Gabapentin premedication: assessment of preoperative anxiolysis and postoperative patient satisfaction.

BACKGROUND: Gabapentin reduces anxiety in psychiatric patients. In this prospective, randomized, double-blinded, placebo-controlled study, we investigated whether a single dose of gabapentin as a premedicant reduces preoperative anxiety, and improves patient satisfaction. MATERIALS AND METHODS: After Institutional Review Board approval and written consent, 210 patients were randomly allocated into 3 groups of oral premedication: placebo, hydroxyzine 75 mg, or gabapentin 1200 mg. Anxiety level was assessed 3 times, using a 100-mm visual analogue scale: before premedication, in the preoperative holding area, and just before induction of general anaesthesia. In the postoperative period, patients were asked about their satisfaction with their premedicant. Data were presented as mean +/- SD. VAS scores were analyzed by repeated-measures analysis of variance followed by a Bonferroni test as appropriate. The chi-square test was used to analyze categorical data. All p values less than 0.05 was considered statistically significant. RESULTS: Baseline anxiety was not statistically different among the 3 groups. Anxiety level in the gabapentin group was significantly lower in the holding area, and before induction of anaesthesia (20 mm +/- 21), than in the hydroxyzine group (33 mm +/- 26 ; p = 0.023) and in the placebo group (36 mm +/- 28; p = 0.004). Anxiety decreased significantly overtime only in the gabapentin group. The gabapentin and hydroxyzine groups had a higher proportion of "satisfied or extremely satisfied" patients (73% and 70% respectively) as compared to the placebo group (48%, p = 0.006). CONCLUSION: A single dose of gabapentin has proven to be an effective premedication to reduce preoperative anxiety.

Metabolic syndrome and Framingham risk score for prediction of cardiovascular events in Caribbean Indian patients with blood glucose abnormalities.

OBJECTIVE: To evaluate the metabolic syndrome (MS) and Framingham risk score (FRS) as predictors of cardiovascular (CV) events in Caribbean Indian patients who have type 2 diabetes (T2D) or impaired glucose tolerance (IGT). METHOD: A longitudinal and retrospective study was conducted involving patients classified as T2D or IGT in a first study in 1997 who responded for a second examination in 2006. Nonparametric tests and Cox's proportional hazards model were used. Hazard ratios (HRs) and their confidence intervals (95% CI) for risk of a first CV event, according to the presence of MS or a high FRS, were estimated. For MS, the models were adjusted for age, gender and smoking status. RESULTS: A total of 148 patients were included in the present study. The mean time without a CV event was 7.5 years (range 0.38-8.45 years). We noted 31 (25 nonfatal) first hospitalizations, for stroke (n=15), angina pectoris (n=8), acute coronary heart disease (n=7) and acute peripheral vascular disease (n=1). Ten (6.8%) patients died and six deaths were related to CV events. The HRs of CV events associated with metabolic syndrome, defined by the National Cholesterol Education Program's Adult Treatment Program III, were not significant. Conversely, HRs of CV events associated with the FRS were 4.78 (95% CI 1.65-13.5) and 2.94 (95% CI 1.42-6.06) for a risk score superior or equal to 10% and superior or equal to 20%, respectively. For coronary heart disease alone, the HRs associated with the FRS were 9.92 (95% CI 1.31-75.2) and 2.88 (95% CI 1.05-7.93), respectively. In these Caribbean Indian patients with blood glucose abnormalities, unlike the FRS, MS failed to identify subgroups at high cardiovascular risk in the short term (8.5 years). Nevertheless, the long-term risk-predictive value of these tools needs to be evaluated.

[Hypertension in the metabolic syndrome among Caribbean non diabetic subjects]. / Place de l'hypertension artérielle dans le syndrome métabolique chez des sujets non diabétiques caribéens.

