Índice de inmunidad-inflamación sistémica (IIS) como marcador pronóstico de mortalidad en pacientes con COVID-19.

OBJECTIVE: To determine if the systemic immune-inflammation index (SII) is a prognostic marker of mortality in COVID-19 patients. METHOD: Retrospective study that included patients admitted to a general hospital in Mexico City with diagnostic of COVID-19, confirmed by quantitative polymerase chain reaction from nasopharyngeal swab specimens in addition to characteristic symptomatology and computerized thoracic tomography imaging. Upon admission an hematic biometry was taken to calculate the SII (neutrophils × platelets/lymphocytes). The optimal cut-off point was determined from a ROC curve; the chi-square test was used to evaluate the association of SII with mortality, the strength of the association was estimated through the odds ratio (OR) and, finally, a multivariate binary logistic regression analysis was performed. RESULTS: 140 individuals were included, 86 (61.4%) men and 54 women (38.6%), the mean age of patients was 52 (± 13.81) years old. The best prognostic cut-off point found was 2332.30 × 109 (area under the curve: 0.68; 95% confidence interval [95% CI]: 0.59-0.77; p < 0.05). The OR was 3.78 (95% CI: 1.83-7.82; p < 0.05). CONCLUSIONS: We demonstrated that the SII is an easily available tool, effective and a prognostic marker of mortality in hospitalized COVID-19 patients.

OBJETIVO: Determinar si el índice de inmunidad-inflamación sistémica (IIS) es un marcador pronóstico de mortalidad en pacientes con COVID-19. MÉTODO: Estudio retrospectivo que incluyó pacientes que ingresaron con diagnóstico de COVID-19 a un hospital general de la Ciudad de México, confirmado mediante prueba de reacción cuantitativa en cadena de la polimerasa con transcriptasa inversa de muestras de hisopado nasofaríngeo, además de la sintomatología característica y los hallazgos de la tomografía computarizada de tórax. A su ingreso se les realizó biometría hemática para el cálculo del IIS (neutrófilos × plaquetas/linfocitos). Mediante una curva ROC se determinó el punto de corte óptimo del IIS. Para evaluar la asociación del IIS con la mortalidad se utilizó la prueba de ji al cuadrado, la fuerza de la asociación con la razón de momios (OR, odds ratio) y se realizó un análisis multivariado de regresión logística binaria. RESULTADOS: Se incluyeron 140 individuos, de los cuales 86 (61.4%) eran hombres y 54 (38.6%) mujeres, con una media de edad de 52 (± 13.81) años. El mejor punto de corte pronóstico fue 2332.30 × 109 (área bajo la curva: 0.68; intervalo de confianza del 95% [IC95%]: 0.59-0.77; p < 0.05). La OR fue de 3.78 (IC95%: 1.83-7.82; p < 0.05). CONCLUSIONES: El IIS mostró ser una herramienta de fácil disponibilidad y un marcador pronóstico de mortalidad al ingreso en pacientes hospitalizados con COVID-19.

Trastornos glucémicos y su asociación con la función pulmonar. Estudio transversal analítico / Glycemic disorders and their impact on lung function. Cross-sectional study

