[Sleep medicine: development, contributions and perspectives. Report of the work group on sleep medicine]. / Medicina del dormir: desarrollo, contribuciones y perspectivas. Reporte del grupo de trabajo en medicina del dormir.

Sleep is a basic biological process that has an impact on all the functions of the body, and interacts bidirectionally with virtually all of the body systems, so that the sleep disorders are associated with disturbances in other systems, either respiratory, neurological, cardiovascular, endocrine, immune, etc., and vice versa. The complexity of the regulatory mechanisms of sleep and the variety of their disorders, together with the clinical evidence accumulated in recent decades, have led to the birth of a new branch in medicine: the Sleep Medicine, with well defined intrinsic disorders. The consequences of sleep deprivation or fragmentation induced by changes in social and work dynamics, as well as sleep disorders have harmful effects on individuals in the short and long-term, the most important are an elevated risk for vehicular and occupational accidents, cardiovascular damage, cognitive impairment, obesity, diabetes mellitus, among others, impacting individuals of all ages. The sleep clinics and laboratories in Mexico, have made significant contributions, at both the basic and clinical levels, for the diagnosis and treatment of sleep disorders; however, without a specific health policy, we will continue to commit resources only on the attention of its effects and not on prevention, making the impact on the economy and quality of life of patients with sleep disorders, much higher than in developed countries. It is necessary to build a program of medical care to incorporate the Sleep Medicine in the priorities of medical care in the National Institutions of Health at all levels. Solutions and guides to optimize the achievement of the proposed results, and increase efficiency and effectiveness of the resources applied in this new field of Medicine are offered.

[Obesity and metabolic syndrome. A challenge for the Mexican Institutes of Health]. / La obesidad y el síndrome metabólico. Un reto para los Institutos Nacionales de Saluda.

Numerous efforts for the development of basic and clinical research in obesity are being made by the National Institutes of Health and Federal Reference Hospitals in Mexico. However, greater interaction among researchers and stronger efforts towards the dissemination of the results are needed. The document outlines the general ideas and proposals of the Academic Group for the Study, Prevention and Treatment of Obesity and Metabolic Syndrome of the Coordinating Committee of the National Institutes of Health and High Specialty Hospitals (CCINSHAE). This is the first step in developing common objectives, with the aim of understanding the effect of these entities in public health and to establish guidelines to limit and eventually overcome them. We discuss the appropriateness of analyzing obesity and the metabolic syndrome together, and the current management of these entities at the National Institutes of Health in Mexico. The problems that arise in clinical practice lead to the need to generate a new model of medical care, including a new health worker and a new patient. It is imperative to establish permanent lines of communication and education with health personnel and with patients. The group proposes an integrated approach for research in these areas. Finally, a master plan that links the National Institutes of Health, particularly in the areas of research and programs within the institutions, is required as a first step in seeking answers useful in solving the problem. The second step would be linking the first and second levels of care through concrete actions needed to limit and reduce obesity and metabolic syndrome in the population.

[The difficult exercise of medicine in primary level healthcare units]. / El difícil ejercicio de la medicina en las unidades del primer nivel de atención.

The positive response from the general physician to the continuing medical education promoted by the National Academy of Medicine of Mexico, the Mexican Academy of Surgery, 32 Medical Schools, and different medical societies will be a real contribution to improving primary healthcare. At present, an additional effort is necessary from primary healthcare providers to lengthen time for patient care with the general physician and to improve facilities for the general physician for his/her continuing medical education.

[Profile of the physician registered in the National Program of Continuous Academic Development for the General Physician]. / Perfil del médico inscrito en el Programa Nacional de Actualización y Desarrollo Académico para el Médico General.

A descriptive, transversal study was done on 881 physicians taking the National Program of Continuous Academic Development for the General Physician (PRONADAMEG) at 27 sites during the second semester of 2002. The general purpose of the study was to determine the sociodemographic, academic, and professional profile of the physician enrolled in the program, as well as their opinion on the program and their need for education. Age of enrolled physicians is between 35 and 54 years (70.6%), sex distribution is equal, and 66% of physicians are married. Ninety four percent have a medical practice that takes up the majority of their time. The study showed that 66.4% of physicians worked at public institutions, mainly at the Mexican Institute of Social Security (IMSS) and the Mexican Health Ministry (SSa). One physician trainied outside of Mexico, and 12.2% have a speciality in family medicine. Of physicians in the study, 32% participated informal continuous medical education and used medical journals for this purpose. The program was seen as helpful by 89% of physicians in the study, and the study suggests that knowing the profile of physicians enrolled in the program will allow academic planning for the program and the true needs for education general physicians.

