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Toll-like receptors (TLRs) are among the main components of the innate immune system. They can detect conserved structures in microorganisms and molecules associated with stress and cellular damage. TLRs are expressed in resident immune cells and both neurons and glial cells of the nervous system. Increasing evidence is emerging on the participation of TLRs not only in the immune response but also in processes of the nervous system, such as neurogenesis and cognition. Below, we present a review of the literature that evaluates the expression and role of TLRs in processes such as neurodevelopment, behavior, cognition, infection, neuroinflammation, and neurodegeneration.

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Exposure to adverse childhood experiences or early life stress experiences (ELSs) increase the risk of non-adaptive behaviors and psychopathology in adulthood. Environmental enrichment (EE) has been proposed to minimize these effects. The vast number of methodological variations in animal studies underscores the lack of systematicity in the studies and the need for a detailed understanding of how enrichment interacts with other variables. Here we evaluate the effects of environmental enrichment in male and female Wistar rats exposed to adverse early life experiences (prenatal, postnatal, and combined) on emotional (elevated plus maze), social (social interaction chamber), memory (Morris water maze) and flexibility tasks. Our results-collected from PND 51 to 64-confirmed: 1) the positive effect of environmental enrichment (PND 28-49) on anxiety-like behaviors in animals submitted to ELSs. These effects depended on type of experience and type of enrichment: foraging enrichment reduced anxiety-like behaviors in animals with prenatal and postnatal stress but increased them in animals without ELSs. This effect was sex-dependent: females showed lower anxiety compared to males. Our data also indicated that females exposed to prenatal and postnatal stress had lower anxious responses than males in the same conditions; 2) no differences were found for social interactions; 3) concerning memory, there was a significant interaction between the three factors: A significant interaction for males with prenatal stress was observed for foraging enrichment, while physical enrichment was positive for males with postnatal stress; d) regarding cognitive flexibility, a positive effect of EE was found in animals exposed to adverse ELSs: animals with combined stress and exposed to physical enrichment showed a higher index of cognitive flexibility than those not exposed to enrichment. Yet, within animals with no EE, those exposed to combined stress showed lower flexibility than those exposed to both prenatal stress and no stress. On the other hand, animals with prenatal stress and exposed to foraging-type enrichment showed lower cognitive flexibility than those with no EE. The prenatal stress-inducing conditions used here 5) did not induced fetal or maternal problems and 6) did not induced changes in the volume of the dentate gyrus of the hippocampus.

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Although COVID-19 in pregnant women and their neonates has been demonstrated, there is not enough evidence about how this vertical transmission occurs. This report describes a SARS-CoV-2 infection in a 21-year-old mother-daughter duo at the time of birth, focusing on the viral RNA detection in the stool of both and the human breast milk.

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PURPOSE: Current evidence suggests the need to improve the management of breakthrough cancer pain (BTcP). For this reason, we aimed to assess the opinion of a panel of experts composed exclusively of physicians from pain units, who play a major role in BTcP diagnosis and treatment, regarding the key aspects of BTcP management. METHODS: An ad hoc questionnaire was developed to collect real-world data on the management of BTcP. The questionnaire had 5 parts: (a) organizational aspects of pain units (n = 12), (b) definition and diagnosis (n = 3), (c) screening (n = 3), (d) treatment (n = 8), and (e) follow-up (n = 7). RESULTS: A total of 89 pain-unit physicians from 13 different Spanish regions were polled. Most of them agreed on the traditional definition of BTcP (78.9%) and the key features of BTcP (92.1%). However, only 30.3% of participants used the Davies' algorithm for BTcP diagnosis. Respondents preferred to prescribe rapid-onset opioids [mean 77.0% (SD 26.7%)], and most recommended transmucosal fentanyl formulations as the first option for BTcP. There was also considerable agreement (77.5%) on the need for early follow-up (48-72 h) after treatment initiation. Finally, 65.2% of participants believed that more than 10% of their patients underused rapid-onset opioids. CONCLUSIONS: There was broad agreement among pain experts on many important areas of BTcP management, except for the diagnostic method. Pain-unit physicians suggest that rapid-onset opioids may be underused by BTcP patients in Spain, an important issue that need to be evaluated in future studies.

