Prevalence of coronary artery disease risk factors in workers at the general hospital of Mexico of the ministry of health.

OBJECTIVE: To assess the prevalence of coronary risk factors in 2,463 health-care workers at the General Hospital of Mexico. METHODS: The study participants--1,620 women (65.8%) and 843 men (34.2%)--ranged in age from 16 to 65 years old. Study subjects were classified into five occupational subgroups: maintenance workers, 477 (19.4%); administrators, 697 (28.3%); physicians, 495 (20.1%); nursing staff, 559 (22.7%); and students, 235 (9.5%). For each participant, a clinical history was elicited, anthropometric determinations were done, and samples were obtained for determining blood glucose, total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride levels. RESULTS: Cholesterol levels above 6.2 mmol/L (>240 mg/dL) were found in 14.9% of the women and 14.8% of the men in the overall study group. Triglyceride levels of more than 2.25 mmol/L (>200 mg/dL) were found in 471 participants (19.1%). The prevalence of obesity was 13.5%, and high blood pressure was detected in 22.2% of study participants. Only 32.2% of subjects engaged in physical exercise one or more times per week; moreover, 32% of those surveyed smoked. The prevalence for diabetes mellitus was 6.25%. The multifactorial coronary risk index was high in 13.2% of men and 43.2% of women older than 30 years of age. CONCLUSION: This study confirmed the high prevalence of risk factors for cardiovascular diseases in personnel of the General Hospital of Mexico. Because many of these risk factors are modifiable, educational efforts and preventive measures should be implemented.

Metformin's effects on glucose and lipid metabolism in patients with secondary failure to sulfonylureas.

OBJECTIVE: To compare results obtained with metformin versus those obtained with DNA-recombinant insulin in obese patients with NIDDM suffering from secondary failure to sulfonylureas. RESEARCH DESIGN AND METHODS: We conducted an open, prospective, randomized, and comparative study comprising a total of 60 patients selected and placed in two parallel groups. We had previously confirmed that the subjects had secondary failure to high doses of sulfonylureas. The initial metformin dosage was a single 850 mg tablet, and the dosage was increased to two or three tablets depending on the patient's metabolic changes. The initial dosage of DNA-recombinant insulin was 24 U, subcutaneously administered and divided into two portions: two-thirds at around 8:00 A.M., before breakfast, and the remaining third at 8:00 P.M., before dinner. The dosage was adjusted based on the patient's clinical and metabolic response. RESULTS: The initial average glucose value for the metformin group was 269.1 +/- 32.2 mg/dl, decreasing by the end of the study to 159.7 +/- 30.5 mg/dl. For the insulin group, these figures went from 270.7 +/- 24.0 mg/dl at the beginning of the study to 134.8 +/- 26.7 mg/dl. This decrease correlates with the reduction in glycosylated hemoglobin from 12.8 to 8.9% for the first group and from 12.3 to 8.2% for the second, as well as with the reduction in triglyceride values from 230.3 to 183.1 mg/dl and from 218.4 to 186.3 mg/dl, respectively. The BMI (27.5-26.4), blood pressure (systolic from 145.7-132.1 mmHg, diastolic from 90.3-84.8 mmHg), and total cholesterol levels (235-202 mg/dl) decreased in only the metformin group. CONCLUSIONS: Metformin is an effective, safe, and well-tolerated treatment that improves metabolic control and favorably modifies secondary clinical alterations due to insulin resistance, such as arterial hypertension, overweight, and hyperlipidemia, in obese patients with NIDDM suffering from secondary failure to sulfonylureas.

[The efficacy, safety and tolerance of fluvastatin sodium 40 mg in patients with hyperlipidemia type IIA]. / Eficacia, seguridad y tolerabilidad de la fluvastatina sódica 40 mg en pacientes con hiperlipidemia tipo IIA.

Fluvastatin sodium is the first wholly synthetic 3 hydroxy-3-methylglytary 1 coenzyme A reductase inhibitor. It reduces cholesterol synthesis, enhances low density lipoprotein catalysis and hepatocyte LDL receptor expression. To evaluate the efficacy, tolerability and safety of fluvastatin sodium 40 mg once a day, we studied 40 patients with type IIA dyslipidemia. We observed a statistically significant reduction in total cholesterol (20.7%, p < 0.01), low density lipoprotein cholesterol (29.5%, p < 0.01), triglycerides (10.56%, p N.S.), very low density lipoprotein cholesterol (10.56%, p N.S.), C-LDL:C-HDL (33.7%, p < 0.01) and an increase in high density lipoprotein cholesterol (2.8%) after 12 weeks of treatment. No patient reported side effects and no clinically significant modifications in safety parameters were observed during the study. We conclude that fluvastatin sodium 40 mg once daily is efficacious, safe and well tolerated in the treatment of type IIA primary dyslipidemia.

