[Pre-anesthetic medication with intranasal dexmedetomidine and oral midazolam as an anxiolytic. A clinical trial]. / Medicación preanestésica con dexmedetomidina intranasal y midazolam oral como ansiolítico. Un ensayo clínico.

INTRODUCTION: Dexmedetomidine is a pharmacological option for sedation in children. In this study, the efficacy of intranasal dexmedetomidine to reduce preoperative anxiety in pediatric patients is compared with that of oral midazolam. MATERIAL AND METHODS: A prospective, randomized, double-blind, controlled trial was conducted on children 2-12 years of age, randomly assigned to one of the following two groups: group A received premedication with oral midazolam and intranasal placebo, group B received intranasal dexmedetomidine and oral placebo. Anxiety was assessed with the modified Yale scale, and a risk analysis and number needed to treat was performed. RESULTS: A total of 108 patients were included, 52 (48.1%) treated with dexmedetomidine, and 56 (51.9%) with midazolam. Anxiety was less frequent in the dexmedetomidine group at 60minutes (P=.001), induction (p=.04), and recovery (P=.0001). Risk analysis showed that dexmedetomidine reduced the risk of anxiety by 28% (RAR=0.28, 95% CI; 0.12 to 0.43) and to prevent one case of anxiety, four patients need to be treated with intranasal dexmedetomidine (NNT=4, 95% CI: 3-9).Changes in heart rate, mean arterial pressure, and oxygen saturation, were statistically significant in the dexmedetomidine group, with no clinical consequences. There were no cases of bradycardia, hypotension or oxygen desaturation. CONCLUSIONS: Intranasal dexmedetomidine premedication is more effective than oral midazolam to reduce preoperative anxiety in pediatric patients.

Eryptosis and oxidative damage in type 2 diabetic mellitus patients with chronic kidney disease.

It has been suggested that oxidative stress may participate in the progression of diabetes and its complications. Long-term complications of type 2 diabetes mellitus (T2DM) include retinopathy, atherosclerosis, shortened life span of erythrocytes, nephropathy, and chronic kidney disease (CKD). Oxidative damage has been associated with erythrocyte apoptosis induction in other pathological conditions. Our aim was to study the presence of eryptosis and its possible relationship with oxidative damage in patients with T2DM without CKD (T2DM/CKD(-)) and in patients with T2DM and CKD (T2DM/CKD(+)).Oxidative damage of lipids erythrocytes were increased in diabetic patients. The highest lipoperoxidation was found in T2DM/CKD(+). Likewise, the lower plasma total antioxidant capacity, GSH/GSSG ratio, and GSH in erythrocytes were found in T2DM/CKD(+) patients. A negative correlation was found between plasma total antioxidant capacity and oxidative damage. Phosphatidylserine (PS) externalization was measured in erythrocytes to evaluate eryptosis. Annexin binding in erythrocytes of T2DM/CKD(+) patients was higher than in healthy subjects and T2DM/CKD(-) patients. A positive correlation between lipoperoxidation and PS externalization in erythrocytes was found. This work showed that the erythrocytes of diabetic patients have increased oxidative damage, a reduction of antioxidant systems and more erythrocyte PS externalization. The duration of diabetes and the presence of CKD increase both oxidative damage and eryptosis. It is possible that a longer time of evolution induces an increase in erythrocyte oxidative damage and the consumption of blood antioxidant systems, adding to the osmotic stress in CKD and so contributes to an increase in PS externalization in diabetic patients.

[Accumulated probability of hypertension in diabetes and of diabetes in hypertension]. / Probabilidad acumulada de hipertensión en diabéticos y de diabetes en hipertensión.

OBJECTIVE: To determine the cumulative probability of hypertension in type 2 diabetic patients, and of diabetes in patients with essential arterial hypertension. METHODS: A 15-years follow-up study of 308 subjects, 156 with type 2 diabetes and 152 with arterial hypertension. Time zero (T0) was the date in which the diabetes or the hypertension were established. The time in years from T0 up to diagnosis of hypertension in diabetics or diabetes in hypertensives was determined. The cumulative probability was calculated with the method of Kaplan and Meier. RESULTS: The incidence of hypertension in the diabetics was 4.36 patient-year, and that of diabetes in hypertensives of 1.23 patient-year (p = < 0.00001; Cl95% 4.8-14.7). After the first 5 years, 40% of the diabetics had hypertension and 12% of the hypertensives developed diabetes; at 15-years follow-up, these figures were 71% and 21% respectively (p < 0.001). CONCLUSIONS: The probability of essential arterial hypertension in type 2 diabetes was significantly higher than the incidence of diabetes in hypertensive subjects. In both instances, the risk was greater for men than for women.