Antecedentes y objetivo: La diabetes mellitus puede afectar a los pulmones en diversas estructuras y funciones. Actualmente, se están realizando investigaciones para establecer la repercusión clínica de la hiperglucemia sobre la función pulmonar. El objetivo de este estudio es determinar si el estado glucémico (euglucémico, prediabetes o diabetes) se asocia con la disminución de los volúmenes pulmonares determinados mediante espirometría. Pacientes y métodos: Se trata de un estudio transversal analítico, realizado en el Hospital General Ticomán de la Ciudad de México. A los participantes se les determinó la concentración de glucosa y hemoglobina glucosilada (HbA1c), para establecer si eran portadores de un trastorno glucémico. A todos ellos se les realizó una espirometría forzada, obteniendo el volumen espiratorio al primer segundo (VEF1), la capacidad vital forzada (CVF), la relación VEF1/CVF, y el flujo espiratorio pico (FEP). Se categorizaron los pacientes en sujetos euglucémicos, prediabéticos y diabéticos según los criterios de la ADA. Se compararon los volúmenes pulmonares entre los grupos. Resultados: Se estudiaron un total de 55 sujetos, siendo 43 mujeres y 12 hombres. De esta muestra, 14 eran euglucémicos, 9 prediabéticos, y 32 diabéticos. Los individuos diabéticos presentan una disminución del %FEP comparados con los sujetos prediabéticos y los euglucémicos. Los valores de glucosa sérica en ayuno correlacionan con la disminución del %VEF1, VEF1/CVF y %FEP, mientras que la HbA1c solo se correlaciona con la disminución del %FEP. Conclusión: Los sujetos con diabetes presentan un %PEF menor que los sujetos euglucémicos y los prediabéticos, mientras que el %VEF1, %CVF y la relación VEF1/CVF no varían entre los diferentes estados glucémicos. El descontrol glucémico agudo se correlaciona con la disminución de más parámetros espirométricos que el descontrol crónico

Background and objective: Diabetes mellitus can affect the lungs, in its various structures and functions. Current research is being conducted to establish the clinical impact of hyperglycaemia on lung function. The objective of this study is to determine if the glycaemic state (euglycaemic, prediabetes or diabetes) is associated with a decrease in lung volume, determined by spirometry. Patients and methods: An analytical cross-sectional study was carried out at the Ticomán General Hospital in Mexico City. Glucose and glycosylated haemoglobin concentration were used as the parameters to determine if the subjects had a glycaemic disorder. They were further categorised into euglycaemic, prediabetic and diabetic subjects according to ADA criteria guidelines. The subjects underwent forced spirometry testing, obtaining expiratory volume at the first second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and peak expiratory flow (FEP). The lung volumes between the groups were compared. Results: A total of 55 subjects were studied; 43 women, and 12 men; 14 euglycaemic, 9 prediabetic, and 32 with diabetes. Diabetic individuals presented a %FEP decrease compared to the prediabetic and euglycaemic subjects. The fasting serum glucose values correlated with decrease of %FEV1, FEV1/FVC and %FEP, while the HbA1c concentration only correlated with the decrease of %FEP. Conclusions: Subjects with diabetes have a lower %PEF than euglycaemic and prediabetic subjects, while the %FEV1, %FVC and the FEV1/FVC ratio do not vary between the different glycaemic states. Acute glycaemic non-control correlated with a decrease in more spirometric parameters than chronic glycaemic non-control

Asociación entre elevación sérica de gamma-glutamil transpeptidasa y riesgo aumentado de evento vascular cerebral isquémico en población mexicana / Relation between serum elevation of gamma-glutamyl transpeptidase and increased risk of ischemic stroke in Mexican population

Resumen: ANTECEDENTES: Las concentraciones elevadas de gamma-glutamil transpeptidasa (GGT) se han asociado con el riesgo de enfermedad coronaria isquémica, diabetes mellitus tipo 2 y evento vascular cerebral. OBJETIVO: Determinar mediante métodos estadísticos estandarizados que la elevación sérica de gamma-glutamil transpeptidasa es predictor temprano de evento vascular cerebral en la población mexicana. MATERIAL Y MÉTODO: Estudio tipo casos y controles, con medición de GGT sérica en pacientes con enfermedades crónico-degenerativas en control y pacientes crónicos con un evento cardiovascular adverso, en este caso, un evento vascular cerebral de tipo isquémico (EVC), efectuado de mayo de 2016 a julio de 2017. RESULTADOS: Se incluyeron 74 pacientes; los pacientes con EVC tuvieron, en pro- medio, 17.81 U/L de GGT más que los controles ajustado por edad, con diferencia estadísticamente significativa (p = 0.038, IC95% 1.04-34.57). CONCLUSIONES: Las concentraciones de gamma-glutamil transpeptidasa se correlacionan de manera directamente proporcional con el riesgo cardiovascular, lo que tiene gran importancia debido a que se ha demostrado que sus concentraciones séricas pueden disminuirse con medidas como dieta y ejercicio, por lo que se abre un amplio panorama para posteriores estudios que puedan reafirmar la validez de éste y hacer otros con un enfoque preventivo.