Combinación de insulina con sulfonilureas en pacientes diabéticos tipo II con control deficiente: estudio abierto / Combination therapy of insulin and sulfonylureas in type II diabetic patients with deficient control. An open study

El tratamiento combinado con insulina y sulfonilureas en pacientes diabéticos tipo II que no responden al tratamiento oral con hipoglucemiantes ha sido un tema de interés reciente. Varios estudios han demostrado mejoría en el control metabólico de la glucemia; sin embargo, no se han determinado las características que presentan los pacientes en los que se obtiene un mayor beneficio. En este estudio, durante 12 semanas evaluamos los resultados alcanzados con el tratamiento combinado de hipoglucemiantes orales por la mañana y de insulina a bajas dosis antes de la cena, en 35 pacientes diabéticos tipo II con falla secundaria a las sulfonilureas. Se demostró una mejoría significativa en el grupo estudiado, tanto en la glucemia de ayuno (de 14.9 a 7.81 mmol/l) como en la postprandial (de 14.09 a 10.86 mmol/l). Fue más notorio el beneficio en aquellos que al inicio del estudio presentaron cifras más altas de glucemia y de péptido C, así como en quienes tuvieron una mejor función renal valorada por medio del filtrado glomerular. La edad, el peso y el tiempo de evolución de la diabetes, no mostraron correlación. Se concluye que la terapia combinada es una buena elección, más aún si tomamos en cuenta los marcadores que correlacionan con un mayor beneficio

[Experience with a screening program for gestational diabetes]. / Experiencia con un programa de escrutinio de diabetes gestacional.

OBJECTIVE: To determine the prevalence of gestational diabetes (GD) in an outpatient clinic in northeastern Mexico. PATIENTS: 732 consecutive pregnant women referred for prenatal care during a two-year period. INTERVENTION AND OUTCOME MEASURE: A 100 g glucose tolerance test was performed in the patients with sampling at 1, 2 and 3 hours postchallenge. The patients were classified according to the criteria of the American Diabetes Association as normal, abnormal, and a third category of those showing a single abnormal value in the tolerance test. RESULTS: Six percent of the women (44/732) had GD and 1.4% (10/732) had one abnormal value. A comparison group was made with a subset of 44 of the 678 women who showed a normal tolerance test. No group differences were seen in parity, and age, nor in body weight gain or changes in body mass index, the latter measured in the initial and final weeks of pregnancy. Significant differences versus the normal women were seen in the GD group for cesarean births (43% vs 30%) and in macrosomy (25% vs 7%). The group with one abnormal test showed high values in cesareans (50%) and macrosomy (10%) but did not reach significant difference with the other groups. CONCLUSIONS: GD was higher in our study than in the only paper on GD prevalence reported in Mexico (3.9%). The higher incidence of cesareans and macrosomy in GD makes it necessary to consider therapeutic interventions in these cases.

Surgical disconnection of the medial basal hypothalamus and pituitary function in the rhesus monkey. III. Thyroxine secretion.

The effects of complete and anterior disconnection of the medial basal hypothalamus (MBH( on TSH secretion in the rhesus monkey were assessed by measuring serum thyroxine concentrations. Following complete MBH disconnection, serum thyroxine concentrations declined to 50% of preoperative control levels within 7 days. In 6 of 10 animals, thyroxine levels remained depressed throughout the postoperative observation period of 60 to 150 days. In the remainder, serum thyroxine concentrations returned to control levels after 3 weeks. Anterior disconnection of the MBH had variable effects on thyroid function. In 4 of 7 animals, serum thyroxine concentrations declined for 5 days following the operation but returned to preoperative levels within the next 3 weeks. In 2 others, serum thyroxine levels did not change while in the remaining animal thyroxine concentrations increased transiently to twice preoperative levels before returning to normal values. Thus, in the monkey, as in the rat, anterior MBH disconnection has little consistent effect on thyroid function, while complete isolation of the MBH causes a moderate decline which is most readily attributable to a decrease in thyrotropin secretion. The variations in the effects of anterior and complete MBH disconnection on thyroid function could not be confidently correlated with variations in the placement of the cuts.