[Prevalence of arterial hypertension and related factors in a marginated rural population]. / Prevalencia de hipertensión arterial y factores asociados en la población rural marginada.

OBJECTIVE: To determine the prevalence and risk factors related to systemic arterial hypertension (SAH) in the rural marginated population of Durango, Mexico. MATERIAL AND METHODS: A comparative cross-sectional study was performed in 627 rural communities, approximately 90% of which have 250 inhabitants or less. The arterial pressure and sociodemographic variables were determined. RESULTS: A total of 5,802 subjects were studied, 4,452 women (76.7%) and 1,350 men (23.3%). SAH was found in 1,271 individuals (21.9%; CI 95% 20.8-23.0) of which 1,011 were women (22.71%; CI 95% 21.5-23.9) and 260 were men (19.26%; CI 95% 17.2-21.4). Of the target population, 3,018 individuals (52.0%) live in communities of less than 250 inhabitants, 2,080 (60.9%) women and 938 (31.1%) men. In this group, SAH was identified in 445 cases (14.74%; CI 95% 13.5-16.0) of which 326 are women (15.7%; CI 95% 14.1-17.3) and 119, men (12.7%; CI 95% 10.6-14.9). The main risk factors related to SAH were obesity, type 2 diabetes, alcohol and tobacco consumption. CONCLUSIONS: The prevalence of SAH in the rural marginated population is apparently related to the degree of development of the communities.

[Postoperative analgesia using epidural administration of bupivacaine plus lidocaine]. / Analgesia postoperatoria con administración epidural de bupivacaína + lidocaína.

OBJECTIVE: To compare the postoperative analgesia of bupivacaine + lidocaine versus lidocaine in lower abdominal surgery. DESIGN: Randomized clinical trial. METHODS: Thirty patients, scheduled for lower abdominal surgery and epidural anesthesia (EA) were randomly assigned to receive EA with 30 mg of bupivacaine plus 240 mg of lidocaine (group A) or 300 mg of lidocaine (group B). A lumbar epidural catheter in L1-L2 or L2-L3 was inserted, and a bolus with total dose was given. The periods of latency and postoperative analgesia, the hemodynamic variable and the preoperative, intraoperative and postoperative data were recorded. RESULTS: Fifteen patients per group were included. There were no differences intergroup in age, height, weight, hemodynamic variables and surgical data. The period of latency was similar in the groups but postoperative analgesia was longer in group A and the postoperative pain scores were higher in group B in the first 120 minutes after surgery. There were no serious complications. In newborns of cesarean section, the Apgar scores at 1 and 5 minutes after delivery were similar in both groups. CONCLUSIONS: The mixture of bupivacaine + lidocaine proved be an effective alternative for epidural use in lower abdominal surgery.

[Folic acid deficiency and its association with neural tube defects in northern Mexico]. / Deficiencia de folatos y su asociación con defectos de cierre del tubo neural en el norte de México.

OBJECTIVE: To evaluate folic acid deficiency and other risk factors and their relationship with the occurrence of neural tube defects (NTD), in the rural population of northern Mexico (Chihuahua, Durango and Zacatecas). MATERIAL AND METHODS: A multicentric case-control study was performed. Cases were both live and stillborn with NTD, and controls were healthy newborns without congenital malformations. Exposure to known risk factors was determined, establishing its association with NTD using multiple logistic regression analysis. RESULTS: Risk factors associated to NTD were: folic acid deficiency (OR 11.1; CI 95% 1.2-106.2, p = 0.04); the antecedents of previous NTD pregnancies (OR 3.3; CI 95% 1.1-18.8, p = 0.05) and stillbirths (OR 7.1; CI 95% 1.1-46.3, p = 0.04). CONCLUSIONS: Folic acid deficiency is one of the major risk factors associated to NTD among the rural population of northern Medico. Further investigations are necessary to determine the role of involved risk factors and implement adequate preventive measures.

[Importance of family support in the control of glycemia]. / Importancia del apoyo familiar en el control de la glucemia.

OBJECTIVE: To determine the importance of family support in the control of glucemia in non-insulin-dependent diabetes mellitus patients. MATERIAL AND METHODS: A case and control study was designed where cases were patients with glycemia < 140 mg/dl and controls, patients with glycemia > or = 140 mg/dl. Family support was determined using the questionnaire Environmental Barriers to Adherence Scales which estimates the support lent by the family to the patient to follow therapeutic indications. The study consisted of 32 cases and 50 controls. RESULTS: Family support received by the patient is significantly associated to the presence of glycemia < 140 mg/dl (OR = 3.9; 95% C.I. 1.4-11.1). Other variables did not show significant association. CONCLUSIONS: Family support lent to patients influences the control of glycemia.