Abstract: BACKGROUND: Elevated levels of gamma-glutamyl transpeptidase (GGT) have been associated with the risk of ischemic heart disease, diabetes mellitus and stroke. OBJECTIVE: To determine, by means of standardized statistical methods, that the serum elevation of GGT is an early predictor of ischemic stroke in the Mexican population. MATERIAL AND METHOD: A case-control study was conducted with measurement of serum GGT in patients with chronic-degenerative diseases without cardiovascular events and chronic patients with an adverse cardiovascular event, in this case, an ischemic stroke, done from May 2016 to June 2017. RESULTS: A total of 74 patients were analyzed; patients with ischemic stroke presented, on average, 17.81 U/L of GGT more than controls adjusted for age, with a statistically significant difference (p = 0.038, 95%CI 1.04- 34.57). CONCLUSIONS: GGT levels correlated directly with cardiovascular risk, which is of great importance, since it has been shown that serum levels can be reduced with measures such as diet and exercise, so that a broad panorama opens up for further studies that can reaffirm the validity of this study and do others with a preventive approach.

Glycemic disorders and their impact on lung function. Cross-sectional study. / Trastornos glucémicos y su asociación con la función pulmonar. Estudio transversal analítico.

BACKGROUND AND OBJECTIVE: Diabetes mellitus can affect the lungs, in its various structures and functions. Current research is being conducted to establish the clinical impact of hyperglycaemia on lung function. The objective of this study is to determine if the glycaemic state (euglycaemic, prediabetes or diabetes) is associated with a decrease in lung volume, determined by spirometry. PATIENTS AND METHODS: An analytical cross-sectional study was carried out at the Ticomán General Hospital in Mexico City. Glucose and glycosylated haemoglobin concentration were used as the parameters to determine if the subjects had a glycaemic disorder. They were further categorised into euglycaemic, prediabetic and diabetic subjects according to ADA criteria guidelines. The subjects underwent forced spirometry testing, obtaining expiratory volume at the first second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and peak expiratory flow (FEP). The lung volumes between the groups were compared. RESULTS: A total of 55 subjects were studied; 43 women, and 12 men; 14 euglycaemic, 9 prediabetic, and 32 with diabetes. Diabetic individuals presented a %FEP decrease compared to the prediabetic and euglycaemic subjects. The fasting serum glucose values correlated with decrease of %FEV1, FEV1/FVC and %FEP, while the HbA1c concentration only correlated with the decrease of %FEP. CONCLUSIONS: Subjects with diabetes have a lower %PEF than euglycaemic and prediabetic subjects, while the %FEV1, %FVC and the FEV1/FVC ratio do not vary between the different glycaemic states. Acute glycaemic non-control correlated with a decrease in more spirometric parameters than chronic glycaemic non-control.

Correlación entre el grosor de la grasa epicárdica y los marcadores bioquímicos de riesgo metabólico / Correlation between epicardial fat thickness and biochemical markers of metabolic risk

Introducción y objetivo: La grasa epicárdica se asocia a riesgo cardiovascular y aterosclerosis, y puede ser medida en forma fiable por ecocardiografía. Nuestro objetivo es evaluar si existe asociación entre el grosor de la grasa epicárdica (GGE) con marcadores bioquímicos de riesgo metabólico. Material y método: Evaluamos 211 pacientes en quienes se realizó la medición del GGE por ecocardiografía. También se les se realizó glucemia, perfil de lípidos y niveles séricos de ácido úrico. Los métodos estadísticos usados fueros odds ratio y coeficiente de correlación y determinación de Pearson. Resultados: No encontramos correlación entre GGE con glucemia (r=0,064), colesterol total (r=0,005), colesterol ligado a lipoproteínas de alta densidad (r=-0,038), ni triglicéridos (r=0,118). Sin embargo, encontramos una correlación significativa entre el GGE con la uricemia (r=0,415, p<0,00001). La odds ratio para presentar GGE>3mm en pacientes con hiperuricemia fue de 6,26 (IC 95%: 2,79-14, p<0,0001). Conclusión: La hiperuricemia se correlaciona significativamente con el GGE en nuestra población. La medición del GGE por ecocardiografía puede ser un método de utilidad para evaluar el riesgo cardiovascular

