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.

[Taste sensitivity diminution in hyperglycemic type 2 diabetics patients]. / Disminución de la sensibilidad gustativa en diabéticos tipo 2 con hiperglucemia.

OBJECTIVE: To determine the relationship between fasting blood glucose (FBG) values and gustatory sensitivity alterations in type 2 diabetic patients (DM2) without peripheral neuropathy (PNP). METHODS: Assessment of the strength of association between FBG and detection and recognition taste thresholds for the four primary tastes measured by chemical gustometry were performed in 140 DM2 without PNP with evolution < 10 years. RESULTS: FBG values above 7.77 mmol/L (140 mg/dL) induce in a dependent manner, the increase in the detection and recognition taste thresholds only to sweetness; whereas, values above 16.65 mmol/L (300 mg/dL) did not cause further decreasing in taste acuity to sweet flavor. Statistically significant differences where found for detection and recognition, taste thresholds for sucrose between well controlled (HbA1c < or = 7 %) normoglycemic and hyperglycemic diabetics, as well as between alarming uncontrolled (HbA1c > 10 %) normoglycemic and hyperglycemic patients. CONCLUSIONS: Hyperglycemia induces a concentration-dependent impairment of sweet taste perception in DM2 patients as the result of an adaptation of the sensory cell to elevated circulating concentrations of glucose.

[Migraine. Review of physiopathogeny and future alternative therapy]. / Migraña. Una revisión de la fisiopatogenia y alternativa terepéutica futura.

This work examines recent discoveries in physiopathogenesis, focusing on the combination of sequential events involved in migraine origin. Recent facts concerning active intestinal peptide, substance P, histamine, HI and H3 receptors, and H3-receptor agonists, all neuromodulators having an intimate relations ship with migraine were examined. Present-day recommended treatment, with an efficacy of barely 70%, and reasons for its poor performance were described. The authors state that the future of migraine treatment should be directed toward the search for drugs that directly interact with the above-mentioned neuromodulators, thus offering patients a more efficacious treatment and fewer undesirable side-effects.

Estimulación eléctrica transcutánea (EET) para reducir el dolor después de la cesárea / Transcutaneuous electrical to reduce pain after cesarean birth

El propósito de este estudio fue evaluar en forma clínica, la eficacia de la estimulación eléctrica transcutánea (n = 25), comparativamente con la ejercida por la administración de 1 g de dipirona iv (n = 25), para reducir el dolor durante el periodo inmediato (4 horas) después de cesárea. Realizamos un ensayo clínico, estudiando las variables: intensidad del dolor, duración del dolor, y consumo adicional de fármacos. Nuestro estudio apoya investigaciones previas, en donde la estimulación eléctrica transcutánea disminuyó hasta en 50 por ciento el requerimiento total de analgésicos. En las 25 pacientes, la estimulación eléctrica transcutánea mostró ser eficaz para reducir la intensidad y duración del dolor de origen cutáneo, así como el dolor relacionado con los movimientos voluntarios. Este efecto probablemente se debe al bloqueo de fibras periféricas tipo A (dolor somático). Sin embargo, en 13 de ellas, el tratamiento referido fue insuficiente para bloquear las fibras tipo C y reducir así el dolor de origen visceral. Lo anterior podría estar en relación con la frecuencia de estímulo y con el sitio de colocación de los electrodos empleados por nosotros.Nuestros resultados son indicativos de que la estimulación eléctrica transcutánea constituye un tratamiento alternativo para reducir el dolor durante el periodo inmediato después de cesárea y disminuir los requerimientos de analgésicos habituales; contribuir para que las madres permanezcan alertas y cooperadoras para interactuar tempranamente con el lactante; y reducir los posibles efectos secundarios incieseables que dichos fármacos pueden ejercer sobre el binomio. Sin embargo, son necesarios nuevos ensayos con estimulación eléctrica transcutánea variando la colocación de los electrodos y empleando diferente frecuencia de estímulo para evaluar el tratamiento del dolor de origen visceral.