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INTRODUCCIÓN Se ha planteado que factores ambientales y relacionados con el estilo de vida pueden contribuir a la severidad y progresión de la inflamación en la artritis reumatoide. Una intervención que genera un alto interés, debido a sus supuestas propiedades antiinflamatorias es la dieta mediterránea. MÉTODOS Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos siete revisiones sistemáticas que en conjunto incluyeron cuatro estudios primarios, de los cuales sólo uno corresponde a un ensayo aleatorizado. Concluimos que la dieta mediterránea podría hacer poca o nula diferencia en el dolor articular o actividad de la enfermedad, y aumentar levemente el peso en pacientes con artritis reumatoide, pero la certeza de la evidencia es baja. Por otra parte, no es posible establecer con claridad si la dieta mediterránea tiene algún efecto sobre la funcionalidad, rigidez matinal o calidad de vida, debido a que la certeza de la evidencia existente ha sido evaluada como muy baja.

INTRODUCTION It has been suggested that environmental and lifestyle factors might contribute to the severity and progression of inflammation in rheumatoid arthritis. An intervention generating high interest due to its supposed anti-inflammatory properties is the Mediterranean diet. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified seven systematic reviews including four primary studies, of which only one corresponded to a randomized trial. We concluded Mediterranean diet may make little or no difference in pain or disease activity and may slightly increase weight in rheumatoid arthritis patients, but the certainty of the evidence is low. On the other hand, it was not possible to clearly establish whether Mediterranean diet has any effect on functionality, morning stiffness or quality of life as the certainty of the existing evidence has been assessed as very low.

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Objective: The objective of the study is to investigate the association of interleukin-6 (IL6) promoter single-nucleotide polymorphisms rs1800797 (-597 G/A) and rs1800796 (-572 G/C) with obesity or metabolic syndrome in Mexican-Americans. Methods: The rs1800797 and rs1800796 single-nucleotide polymorphisms were genotyped in Mexican-Americans (n = 437) from South Texas, and results were correlated with measures of obesity and metabolic syndrome including body mass index, waist circumference, blood pressure, cholesterol, triglycerides, glucose, liver enzymes, plasma IL6 and high-sensitive C-reactive protein (hs-CRP). Results: Significant associations were found for the rs1800796 variant with increased waist circumference, insulin resistance, lower IL6 levels and higher hs-CRP levels. The rs1800797 variant showed no associations with metabolic traits but was associated with higher IL6 levels and lower hs-CRP levels. Conclusions: Findings in this study support the anti-inflammatory, anti-obesity and glucose homeostatic roles of IL6 in Mexican-American youth.

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Turner syndrome (TS) is one of the most common sexual chromosome abnormalities and is clearly associated with an increased risk of autoimmune diseases, particularly thyroid disease and coeliac disease (CD). Single-nucleotide polymorphism analyses have been shown to provide correlative evidence that specific genes are associated with autoimmune disease. Our aim was to study the functional polymorphic variants of PTPN22 and ZFAT in relation to thyroid disease and those of MYO9B in relation to CD. A cross-sectional comparative analysis was performed on Mexican mestizo patients with TS and age-matched healthy females. Our data showed that PTPN22 C1858T (considered a risk variant) is not associated with TS (X2  = 3.50, p = .61, and OR = 0.33 [95% CI = 0.10-1.10]). Also, ZFAT was not associated with TS (X2  = 1.2, p = .28, and OR = 1.22 [95% CI = 0.84-1.79]). However, for the first time, rs2305767 MYO9B was revealed to have a strong association with TS (X2  = 58.6, p = .0001, and OR = 10.44 [95% C = 5.51-19.80]), supporting a high level of predisposition to CD among TS patients. This report addresses additional data regarding the polymorphic variants associated with autoimmune disease, one of the most common complications in TS.

