la satisfacción de necesidades vitales y afectivas.

OBJECTIVE: To determine the incidence (preliminary) of allergic rhinitis in a population-based sample of adolescents and its relation on how they meet basic and affective need satisfaction. MATERIAL AND METHODS: We used ISAAC survey to assess rhinitis-related symptoms in a population-based sample of adolescents from Morelia, Michoacán, Mexico. Some items were added to the survey to evaluate how they meet basic and affective needs. Random sample included 1,333 adolescents aged 11-16 years from several schools of Morelia, Michoacán. Allergic rhinitis impact on basic and affective need satisfaction was assessed. Relative risk (RR) and 95% confidence interval (CI) were estimated. RESULTS AND DISCUSSION: Until 2003, such disease was diagnosed in 12% of cases; however, the number went up after the survey: rhinitis-related symptoms were seen in 46% of those polled, of which prevalence, sensitivity and specificity rates were 27, 90, 70%, respectively. More symptoms were reported from July through December. Sixty percent of adolescents with allergic rhinitis reported sleep disturbances, with adverse effects on bed rest period (RR 2.64) [1.01-6.94]. Well-balanced diet was seen in 62% of adolescents with such disease (RR 1.56) [1.34-1.79]. Sixty-seven percent of such teenagers said that the disease does no interfere with their performance in school (RR 1.41) [0.61-3.24] and 22% felt unaccepted (RR 1.8) [0.795-16.63]. CONCLUSIONS: The estimation of incidence of allergic rhinitis found in this study is higher than in other reports. Basic and affective need satisfaction was affected; thus, implementation of psychotherapy within a multi-disciplinary approach is required.