Prehypertension is associated with peripheral arterial disease and low ankle-brachial index.

Patients with prehypertension suffer endothelial dysfunction and are at increased cardiovascular risk. Ankle-brachial index (ABI) constitutes an efficient tool for diagnosing peripheral arterial disease; but also an ABI<0.9 is an independent and positive predictor of endothelial dysfunction and is associated with increased cardiovascular risk and mortality. THE AIM: of this study was testing whether ABI was decreased in prehypertensive patients when compared with normotensive subjects. METHODS: We included 70 prehypertensive patients older than 19 years, in whom the ABI was registered with a 5 megahertz Doppler (Summit Doppler L250, Life Dop., USA). The highest ankle systolic pressure was divided by the highest brachial systolic pressure. We also included 70 normotensive subjects in whom the ABI was registered in the same way. The measurements were performed by the same physician who was blinded about the study. Statistical analysis was performed with odds ratio and student t-test. RESULTS: The ABI values in normotensive subjects were 1.023±0.21, whereas prehypertensive patients significantly had lower ABI (0.90±0.14p=0.00012). We found ABI <0.9 in 30 prehypertensive patients (42.85%) and 13 normotensive patients (18.5%). The odds ratio of ABI <0.90 in prehypertensive patients was 3.288 (IC95 1.5-7.0, p=0.0023). A regression analysis failed to show any independent association between ABI values and any other clinical parameter. CONCLUSIONS: Prehypertensive patients had lower ABI and higher prevalence of peripheral artery disease when compared with normotensive subjects; this fact increases their cardiovascular risk. ABI must be included in global evaluation of prehypertensive subjects.

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.

Edema pulmonar no cardiogenico inducido por dextran 40 / Non cardiogenic pulmonary edema induced by dextran 40. case report

El dextran 40 debe ser considerado como otro factor etiológico del edema pulmonar no cardiogénico inducido por drogas. La reacción anafiláctica a los expansores del plasma como el dextran 40 es rara; no obstante, como es utilizado frecuentemente en la práctica clínica, se puede observar este efecto. Este trabajo reporta un caso de edema pulmonar no cardiogénico, inducido por drogas (dextran 40) al finalizar la anestesia general en un paciente masculino de 62 años de edad a quien se le realizó una exploración vascular con colocación de injerto bifemoral en pantalón y endarterectomia bilateral por trombosis de injerto aortobifemoral. El paciente evolucionó satisfactoriamente el tratamiento convencional antiedema pulmonar no cardiogénico, no así, del problema quirúrgico, por lo que fue reintervenido para revisión de puente femoropopiteo y aplicación de injerto, bajo BPD L3-L4 sin incidentes. Fue dado de alta a los 17 días de la segunda intervención