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OBJECTIVE: To report of experience of intrauterine hydrostatic condom to control obstetric hemorrhage. MATERIAL AND METHOD: Descriptive, retro-prospective study. The method was use in patients who had obstetric hemorrhage and do not responded to medical management during the period from March 1st to August27, 2015 in a rural facility. RESULTS: 955 patients that had a vaginal delivery were identified, 40 (4.1%) of which needed the application of the method. The method was unsuccessful in 2 of 40 patients (5%), one requiring emergency obstetric hysterectomy and other exploratory laparotomy with conservative measures. 11 of 40 patients (2 7.5%) required at least 1-3 globular packs transfusion. None of the 38 patients (95%) who responded to the method presented endometritis in the postpartum follow up or complications associated with the use of hydrostatic condom. CONCLUSION: The use of intrauterine hydrostatic condom is an effective method to control postpartum obstetric hemorrhage secondary to uterine atony unresponsive to medical management.

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A very high prevalence of multiple sclerosis (MS) has been reported in some Western European and North American countries. The few surveys of MS epidemiology in South America reveal lower prevalence rates, implying that susceptibility varies between distinct ethnic groups, thus forming an important determinant of the geographic distribution of the disease. The objective of this study is to review MS prevalence estimates in different Latin American and Caribbean countries. We reviewed surveys of regional MS prevalence from 1991 to 2011. Sources included an online database, authors' reports and proceedings or specific lectures from regional conferences. We obtained a total of 30 prevalence surveys from 15 countries, showing low/medium MS prevalence rates. Both the number and the quality of prevalence surveys have greatly improved in this region over recent decades. This is the first collaborative study to map the regional frequency of MS. Establishment of standardized methods and joint epidemiological studies will advance future MS research in Latin America and the Caribbean.

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In regenerative medicine, the generation of biocompatible substitutes of tissues by in vitro tissue engineering must fulfil certain requirements. In the case of human oral mucosa, the rheological properties of tissues deserve special attention because of their influence in the acoustics and biomechanics of voice production. This work is devoted to the rheological characterization of substitutes of the connective tissue of the human oral mucosa. Two substitutes, composed of fibrin and fibrin-agarose, were prepared in cell culture for periods in the range 1-21 days. The time evolution of the rheological properties of both substitutes was studied by two different experimental procedures: steady-state and oscillatory measurements. The former allows the plastic behaviour of the substitutes to be characterized by estimating their yield stress; the latter is employed to quantify their viscoelastic responses by obtaining the elastic (G') and viscous (G'') moduli. The results demonstrate that both substitutes are characterized by a predominant elastic response, in which G' (order 100 Pa) is roughly one order of magnitude larger than G'' (order 10 Pa). But the most relevant insight is the stability, throughout the 21 days of culture time, of the rheological quantities in the case of fibrin-agarose, whereas the fibrin substitute shows a significant hardening. This result provides evidence that the addition to fibrin of a small amount of agarose allows the rheological stability of the oral mucosa substitute to be maintained. This feature, together with its viscoelastic similitude with native tissues, makes this biomaterial appropriate for potential use as a scaffold in regenerative therapies of human oral mucosa.

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BACKGROUND AND PURPOSE: Functional brain variability has been scarcely investigated in cognitively healthy elderly subjects, and it is currently debated whether previous findings of regional metabolic variability are artifacts associated with brain atrophy. The primary purpose of this study was to test whether there is regional cerebral age-related hypometabolism specifically in later stages of life. MATERIALS AND METHODS: MR imaging and FDG-PET data were acquired from 55 cognitively healthy elderly subjects, and voxel-based linear correlations between age and GM volume or regional cerebral metabolism were conducted by using SPM5 in images with and without correction for PVE. To investigate sex-specific differences in the pattern of brain aging, we repeated the above voxelwise calculations after dividing our sample by sex. RESULTS: Our analysis revealed 2 large clusters of age-related metabolic decrease in the overall sample, 1 in the left orbitofrontal cortex and the other in the right temporolimbic region, encompassing the hippocampus, the parahippocampal gyrus, and the amygdala. The division of our sample by sex revealed significant sex-specific age-related metabolic decrease in the left temporolimbic region of men and in the left dorsolateral frontal cortex of women. When we applied atrophy correction to our PET data, none of the above-mentioned correlations remained significant. CONCLUSIONS: Our findings suggest that age-related functional brain variability in cognitively healthy elderly individuals is largely secondary to the degree of regional brain atrophy, and the findings provide support to the notion that appropriate PVE correction is a key tool in neuroimaging investigations.