[Clinical and paraclinical course in patients with lower infarction with and without precordial ST segment depression]. / Evolución clínica y paraclínica de los pacientes con infarto inferior con y sin depresión precordial del segmento ST.

OBJECTIVE: To know the early (30 days) and mid-term (6 months) clinical and paraclinical evolution of patients surviving an inferior infarct with or without precordial depression of the ST segment (RST). MATERIAL AND METHODS: We studied all patients with inferior myocardial infarction during 1998. Patients were divided in two groups according to the presence or absence of a significant and persistent low level of RST (> 2 mm for more than 24 h) at the precordial leads. We compared the clinical, paraclinical evolution and survival at 30 days and 6 months after infarction. RESULTS: We studied 127 patients, 93 of them had persistent RST depression in the precordial leads, whereas the other 34 only presented changes at the inferior wall. The study revealed that those patients with changes in the anterior wall had a slightly higher frequency of cardiac failure, conduction disorders, deterioration of the left ventricular function, and plurivascular coronary disease. Likewise, it was flaund that RST depression at the precordial leads induced a greater mortality at 6 months. CONCLUSIONS: In patients with inferior myocardial infarction, the precordial depression of RST seems to be associated with an adverse clinical and paraclinical evolution, as well as a higher mortality. However, the differences are not statistically significant, therefore more studies are needed to elucidate this point.

Enfermedad arterial coronaria y diabetes mellitus. Cardiología intervencionista / Coronary artery disease and diabetes mellitus. Interventionist cardiology

En nuestro país la diabetes mellitus afecta a un número importante de individuos, con una frecuencia de 6 a 12 por ciento que muestra clara tendencia a incrementarse con la edad. Su relación como factor de riesgo independiente para el desarrollo de enfermedades cardiovasculares está bien demostrada. Existen diversos mecanismos implicados en el desarrollo de la aterosclerosis: hiperglucemia, resistencia a la insulina, glicación de proteínas y acumulación de sorbitol, entre otros. Al comparar diabéticos y no diabéticos, la enfermedad arterial coronaria (manifestada como angina de pecho, infarto del miocardio y muerte cardiaca súbita) es responsable de 70 a 80 por ciento de los fallecimientos en pacientes con diabetes tipo 2; tiene una frecuencia dos a cuatro veces mayor en los primeros y resultados menos satisfactorios en la angioplastia transluminal percutánea y la revascularización miocárdica. Dichos procedimientos de intervencionismo y otros como la colocación de Stents (prótesis endovasculares que mantienen la arteria abierta posterior a la angioplastia transluminal) constituyen una alternativa útil aún en proceso de estudio.

El fibrinógeno plasmático durante la etapa aguda de angina o infarto del miocardio / Fribrinogeno plasma during the acute stage of angina or miocardial infarction

Estudiamos prospectivamente los niveles plasmáticos de fibrinógeno en pacientes con diagnóstico de infarto agudo del miocardio (IAM) o angor inestable (AI), mediante datos clínicos, electrocardiográficos, enzimáticos y por gammagrafía con pirofosfatos. Incluimos a 40 pacientes: 21 con IAM y 19 con AI, comparándose los resultados obtenidos en forma individual y en conjunto con 10 individuos sanos como control. Dentro del grupo de IAM se incluyeron a 15 hombres y seis mujeres con edades de 35 a 69 años (media de 56.4); el grupo de AI de 15 hombres y cuatro mujeres con edades de 38 a 69 años(media de 53.1); el grupo control con cuatro hombres y seis mujeres con edades de 28 a 62 años (media de 52.3). A todos los pacientes se les determinaron niveles plasmáticos de fibrinógeno, tiempo de protrombina, tiempo parcial de tromboplastina, plaquetas, colesterol y se interrogaron factores de riesgo coronario a su ingreso. No hubo diferencias significativas en cuanto a niveles plasmáticos de fibrinógeno estudiados comparativamente entre el grupo control y los pacientes con IAM fueron de 397 ñ 131 vs. 605 ñ 174 respectivamente (p<0.001). En el grupo control y en el de AI fueron de 397 ñ 131 vs. 455 ñ 108 respectivamente (p=0.19 NS) y la comparación entre el grupo control y los pacientes con IAM y AI fueron de 397 ñ 131 vs. 534 ñ 164 (p<0.001). El fibrinógeno elevado parece ser un factor contribuyente a la enfermedad arterial coronaria, así como un factor de riesgo independiente, tanto o igual a otros