Introduction and objective: Epicardial fat has been associated with increased cardiovascular risk and the development of atherosclerosis. Transthoracic echocardiography provides a reliable measurement of epicardial fat thickness (EFT). The aim of this study is to evaluate the relationship between EFT and biochemical parameters of metabolic risk. Material and method: We assessed 211 patients who underwent echocardiography; EFT was measured by two cardiologists. In addition, patients’ glycaemia, lipid profile and serum uric acid were measured. Statistical analysis was performed with the Pearson coefficient test and Odds ratio. Results: A positive correlation between EFT with glycaemia (r=.064), total serum cholesterol (r=.0056), high density lipoproteins (r=-0.038), or with triglycerides (r=.118) was not observed. However, we did find a significant positive correlation between EFT and serum uric acid (r=.415, P<.00001). The odds ratio for EFT>3mm in patients with hyperuricemia was 6.26 (IC 95 2.79-14, P<.0001). Conclusion: Hyperuricemia is strongly associated with EFT in Mexican patients; EFT is a useful tool for global cardiovascular risk calculation

[Effect of the components of the metabolic syndrome on pulmonary function. The unexpected role of high-density lipoprotein cholesterol]. / Efecto de los componentes del síndrome metabólico en la función pulmonar. El inesperado papel del colesterol ligado a lipoproteínas de alta densidad.

BACKGROUND: Metabolic syndrome is a condition that predisposes to cardiovascular disease and diabetes mellitus. In addition, it can have effects over neoplastic pathologies, liver and pulmonary function. Our objective is to analyze the effect of the metabolic syndrome and its components on pulmonary function. METHOD: 110 subjects from Mexico City were evaluated and anthropometric measurements, glucose determination, triglycerides and high-density lipoprotein (HDL) cholesterol were made. They underwent a simple spirometry. Diagnosis of metabolic syndrome was made following the NCEP-ATPIII criteria. RESULTS: Of 110 individuals, 90 (82%) were women and 20 men (18%); 71 subjects (65%) presented metabolic syndrome. Subjects with central obesity had a forced vital capacity (FVC) lower than subjects without central obesity (2.72 vs. 3.11 liters; p < 0.05). Those with low HDL had better spirometric results than subjects with normal HDL (FEV1 2.36 vs. 1.85 liters; p < 0.05), FVC (2.95 vs. 2.45 liters; p < 0.05) and FEV1/FVC ratio (0.78 vs.74; p < 0.05). Hypertensive subjects presented lower volumes in FEV1 (1.91 vs. 2.38; p < 0.05) and FVC (2.49 vs. 2.99; p < 0.05). CONCLUSION: There is no difference between the spirometry volumes of patients with metabolic syndrome versus the metabolically healthy subjects. The only factors associated with a decrease in FEV1 and FVC are central obesity and arterial hypertension. An unexpected finding was the negative correlation between HDL levels and lung function.

