Registro de Alteplasa en Síndromes Coronarios Agudos con elevación del ST (REALSICA) / Alteplase in acute coronary syndromes

OBJECTIVE: The registry intends to establish the safety and security of one-hour 100 mg alteplase infusion and 50 mg in 30 minutes to facilitate percutaneous coronary intervention (PCI) in a cardiology hospital with primary angioplasty program (24 hours 365 days a year) with current doses of unfractionated heparin and enoxaparin. METHODS AND RESULTS: REALSICA II is a prospective registry that included 103 patients with final diagnosis of ST elevation myocardial infarction in which Alpert's quality criteria were used. Seventy two patients were under one-hour 100 mg alteplase infusion and thirty one under 30 minutes 50 mg alteplase infusion to facilitate PCI. Patients were young and predominantly males. In both groups > 50% had extensive ST elevation myocardial infarction and 68% were Killip & Kimball I. The majority received reperfusion > 3 hours after the onset of symptoms. In-hospital and follow-up treatment were compliant with Mexican Cardiology Society guidelines. ECG reperfusion was observed in 59% and TIMI III flow in 19% of PCI group. Any intracranial hemorrhage was observed. Global cardiovascular mortality was 11%. Patients under PCI had low incidence of recurrent ischemia and reinfarction. CONCLUSION: REALSICA registry showed in non-complicate acute myocardial infarction ST elevation safety and security of one-hour 100 mg alteplase infusion with current recommended unfractionated heparin and enoxaparin doses in ST elevation myocardial infarction. In complicated patients the regimen to facilitate PCI was associated with increased hemorrhagic complications and requires further research.

Detección de diabetes mellitus no insulinodependiente en adultos asintomáticos / Screening for non-insulin dependent diabetes mellitus in asymptomatic adults

Se estudio un grupo de 1,011 adultos clínicamente sanos mayores de 20 años que asistieron por algún motivo a las unidades de medicina familiar del IMSS. Se interrogaron antecedentes de biabetes mellitus en familiares directos, se midieron la estatura, el peso y los perímetros de la cintura y de la cadera, con los cuales se calcularon los índices de masa corporal (IMC) y la relación cintura/cadera; se tomó una muestra de sangre capilar para la determinación de glucosa empleando un refractómetro. El 35.6 por ciento del grupo refirió antecedentes de diabetes en familiares directos y 26 por ciento tuvieron un IMC > 30. Las personas con cifras de glucosa arriba de 160 mg/dL (17/1011) fueron evaluados con glucemias de ayuno: se diagnóstico diabetes mellitus en 12/17 (1.2 por ciento del total de la muestra). No se encontró ninguna persona menor de 30 años con diabetes mellitus, pero se encontraron 3/237 en los de 30-39 años (1.3 por ciento en este subgrupo) y se identificaron nueve personas en el grupo de mayores de 40 años. La obesidad centrípeta predominó en los varones obesos, 74/74, mientras que sólo se identificó en 61/189 (32.3 por ciento) de las mujeres obesas