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A remote sensing study was conducted in year 2006 in four locations of the Metropolitan Area of Mexico City (MAMC). Two of the sites were the same studied back by us in year 2000 and by others in year 1994. A database was compiled containing 11,289 valid measurements for the carbon monoxide (CO), total hydrocarbons (THC), and nitric oxide (NO) exhaust vehicles emissions. Valid measurements were binned for each pollutant by the vehicle specific power (between -5 and 20 kW tonne(-1)) for the 2000 and 2006 databases. The mean average CO, THC, and NO emissions for year 2006 were determined to be 1.10 +/- 0.18 vol.%, 299 +/- 88.4 ppm, and 610 +/- 115.0 ppm, respectively. Matching the vehicle driving patterns of the fleet measured in year 2000 with the emissions factors obtained in this work, allows estimating the trends in the exhaust emissions of vehicles in the MAMC. The adjusted results of the remote sensing study performed in year 2006 shows that the fleet has decrease 22% in CO and 17% in NO emissions, with small change in total hydrocarbons emissions. The improvements could be related with the introduction in year 2001 of vehicles that met tighter emissions standards, particularly for nitrogen oxides.

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Introducción. Es común el empleo de castigos físicos en la crianza de los hijos, sin considerar sus posibles efectos psicológicos negativos. Se partió de la hipótesis de que los niños con conductas disruptivas sufren más castigos físicos por parte de los progenitores, y que éstos mantienen creencias más agresivas sobre la disciplina en la crianza. Material y métodos. Se realizó un estudio de escrutinio comparativo, abierto y de corte transversal en 2 grupos de 100 escolares: un grupo clínico con diagnósticos de trastornos disruptivos del comportamiento y un grupo control de una escuela pública. Se aplicaron a los progenitores el Cuestionario de Conners para la evaluación de psicopatología en niños y la Escala de Creencias y Castigos. Los resultados se analizaron mediante la prueba de x2. Resultados. Se observó que 54% de los padres del grupo clínico y 17% del grupo control pensaban que "cuanto más estrictos son los padres, mejores serán los niños también". Tres de los tipos de castigo, ejemplos claros de maltrato, también fueron significativamente más frecuentes en el grupo clínico. Conclusión. En este estudio se encontró asociación entre creencias y prácticas disciplinarias de los padres y comportamientos agresivos de los hijos. Se propone la estrategia de convencer a los padres de lo inapropiado de sus creencias, enseñarles técnicas disciplinarias adecuadas y así evitar el maltrato a los menores.

Introduction. Many parents believe it is legitimate to punish their children to correct improper behavior, and they do it without taking into account its negative psychological consequences. The hypothesis of this clinical study was that children with disruptive behavioral disorders were punished more and their parents held more aggressive beliefs regarding child rearing than children that didn't exhibit disruptive disorders, that served as the comparative group. Material and methods. This is an open, comparative and transverse study of 2 groups of children, 100 with disruptive behavioral disorders and 100 from a public school that were reported as non disruptive. Parents responded the Conners' Parents Rating Scale-long version and the Beliefs and Punishment Scales. Results. More parents in the clinical sample thought that "The stricter the parents are, the better the children turn out", x² 29.89, P =0. Three types of punishment were also more common in the clinical sample, P =0. Conclusion. There is an association between disciplinary beliefs and practices in parents and conduct problems in their children. A strategy is proposed to modify parental beliefs and disciplinary practices in order to avoid abusive parenting.