ANTECEDENTES: El síndrome metabólico es un estado que predispone a enfermedad cardiovascular y diabetes mellitus. Además, puede repercutir en la función hepática, en patologías neoplásicas y en la función pulmonar. Nuestro objetivo es analizar el efecto del síndrome metabólico y sus componentes sobre la función pulmonar. MÉTODO: Se evaluaron 110 sujetos de la Ciudad de México a quienes se realizaron mediciones antropométricas, determinación de glucosa, triglicéridos y colesterol ligado a lipoproteínas de alta densidad (HDL). Se les practicó una espirometría simple. Se realizó el diagnóstico de síndrome metabólico siguiendo los criterios NCEP-ATPIII. RESULTADOS: De 110 individuos, 90 (82%) fueron mujeres y 20 hombres (18%), y 71 (65%) presentaron síndrome metabólico. Los sujetos con obesidad central tuvieron una capacidad vital forzada (CVF) menor que aquellos sin obesidad central (2.72 vs. 3.11 l; p < 0.05). Los que presentaron colesterol HDL bajo tuvieron mejores resultados espirométricos que los sujetos con colesterol HDL normal (volumen espiratorio forzado en el primer segundo [VEF1] 2.36 vs. 1.85 l; p < 0.05), mejor CVF (2.95 vs. 2.45 l; p < 0.05) y mejor relación VEF1/CVF (78 vs. 74; p < 0.05). Los sujetos hipertensos presentaron menores volúmenes en VEF1 (1.91 vs. 2.38; p < 0.05) y CVF (2.49 vs. 2.99; p < 0.05). CONCLUSIÓN: No existe diferencia en los volúmenes espirométricos de pacientes con síndrome metabólico al compararlos con sujetos metabólicamente sanos. Solo la obesidad central y la hipertensión arterial se asocian con disminución del VEF1 y la CVF. Un hallazgo inesperado es la correlación negativa entre los valores de colesterol HDL y la función pulmonar.

Valor del índice proteína C reactiva/albúmina en el diagnóstico de sepsis / Value of C-reactive protein (CRP)/albumin index in the diagnosis of sepsis

Resumen ANTECEDENTES La sepsis es una de las principales causas de morbilidad y mortalidad en todo el mundo, en esta enfermedad el efecto de la respuesta inflamatoria puede empeorar el pronóstico del paciente. OBJETIVO Averiguar si existe correlación entre el índice proteína C reactiva (PCR)/albúmina y las escalas SOFA y qSOFA a fin de establecer su utilidad como herramienta diagnóstica. MATERIAL Y MÉTODO Estudio transversal analítico, realizado de julio de 2016 a junio de 2017 en el Servicio de Urgencias del Hospital General Xoco, SEDESA. Se incluyeron pacientes en quienes se estableció diagnóstico de sepsis mediante las escalas SOFA y qSOFA en quienes se determinó el índice PCR/albúmina, posteriormente se procedió a buscar correlación entre estas mediciones. RESULTADOS Se incluyeron 30 pacientes. No se observó correlación entre los puntajes qSOFA (p = 0.79) y SOFA (p = 0.40) con el índice PCR/albúmina. El índice PCR/albúmina fue menor en el sexo femenino (p = 0.03). Se encontró una relación estadísticamente significativa de la muerte hospitalaria con un índice PCR/albúmina menor (p = 0.05). Otras variables que se correlacionaron con la muerte fueron la edad (p = 0.01) y la escala SOFA (p = 0.02). CONCLUSIONES No existe correlación significativa entre el índice PCR/albúmina y los puntajes qSOFA y SOFA en el diagnóstico de sepsis. Se encontró un índice PCR/albúmina menor en los pacientes del sexo femenino y que tuvieron muerte hospitalaria. Otras variables que se correlacionaron con la muerte fueron la edad y el puntaje SOFA.

Abstract BACKGROUND Sepsis is one of the main causes of morbidity and mortality worldwide, in this entity the impact of the inflammatory response can worsen the patient's prognosis. OBJECTIVE To find out if there is a correlation between the C-reactive protein (CRP)/albumin index and SOFA and qSOFA scores that allow us to establish its utility as a diagnostic tool. MATERIAL AND METHOD A cross-sectional analytical study carried out from July 2016 to June 2017 at the Emergency Department of the General Hospital Xoco, SEDESA. We included patients who were diagnosed with sepsis using SOFA and qSOFA scales in whom the CRP/albumin index was determined. We then proceeded to search for correlation between these measurements. RESULTS There were included 30 patients. There was no correlation between qSOFA (p = 0.79) and SOFA (p = 0.40) scores with the CRP/albumin index. This index was lower in females (p = 0.03). We found a statistically significant relationship of hospital death with a lower CRP/albumin index (p = 0.05). Other variables that correlated with death were age (p = 0.01) and SOFA (p = 0.02). CONCLUSIONS There is no significant correlation between CRP/albumin index and qSOFA and SOFA score in the diagnosis of sepsis. A lower CRP/albumin index was found in female patients and who died in hospital. Other variables that correlated with death were age and SOFA score.

