[Anti-hypertensive effect of eprosartan in diabetic patients]. / Efecto antihipertensivo del eprosartan en pacientes diabéticos.

OBJECTIVE: Diabetes mellitus seems to induce an special difficulty to control the high blood pressure. This effect is more severe on the SBP. Previous reports suggest that a new angiotensin receptor blocker, eprosartan, might have a higher efficacy to reduce SBP. It has been evaluated the BP decrease obtained with eprosartan in a group of diabetics patients compared to non diabetic patients. MATERIAL AND METHODS: 81 patients were recruited of whom 65 have ended follow-up. 34 patients were diabetics (mean age 66.7+/-10.7 years, 15 men and 19 women) and 31 were non diabetics control patients (mean age 61.8+/-12,8 years, 13 men and 18 women). All patients were treated with (600 mg) once daily. The doses was ingested in the morning. They were made three follow up visits (1, 3 and 6 mo after the first visit). RESULTS: SBP was significantly decreased both in diabetics (baseline 170.9+/-12.0, final 139.1+/-13.0 mmHg, p < 0.001) and in non diabetics group (baseline 169.9+/-18.0, final 142.0+/-13.3 mmHg, p < 0.001). DBP was also reduced in both groups (diabetics: baseline 92.9+/-9.7, final 78.4+/-8.5 mmHg, p < 0.001; non diabetics: baseline 95.6+/-7.9, final 79.1+/-7.4 mmHg, p < 0.001). Differences between the groups were not significant in any visit. Final BP reduction reached was -31.7/-14.6 mmHg in diabetics vs -27,6/-16,5 mmHg in non diabetics patients (difference is not significant) Pulse pressure changes were not different between the two groups (diabetics, 17.8+/-14.5, vs non diabetics, 11.1+/-13.2 mmHg). Two diabetic patients need a second drug to achieve BP goal and no one in non diabetic group. No adverse effects were reported. CONCLUSIONS: Eprosartan seems to be an effective drug to reduce SBP, DBP and pulse pressure with the same effectiveness in diabetics and non diabetic patients.

Efecto antihipertensivo del eprosartan en pacientes diabéticos / Anti-hipertensive effect of eprosartan in diabetic patients

Objetivo: La presencia de diabetes mellitus parece conferir una dificultad especial en el control de la HTA incidiendo particularmente sobre el componente sistólico de la PA. Estudios previos sugieren que un nuevo antagonista de los receptores de angiotensina, eprosartan, podría tener una mayor eficacia en la reducción de la PAS. Se ha evaluado de forma comparativa la reducción de la PA obtenida con eprosartan en un grupo de pacientes diabéticos y sin diabetes mellitus. Material y métodos: Se reclutaron para el estudio 81 pacientes de los cuales 65 habian terminado el periodo de seguimiento. De ellos, 34 pacientes eran diabéticos (edad 66,7 ± 10,7, 15 hombres y 19 mujeres) y 31 no padecían diabetes (edad 61,8 ± 12,8, 13 varones y 18 mujeres). Todos los pacientes fueron tratados con eprosartan (600 mg) en dosis única matutina. Se realizaron visitas de revisión al mes, a los 3 meses y a los 6 meses de la primera consulta. Resultados: La PAS se redujo significativamente tanto en el grupo de diabéticos ( inicial 170,9 ± 12,0, final 139,1 ± 13,0 mmHg, p < 0,001) como en el grupo sin diabetes (inicial 169,9 ± 18,0, final 142,0 ± 13,3 mmHg, p < 0,001). Lo mismo ocurrió con la PAD tanto en diabéticos (inicial 92,9 ± 9,7, final 78,4 ± 8,5 mmHg, p < 0,001) como en pacientes sin diabetes (inicial 95,6 ± 7,9, final 79,1 ± 7,4 mmHg, p < 0,001). Las diferencias entre ambos grupos no fueron significativas ni en la visita inicial ni en ninguna de las visitas de revisión. La reducción final obtenida fue -31,7 / -14,6 mmHg en diabéticos y -27,6 / -16,5 mmHg en paciente sin diabetes (diferencia sin significación). La reducción final en la presión de pulso no fue diferente entre ambos grupos (diabéticos, 17,8 ± 14,5, frente a pacientes sin diabetes, 11,1 ± 13,2 mmHg). Dos pacientes diabéticos necesitaron añadir otro fármaco al tratamiento para conseguir el control de la PA y ninguno en el grupo de pacientes sin diabetes. No se han detectado efectos secundarios. Conclusiones: El eprosartan demostró ser un fármaco efectivo para reducir ambos componentes de la PA, sin perder eficacia en los pacientes que padecen diabetes mellitus (AU)

[Relationship between clozapine plasma levels and withdrawal symptoms]. / Relación entre los síntomas de discontinuación y los niveles plasmáticos de clozapina.

Discontinuation of clozapine and an attempt to change his medication to sertindol has led to serious psychotic and somatic symptoms in an schizophrenic patient treated with clozapine for five years, however after readministration of clozapine these symptoms rapidly disappeared. To further analyse the case we have developed an HPLC method for the measurement of plasma levels of clozapine and its main metabolite N-desmethyl clozapine in order to monitor the plasma levels of clozapine and to correlate with the clinical symptoms. The present results confirmed that after discontinuation of clozapine no measurable amount of drug or its main metabolite were present in the plasma of the patient. The correlation between the plasma levels of clozapine and the changes in the clinical state of the patient confirmed that the patient's severe psychotic and somatic symptoms were the result of discontinuation of clozapine treatment. The clozapine plasma concentration of the patient reported here was low (100 ng/ml) compared to the generally accepted plasma levels for antipsychotic action of clozapine (350 ng/ml), however the somatic and psychotic clozapine withdrawal symptoms rapidly and completely disappeared.

[Poisoning by organophosphate insecticides. Epidemiology and prevention]. / Por. Epidemiología y prevención.

In an agrarian environment, exposure to anticholinesterasic insecticides is a potential health problem. Acute or chronic intoxication may cause serious health problems due to its frequency or its severity. Extremadura is, as are other Spanish autonomous regions, mainly a rural environment which means that this problems carries special relevance there. In this article, the authors evaluate the number of cases of intoxication, the validity of the measures taken, and they describe the pedagogical programs which exist dealing with this problem. They review the physiopathological causes of this intoxication, its symptoms and its treatment. The authors reveal the results obtained from a questionnaire given to a group of Extremaduran farmers. Furthermore, the authors provide information to health professionals responsible for the treatment and prevention of this intoxication; the authors consider health education, especially in an agrarian environment, to be one of the most important action plans in order to prevent this intoxication and to reduce its mortality and chronic manifestations due to exposure to these agents.

[Subcutaneous drug administration. Indications for the use in terminal patients]. / Vía subcutánea. Indicaciones de uso en el enfermo terminal.

The preferred methods to administer medicines to the sick are oral, under the tongue, or rectal; but in the case of the terminally ill patient, we may encounter the problem that the drugs which they tend to require do not come in either of these preferred administering methods since these patients symptoms and problems demand complex responses. In these cases, the subcutaneous way winds up being highly recommended; therefore, the authors present the pharmacological bases of this method, they describe continuous subcutaneous perfusion, and all those aspects of this method which might be interesting to the professionals who employ it.