[The prevalence of non-insulin-dependent diabetes mellitus in the rural population of Durango, Mexico]. / Prevalencia de diabetes mellitus no insulinodependiente en la población rural de Durango, México.

This study was carried out to determine the prevalence of non-insulin-dependent diabetes mellitus (NIDDM) in rural inhabitants of Durango, Mexico, and some of the risk factors for the disease. A random samples of 30,996 individuals aged 30 years and over was selected from 627 rural communities in Durango. These persons were interviewed between November 1993 and December 1994 to obtain information on several sociodemographic variables. A capillary blood sample was collected from each individual to determine his or her glucose level after 10-12 hours of fasting. Measures of central tendency and dispersion were calculated, and percentage distributions for the study variables were determined. Comparisons among proportions were made utilizing the chi-square test, and means were compared using Student's t test. The strength of associations was estimated with odds ratios, and 95% confidence intervals (CI 95%) were calculated for proportions. The final sample consisted of 31,028 persons, of whom 22,890 (73.8%) were women and 8,138 (26.2%) were men. A total of 1,004 cases of NIDDM were detected (3.2%; CI 95%:3.0 to 3.4), 767 in women and 237 in men. Only 9.2% of the study population was obese. The highest frequency of NIDDM was documented in persons 60 to 69 years of age. Family history of NIDDM was identified in 59.5% of the persons with the disease (CI 95%: 58.9 to 60.0) and in 26.3% of the healthy persons (CI 95%: 25.8 to 26.8). The low prevalence of NIDDM found in this study may be related to the low level of obesity in the population surveyed.

[Survival analysis in cirrhotic patients]. / Análisis de supervivencia en pacientes cirróticos.

BACKGROUND: Hepatic cirrhosis (HC) is a chronic and progressive disease that, independently of its etiology, favors the presence of some complications that impair the survival of patients. AIMS: To determine the frequency, etiology, and main decompensation factors, as well as analyse survival curves in HC of a population of Durango, México. METHODS: Cirrhotic patients of both sexes from the Hospital General del IMSS in Durango were included. The etiology of cirrhosis, the factors of decompensation and the grade of portal hypertension (PHT) were determined. A 39 month follow-up was done, registering complications and cause of death. STATISTICAL ANALYSIS: Fisher's exact test, Friedman's variance analysis, Mantel-Haenzsel chi-square test and Kaplan-Meier methods were used. RESULTS: Fifty patients were studied, 30 female and 20 male. The mean age was 54.3 years old (range 32-74 years). The more frequent etiology was alcoholic in 42% patients (19 male and 2 female). Forty three patients (86%) had decompensation by ascitis; 19 (38%) had variceal bleeding, 18(36%) had encephalopathy and 16(32%) were icteric. Twenty six patients (52%) had PHT III, and 30 (60%) were Child-Pugh class B. CONCLUSIONS: Survival in the decompensated group at 19.8 months follow-up was 62% and 73% in the total group, 20% died. Statistical significance (p < 0.05) was found between PHT grade and Child-Pugh functional class; hepatic reserve correlated inversely with bleeding (p < 0.05) and encephalopathy (p < 0.05) probability. The advanced grade of PHT directly correlated with bleeding encephalopathy and mortality (p < 0.05). We did not find any association between the etiology of cirrhosis and the incidence of complications.

[Prevalence of risk factors associated with hepatitis C in blood donors in the municipality of Durango, Mexico]. / Prevalencia y factores de riesgo asociados a hepatitis "C" en donadores de sangre en el municipio de Durango, México.

OBJECTIVE: To determine the prevalence of anti-viral hepatitis C antibodies (HCV-Ab+) in voluntary blood donors and to identify the main risk factors associated with it. MATERIAL AND METHODS: A case-control study was conducted over a 20-month period beginning in June 1993. A clinical history was obtained from all blood donors seen at the Centro Estatal de la Transfusión Sanguínea (State Blood Transfusion Center) and the Instituto Mexicano del Seguro Social in Durango, Mexico. HCV-Ab+ was determined in 5 915 serum assays using the second generation enzymatic immunoassay (UBI HCV EIA). RESULTS: The prevalence of HCV-Ab+ was 1.47 per 100 donors. The HCV-Ab+ prevalence was similar for urban and rural donors (1.54% and 1.34%) with no history of work migration. The main risk factors associated with HCV were a history of transfusions, (odds ratio -OR- 14.80, 95% confidence interval -CI-4.97-47.17) and sexual promiscuity or intercourse with prostitutes, (OR 6.53, 95% CI 2.61-16.54). CONCLUSIONS: The high prevalence of HCV-Ab+ may be explained by the lack of epidemiological surveillance of the population at risk. These data underscore the need for routine screening of HCV-Ab among voluntary blood donors and male or female prostitutes.