OBJECTIVE: To study the metabolic syndrome (MS) components in Caribbean non diabetic individuals and to determine the magnitude of hypertension (HT) in those with and without MS. RESEARCH METHODS: We conducted a cross-sectional study, of 966 consecutive subjects aged 18-74 years. The MS was identified according to the NCEP/ATpiiI definition. Age, gender, body mass index and the MS components (blood pressure, waist circumference, fasting blood glucose, triglycerides, HDL cholesterol) were taken into account. The Principal component analysis (PCA) was used to understand correlations between these continuous variables within the data base, and to identify principal factors (combinations of variables) and the magnitude of HT in these combinations. RESULTS: In the overall study population, mean age was 38 years and there were 60.1% of women. HT was more frequently found in men than in women (52.2% vs. 41.3%; p=0.001). Prevalence of MS was 11.3%. With PCA, in the complete sample of men, the first factor, explained 31.5% of the total variance in the original variables and was dominated by blood pressure, clustered with age and fasting blood glucose (FBG). In the women's sample, the first factor (31.1% of the variance) was dominated by obesity combined with FBG and lipids. In subjects with the metabolic syndrome the principal factors were dominated by blood pressure in both genders with higher loadings in men than in women. CONCLUSION: In this non diabetic population study the prevailing obese women profile clustering with fasting glucose and lipid disturbances might explain the higher prevalence of type 2 diabetes among women, observed in this Caribbean region.

Metabolic syndrome components in Indian migrants with type 2 diabetes. A matched comparative study.

OBJECTIVE: To study the metabolic syndrome (MS) in Indian subjects with type 2 diabetes (T2D) in comparing them with controls from the Indian community and from the general population. METHOD: An adapted definition of MS by the Third report of the National Cholesterol Education Program's Adult Treatment Panel III was used. We defined three groups matched for sex and age (+/-5 years). Non parametric tests for comparison of matched samples and conditional logistic regression were used. RESULTS: We selected 71 Indians with T2D (group 1) and two control groups with fasting blood glucose<6.1 mmol/L: 71 Indians (group 2) and 213 subjects from the general population (group 3). Patients were 24 to 76 years-old and each group contained 56% men. Globally, MS was identified in 77% of the group 1 when diabetes was taken into account. When diabetes was excluded there were 47% of MS in group 1, 18% in group 2 and 16% in group 3. The clusters of four factors (hypertension, large waist circumference, hypertriglyceridemia and Low HDL-C) were more common in Indians. The most frequent factors were hypertriglyceridemia and large waist circumference in Indians. Indians with T2D had a 5-fold higher risk of MS than the general population group, OR (95% CI): 4.93 (2.71 - 8.97); P<0.001. CONCLUSION: The high frequency of MS and of hypertriglyceridemia in Indians with T2D highlights the need for screening and management of MS in this population facing a high cardiovascular risk.

[Hypertension and cardiovascular risk associated with obstructive sleep apnea in adult in Guadeloupe (French West Indies)]. / Hypertension artérielle et risque cardiovasculaire associés au syndrome d'apnées obstructives du sommeil chez l'adulte en Guadeloupe.

BACKGROUND AND PURPOSE: In Guadeloupe, data on the relationships between arterial hypertension and obstructive sleep apnea are unavailable. The aim of this study was: to assess the frequency of hypertension and non-dipper pattern evaluated by 48-hour ambulatory blood pressure monitoring in an adult population identified obstructive sleep apnea/non-obstructive sleep apnea during overnight polygraphy ; to determine the cardio-metabolic factors associated with obstructive sleep apnea. DESIGN AND METHOD: A cross-sectional study was realized at Pointe-à-Pitre Hospital. Patients were referred for suspected sleep apnea to sleep specialist and performed a nocturnal polygraphy. Diagnosis was confirmed if the apnea-hypopnea index was ≥ 5. We obtained two groups: sleep apnea/non-sleep apnea. All patients underwent 48-hour ambulatory blood pressure monitoring. The cardio-metabolic factors were identified and assessed (fasten level of hs-CRP and Homa-IR index). RESULTS: A total of 204 patients were included. Mean age at diagnosis was 54 ± 10 years, 63% were women. OSA was present in 69.6% with a higher frequency in men than in women. Difference was not significant between the two groups for hypertension frequency (84.5% vs 77%; P=0.22), non-dipper pattern (77.5% vs 76%; P=0.79) and hs-CRP. Differences for age, snoring, body max index, mean waist circumference, Homa-IR index, obesity, dyslipidemia, and type 2 diabetes were significant. CONCLUSIONS: Our data highlight raised frequency of cardiovascular metabolic factors in patients with obstructive sleep apnea and confirm their high cardiovascular risk.