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Introducción. Es bien conocido el temor de muchos niños (y no pocos adultos) a las agujas, de ahí su resistencia a asistir a la consulta médica por el miedo a ser víctimas de la venopunción. Los objetivos de este estudio fueron: describir la influencia de los factores propios del paciente en el estrés anticipatorio y el real a la venopunción, describir la influencia de la participación de los padres en el estrés anticipatorio y el real, y determinar la relación entre el estrés anticipatorio y el real ante la venopunción. Material y métodos. Se integró una muestra de 178 niños y adolescentes que acudieron a venopunción al laboratorio. Se utilizaron 2 escalas: del dolor y del estrés. Antes de la punción, los niños determinaron qué tanto suponían les iba a doler el procedimiento (dolor predictivo) y 2 observadores estandarizados calificaron el grado de estrés aparente previo a la punción (estrés anticipatorio). La respuesta observada en el paciente fue considerada estrés real. Finalmente, el niño señaló el grado de dolor sufrido efectivamente (dolor estimado). Resultados. Los primeros 4 tuvieron significancia estadística: 1. A mayor grado de estrés anticipatorio mayor fue el estrés real. 2. Los menores que predijeron que el dolor sería intenso obtuvieron mayores calificaciones de estrés real. 3. Los niños de mayor edad obtuvieron menores calificaciones de estrés real. 4. A mayor escolaridad, menor estrés real. 5. Cuando había el antecedente de venopunción reciente, mayor era el estrés real. 6. Los pacientes de sexo masculino mostraron mayor estrés real que los de sexo femenino. 7. La presencia de los padres durante la realización del procedimiento tendía a aumentar el estrés real. 8. Cuando el menor acostumbraba dormir en la cama de sus padres había una tendencia a experimentar mayor estrés real. Conclusión. Estos resultados dan la pauta para promover que padres y clínicos expliquen al niño este procedimiento, así como la aplicación de técnicas ...

Introduction. The fear of many children (and adults) to needles is well known, it explains their resistance to attend medical consultation because they are afraid of venepuncture. Objective. To describe the influence of patient's factors in children's anticipatory and real distress due to venepuncture; to describe the influence of parents in children's anticipatory and real distress and to determine the relationship among anticipatory and real distress due to venepuncture. Material and methods. One hundred and seventy eight children and adolescents ages 7 to 16, who attended a 3rd level pediatric hospital laboratory for blood sampling were studied. Pain and distress scales were used in order to determine predictive pain (children's presumption of pain induced by venepuncture). Two observers rated their anticipatory distress before venepuncture. They also rated their real distress during the painful proceeding. Finally, children themselves rated the real pain they suffered. Results. The first 4 results were statistically significant. 1. Anticipatory distress was directly related to real distress. 2. Those children who predicted higher pain showed higher rates of real distress. 3. Older children had lower rates of real distress. 4. Higher school grades were related to less real distress. 5. Recent venepuncture was related to higher real distress. 6. Boys showed more real distress than girls. 7. Parents presence during blood sampling was related to real distress. 8. When children used to share bed with parents there was a trend to show more real distress. Conclusion. These results support the idea that parents and clinicians should explain this painful proceeding to children in advance, and the possible usefulness of cognitive behavioral techniques in order to diminish venepuncture distress.