Correlation between epicardial fat thickness and biochemical markers of metabolic risk. / Correlación entre el grosor de la grasa epicárdica y los marcadores bioquímicos de riesgo metabólico.

INTRODUCTION AND OBJECTIVE: Epicardial fat has been associated with increased cardiovascular risk and the development of atherosclerosis. Transthoracic echocardiography provides a reliable measurement of epicardial fat thickness (EFT). The aim of this study is to evaluate the relationship between EFT and biochemical parameters of metabolic risk. MATERIAL AND METHOD: We assessed 211 patients who underwent echocardiography; EFT was measured by two cardiologists. In addition, patients' glycaemia, lipid profile and serum uric acid were measured. Statistical analysis was performed with the Pearson coefficient test and Odds ratio. RESULTS: A positive correlation between EFT with glycaemia (r=.064), total serum cholesterol (r=.0056), high density lipoproteins (r=-.038), or with triglycerides (r=.118) was not observed. However, we did find a significant positive correlation between EFT and serum uric acid (r=.415, P<.00001). The odds ratio for EFT>3mm in patients with hyperuricemia was 6.26 (IC 95 2.79-14, P<.0001). CONCLUSION: Hyperuricemia is strongly associated with EFT in Mexican patients; EFT is a useful tool for global cardiovascular risk calculation.

Circulating Levels of Uric Acid and Risk for Metabolic Syndrome.

Hyperuricemia leads to insulin resistance, whereas insulin resistance decreases renal excretion of uric acid, both mechanisms link elevated serum uric acid with metabolic syndrome. The aim of this study is to evaluate the probability for the development of metabolic syndrome in low-income young adults with hyperuricaemia. METHODS: We evaluated 103 patients less than 40 years of age, from a low-income population, and without history of cardiovascular disease, in all of them the presence of metabolic syndrome was assessed in accordance with the International Diabetes Federation criteria. In all patients, fasting serum uric acid levels were measured; hyperuricaemia was defined as serum uric acid values 6.5 mg/dl in men and 5.1 mg/dl in women. Statistical analysis was performed with odds ratio. RESULTS: 83 of our patients (80.5%) suffered metabolic syndrome, the odds ratio for the presence of metabolic syndrome in patients with hyperuricaemia was 5.1 (p=0.002, I.C 1.8- 14.5). When patients were evaluated by gender a significantly association between hyperuricaemia and metabolic syndrome was found in women (odds ratio 3.6, p=0.048, C.I. 1.0-12.9), and men (odds ratio 10.2, p= 0.015, IC 1.5-13.2). When uric acid was correlated with the components of metabolic syndrome, we only found a positive correlation with waist circumference (r=0.483). CONCLUSION: Our results showed a significant association between hyperuricemia and metabolic syndrome in low-income young adults in Mexico. DR is associated with estimated risk of CVD in type 2 diabetic patients.

Correlation between biopterin levels and intimal-media thickness in type-2 diabetic hypertensive patients.

BACKGROUND: Biopterins have a crucial role in the function of nitric oxide synthase, uncoupling of the enzyme leads to endothelial dysfunction and vascular damage, The aim of this study was to evaluate the relationship between the levels of biopterins with carotid intima-media thickness (CIMT) in hypertensive type-2 diabetic patients. METHODS: We studied 30 hypertensive type-2 diabetic patients and 30 normotensive non-diabetic age-matched subjects, in whom biopterins levels were measured by reverse phase high performance liquid chromatography with fluorescence detection. Additionally, the CIMT of both the common and internal carotid arteries was measured. The levels of biopterins and CIMT were correlated using the Pearson correlation coefficient test. RESULTS: We did not find a significantly correlation between biopterins levels and CIMT. However, we found a significantly inverse correlation between the BH4/BH2 ratio and the CIMT in patients (r = -0.54, p < 0.01). A multiple regression analysis revealed that the CIMT correlated significantly and independently with the BH4/BH2 ratio. CONCLUSION: Our results suggest that the BH4/BH2 ratio seems to be a better marker of vascular disease than biopterin levels.