A randomized trial of captopril for microalbuminuria in normotensive adults with sickle cell anemia.

PURPOSE: Nephropathy is a common complication of sickle cell anemia and is often preceded by proteinurea. Our aim was to evaluate the effect of angiotensin-converting enzyme inhibition on microalbuminuria in sickle cell patients. PATIENTS AND METHODS: We performed a randomized, double-blind, placebo-controlled trial in 22 normotensive patients with sickle cell anemia and persistent microalbuminuria. Patients received captopril (25 mg/day) or placebo and were followed up for 6 months. Albuminuria, blood pressure, and serum creatinine and hemoglobin concentrations were measured at baseline and at 1, 3, and 6 months. The primary outcome variable was the 6-month change in albuminuria between the two groups. RESULTS: Baseline albuminuria was 121 (SD 66) mg per 24 hours in the captopril group and 107 (SD 86) mg per 24 hours in the placebo group. Microalbuminuria decreased from baseline in the captopril group but increased in the placebo group. The mean absolute change and the mean percentage change in microalbuminuria were significantly different between the two groups at 6 months (absolute change -45 mg per 24 hours in the captopril group versus +18 mg per 24 hours in the placebo group, P <0.01; and percentage change -37% in the captopril group versus +17% in the placebo group, P <0.01). The 95% confidence intervals (CI) for the difference in albuminuria between the two groups were 63 (CI 40 to 86) mg per 24 hours for the mean absolute change and 54% (CI 22% to 85%) for the mean percentage change. Blood pressure decreased slightly from baseline in captopril-treated patients and did not change in the placebo group. The change was significantly different between the two groups only for diastolic blood pressure at 6 months (P <0.01). CONCLUSION: Captopril reduces albuminuria and slightly decreases blood pressure in patients with sickle cell anemia. More studies are required to demonstrate the sustained benefit on protein excretion.

Anthropometric parameters and type 2 diabetes: a case-control study in a Guadeloupean population.

OBJECTIVE: The aim of this study was to quantify the association between three anthropometric parameters and type 2 diabetes in an adult population in Guadeloupe and to evaluate the effect of age on these associations. DESIGNS AND METHODS: We conducted a case-control study in a population recruited in an Health Center of Guadeloupe in Year 2000. A total of 309 subjects with documented type 2 diabetes were matched on sex and age (+/- 2 Years) with controls free of any glycemic abnormality. Student t-test was used and conditional logistic regressions were performed separately for men and women to quantify the association between type 2 diabetes and the explanatory variables, body mass index (BMI), waist to hip ratio (WHR) and waist circumference (WC). RESULTS: Mean (SD) WC was 89.0 cm (0.9) in non diabetics men and 97.3 cm (1.1) in diabetics ones, p<10-4. In women, it was 87.7 (0.8) cm for non diabetics and 96.3 cm (0.9) for diabetics. This difference was persistent for any tertile of age in each sex. It was discordant for BMI and WHR at higher tertile for men and women. In the multivariate analysis, Odds ratio[CI95%] for WC was 9.67 [2.32-40.20] in men and 2.97 [1.70-5.19] in women. It was 2.94 [0.99-8.74] in men and 6.15 [3.11-12.17] in women for WHR. Results for BMI were non significant in both sex. CONCLUSION: Differences between WC and WHR over age groups and sex in predicting type 2 diabetes should be taken into account when using these parameters routinely in medical practice.

Lipid profile in an adult population in Guadeloupe.