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Introducción. En los niños con enuresis no debida a enfermedad médica es común la presencia de síntomas psicológicos. El objetivo de este estudio fue explorar si existen diferencias en adaptación psicosocial y grado de psicopatología de niños con enuresis en comparación con sus hermanos sin enuresis. Material y métodos. Estudio transversal, comparativo, observacional y abierto de 30 niños enuréticos de 9 a 14 años de edad, referidos al psiquiatra por sus médicos familiares, y sus hermanos no enuréticos. Ellos y sus progenitores respondieron la Escala de Columbia (CIS) que mide adaptación psicosocial y la Escala de Comportamiento de Niños y Adolescentes (CBCL), que mide grado de psicopatología. Los datos fueron analizados mediante coeficiente de correlación de Spearman y x2. Resultados. El tipo de enuresis más frecuente fue el nocturno (25). Los progenitores empleaban medidas punitivas en su corrección, además de dar a sus hijos infusiones y ungüentos. Más de la mitad de los niños enuréticos y ninguno de sus hermanos sanos presentaron psicopatología en grado clínico. Casi todos los niños enuréticos (29) y sólo 2 de los no enuréticos manifestaron mala adaptación psicosocial. Las diferencias fueron significativas. Conclusiones. Los niños con enuresis mostraron más psicopatología, y sobre todo más mala adaptación psicosocial, que sus hermanos no enuréticos, lo cual puede deberse a comorbilidad asociada o resultar del hecho de mojar la cama. Las medidas correctivas empleadas por los progenitores eran inútiles o francamente punitivas. Es necesario que pediatras y médicos familiares ejerzan acciones psicoeducativas para corregir las ideas distorsionadas que, con fuerte influencia cultural, mantienen los progenitores sobre las causas y el tratamiento de la enuresis.

Introduction. Behavioral disorders in children and adolescents with enuresis not due to general medical conditions are common. The objective of this study was to demonstrate differences in psychosocial adaptation between children with enuresis and their nonenuretic siblings. Material and methods. This was a cross sectional, comparative, observational and open study of 30 children 9 to 14 years of age with enuresis, referred to the psychiatrist by their family physicians, and their healthy siblings. Both groups of children and their parents responded the Columbia Impairment Scale, which assesses functional impairment and the parents responded the Child Behavior Checklist to assess their children's psychopathology. Data were analyzed with Spearman's correlation and x2. Results. Primary enuresis was the most common type (25). Parents used to employ punitive measures in an attempt to correct the symptom, besides ointments and herbal infusions. More than half of children with enuresis and none of their healthy siblings had clinical psychopathology scores in CBCL. Almost all children with enuresis (29) and only 2 of their siblings had functional impairment in CIS. Differences between both groups were significant. Conclusions. Children with enuresis showed more psychopathology and functional impairment than their healthy siblings. This may be due either to associated comorbidity or to bed-wetting itself. Corrective measures practiced by parents were useless or even aggressive. It is necessary for pediatricians and family physicians to give psychoeducation to parents of children with enuresis in order to correct culturally influenced distorted ideas on the causes and treatment of enuresis.

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A novel optical fiber reflectance sensor is coupled to a multisyringe flow injection system (MSFIA) for the preconcentration and determination of 1-naphthylamine (NPA) in water samples using C18 disks (octadecyl groups). NPA, being a first-class carcinogen, is important from a toxicological point of view and, therefore, its quantification is of considerable interest. In this study, the Griess reaction is used for sensitive and selective spectrophotometric determination of NPA. The reaction involves conversion of nitrite into nitrous acid in acidic medium followed by diazotization of sulphanilic acid and formation of a diazonium salt. The diazonium salt is then combined with NPA to form 4-(sulphophenylazo)-1-naphthylamine, an azo dye. This compound is subsequently retained onto a C18 disk followed by spectrophotometric detection at 540 nm, and it is then eluted with methanol in water (80%, v/v), so that the C18 disk is regenerated for subsequent experiments. Under the established optimum conditions, a calibration graph for NPA was constructed. Good linearity was observed within a concentration range from 10 to 160 microg l(-1). The lineal regression equation is A=(0.0027+/-0.0001) [NPA]+(0.0296+/-0.0047), r=0.9991; relative standard deviation values obtained from the analysis of 10 samples of 10, 80 and 160 microg l(-1) are 4.7, 1.2 and 0.6%, respectively. The mean value relative errors for concentrations of 10, 80, 160 microg l(-1) are 3.4, 0.9 and 0.4%, respectively. The detection and quantification limits were 1.1 and 3.7 microg l(-1). A sampling throughput of 14 injections per hour is achieved. The repeatability calculated for five different C18 disks was E(rel)=2.8%. The proposed technique has been validated by replicate analysis (n=6) of several water samples with spiked NPA, giving satisfactory results.