Depression increases the risk for uncontrolled hypertension.

BACKGROUND: Because hypertension and depression share common pathways, it is possible that each disease has an impact on the natural history of the other. OBJECTIVE: To determinate whether depression influences blood pressure control in hypertensive patients. METHODS: Forty hypertensive patients undergoing antihypertensive treatment, excluding beta-blockers and central-acting agents, self-measured their blood pressure several times a day for three days using a validated, commercially available device. All patients also completed the Zung Self-rating Depression Scale survey for depression. Associations between the results of the blood pressure and depression tests were determined using the Spearman correlation coefficient; RR was also measured. RESULTS: Of the 40 patients, 23 were depressed, and 21 of these 23 had poor control of their blood pressure. The RR for uncontrolled hypertension in depressed patients was 15.5. A significant correlation between systolic (r=0.713) and diastolic (r=0.52) blood pressure values and depression was found. CONCLUSION: Depression is common in patients with uncontrolled hypertension and may interfere with blood pressure control. Screening for depression in hypertensive patients is a simple and cost-effective tool that may improve outcomes.

[Validation of diagnosis scales for differencing hemorrhagic from ischemic cerebral vascular disease]. / Escalas clínicas para diferenciar enfermedad vascular cerebral hemorrágica de isquémica.

BACKGROUND: differentiating hemorrhagic from ischemic cerebral vascular disease (CVD) is the starting point for the treatment. The aim was to compare the diagnostic accuracy of the scales that differentiate hemorrhagic from ischemic stroke. METHODS: we applied the scale of Siriraj Stroke Score (SSS) and Greek Stroke Score (GSS) to patients with stroke. The results were described as means and frequencies. For significant variables odds ratio was calculated. We calculated the validity of both scales compared to the head computed tomography. RESULTS: ninety one patients had ischemic stroke and 28 were hemorrhagic. The mean systolic blood pressure in ischemic stroke was 138.94 mmHg (SD ± 26.90) and hemorrhagic was 165.55 mmHg (SD ± 36.40) p = 0.0007. The atherogenic index (AT) in ischemic stroke was 4.52 (SD ± 1.52) and in hemorrhagic was 4.84 (SD ± 2.01) p = 0.87. The specificity of the SSS for hemorrhagic stroke is 85.5 % and 96.7 % for the GSS. CONCLUSIONS: the GSS has a high specificity for hemorrhagic stroke.

Beneficial effect of combination therapy using an angiotensin-converting enzyme inhibitor plus verapamil on circulating resistin levels in hypertensive patients with type 2 diabetes.

BACKGROUND: Resistin levels are strongly correlated with insulin resistance and vascular inflammation. Type 2 diabetic and hypertensive patients have higher circulating levels of resistin, which is associated with endothelial dysfunction. OBJECTIVE: To compare the effect of trandolapril (T) and its fixed-dose combination with verapamil (FDTV) on resistin levels in hypertensive, type-2 diabetic patients. METHODS: Forty type-2 diabetic patients with never-treated hypertension were randomly assigned to two groups. One group received FDTV 2 mg/180 mg once per day; the other group received T 2 mg once per day. Study drugs were administered for three months in both groups. Resistin levels were measured using ELISA at the beginning of the study and at study end. Patients were evaluated monthly for blood pressure, fasting serum glucose levels and adverse events. Statistical analysis was performed using ANOVA. RESULTS: All patients experienced a significant reduction in blood pressure. Both therapeutic regimens reduced resistin levels; however, FDTV treatment resulted in a greater decrease in resistin levels (mean [± SD] 25.5±13 ng/mL to 17.2±10 ng/mL) when compared with T treatment (22.4±12 ng/mL to 18.5±8 ng/mL) (P<0.05). None of the patients experienced an adverse event. CONCLUSION: Results showed that FDTV resulted in a greater reduction in resistin levels than T treatment alone.