The purpose of this study was to provide data on lipid distribution and to investigate the association between hypercholesterolemia and other factors. A cross-sectional survey of insured subjects in an Health Center of Guadeloupe in 1999. Data from a consecutive series of 1 010 individuals aged 18 years and older, collected during a 3 month-period, were used. Standardized interviews and measurements of blood lipid abnormalities and other cardiovascular risk factors were carried out. Overall, 27% had elevated total cholesterol (TC) levels above 200 mg/dL, 11.7% had TC levels above 240 mg/dL, 18.1% had LDL-C levels above160 mg/dL, 12.5% had HDL-C below 35 mg/dL and 2.7% had triglyceride levels above 200 mg/dL. Isolated low HDL-C was found in 22% of the subjects and 10.8% had both TC above 240 mg/dL and LDL-C above 160 mg/dL. Only 22% of the subjects with high TC were aware of their diagnosis and 5% were treated. The risk of having hypercholesterolemia above 200 mg/dL was independently and significantly higher in case of hypertension, age above 45 in men or 55 in women, body mass index above 30 and familial history of dyslipidemia. These findings document the first report on dyslipidemia in Guadeloupe. It showed that the prevalence of hypercholesterolemia and hypertriglyceridemia was lower than in developed countries, but markedly higher than in Africa. Modifications of lifestyle and adapted therapeutics are necessary to decrease cardiovascular mortality.

[Survival analysis of diabetic patients on dialysis in Guadeloupe]. / Survie des patients diabétiques dialysés en Guadeloupe.

BACKGROUND: Both diabetes and hypertension, two conditions that can lead to renal failure, have a high prevalence in Guadeloupe. OBJECTIVE: To determine the clinical and epidemiological features of diabetic patients on end stage renal failure and to evaluate their survival. PATIENTS AND METHOD: Data of the Guadeloupe Kidney registry were analysed for patients who began chronic dialysis during 1978-1997. Follow up information on survival status was obtained up to January 26(th) 1999. Cox proportional hazard analysis was used to determine the relative risk (RR) of death between levels of independant variables. RESULTS: There were 784 dialysis patients of whom 174 (22%) were diabetics. Among the latter, there were 97 women (55,7%), mean age at the start of dialysis was 60.6 years (range 26-83) and arterial hypertension was present before the start of dialysis in 67% of them. Median survival MS (95%CI) was significantly lower in diabetics 42 months (31-52) than in non diabetics 83 months (70-96), p<10(-4). In diabetics, the cumulative probability of survival was 83% (1 year) and 39% (5 years) and the RR of death (95% CI) were 1.90 (1.10-3.22) and 3.43 (2.00-5.87) for diabetics admitted in dialysis in age-class 55-64 years and 65-83 years, respectively, when that for age-class 54 years was set at 1. 00. The RR for diabetics was 1.67 (1.33-2.10) relative to non diabetics. CONCLUSION: Prospective studies are warranted to describe the role of comorbid conditions in diabetic patients survival. Prevention of degenerative complications should be a priority in this population.

Cardiovascular risk factors associated with diabetes in an Indian community of Guadeloupe. A case control study.

Indians of Guadeloupe have an especially high prevalence type 2 diabetes mellitus and a particular susceptibility to coronary heart disease. This case-control study conducted from September 15 to 24, 1997, analysed cardiovascular risk factors associated with diabetes and particularly dyslipidaemia in the Indian community of Guadeloupe. The 172 subjects included 86 diabetic patients of Indian origin and 86 age- and sex-matched non-diabetic controls. All subjects underwent a physical examination by the same observer. Obesity and hypertension were assessed, and fasting lipid concentrations were measured. The body mass index and waist-to-hip ratio were higher among patients than controls: 27.8 vs 25.1 Kg/m2 (p < 0.001) and 0.94 vs 0.90 (p < 0.001). Mean arterial systolic and diastolic pressures were higher for patients than controls (p < 0.001). Median HDL-cholesterol was 1.23 mmol/L for patients vs 1.4 mmol/L for controls (p < 0.001), and median triglycerides were 2.0 vs 1.3 mmol/L (p < 0.001). Mean apolipoprotein B was 1.40 +/- 0.36 g/L for patients vs 1.23 +/- 0.35 g/L for controls (p < 0.001). Our results show slight hypertension, central obesity, a lower plasma HDL-cholesterol concentration, a higher triglyceride concentration, and a higher apolipoprotein B concentration for diabetics. These data would appear to have important implications for the prevention of cardiovascular disease in this population.