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El estado dippers es un factor de riesgo independiente en los pacientes hipertensos (Risers-R-) Non-dippers-ND-> Dippers-D>Dippers extremos-DE). Se evaluó el efecto de la nueva nifedipina en microgránulos (NMG) una vez al día en la disminución de la presión arterial nocturna medida a través del MAPA con Mobil-o-Graph-CE0434-(I.E.MGmbh-Cockerillstr. 69 D-Stolberg. Germany). Se incluyeron pacientes hipertensos (PAS mayor igual 140 y/o PAD mayor igual 90 mmHg, medidas con esfigmomanómetro de Hg) que recibieron de 30 a 60 mgrs/día de NMG, en un estudio prospectivo abierto comparativo y cruzado en time-doses 8 am ó 8 pm; que luego de 6 semanas de tratamiento mantuvieran PAS < 140 mmHg. Se reclutaron 73 pacientes. 40 pacientes (54.8 por ciento), mantuvieron su estado: NDn = 22 (disminución de la PAS nocturna entre 0 y 10 por ciento), D n= 16 (disminución de PAS nocturna entre 10 y 20 por ciento) y Rn = 2 (incremento de la PAS nocturna). Los otros 33 pacientes (45.2 por ciento) modificaron su estado: cinco: 3D y 2ND cambiaron a DE (disminución de la PAS nocturna > 20 por ciento), once: 2DE y 9ND se transformaron en D, catorce: 6R, 1DE y 7D hacia ND y 3D cambiaron a R. No hubo diferencias significativas en el cambio de estado dippers en ambos grupos (30 ó 60 mgrs), 17 pacientes mejoraron su estado (9ND y 2DE) se transformaron en D y 6R pasaron a ND; 16 pacientes dipper se mantuvieron. Estos resultados sugieren que la NMG ofrece en el 45 por ciento de los pacientes estudiados un beneficio independiente de la reducción de la presión arterial, manteniendo o mejorando el estado dippers ofreciendo una mejor predicción en la disminución de eventos cardiovasculares y del pronóstico de los accidentes cerebrovasculares

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RESUMEN

La magnitud, velocidad y eficacia antihipertensiva de la nifedipina de liberación programada en microgránulos (NLPM) fue evaluada en pacientes con hipertensión moderada a severa. Un total de ciento treinta y cinco pacientes fueron evaluados durante seis semanas en un estudio prospectivo, abierto, comparativo y cruzado. 25.9% (n = 35) fueron pacientes controles normales, del resto eran pacientes hipertensos, 40% (n = 54 pacientes) recibieron 30 mgrs (8am ó 8pm) de NLPM y 20.7% (n = 28 pacientes) recibieron 60 mgrs (8am ó 8pm) de NLPM, el 13.3% de los pacientes admitidos (n = 18) fueron considerados como fracasos de la medicación. Ambas dosis a los distintos horarios de la toma disminuyeron significativamente las presiones arteriales (p < 0.05). En los pacientes que lograron el punto deseado con 30 mgrs, éste se logró desde la 3ra. semana de administrado el medicamento manteniéndose en los niveles tensionales buscados hasta el final del estudio, siendo la magnitud más elevada de reducción de: 8am PAS 15.5 mmHg (12.2%), PAD 12 mmHg (12.6%), PAM 12.2 mmHg (10.9%) y 8pm de: PAS 14.1 mmHg (9.7%), PAD 9.5 mmHg (10.6%) y PAM 11.2 mmHg (10.05%), en cambio en aquellos que lograron el punto deseado con la administración de 60 mgrs, se observaron reducciones desde la 3ra. semana obteniéndose el efecto máximo a la 6ta.semana siendo la magnitud más elevada de reducción de: 8am PAS 26.3 mmHg (16.34%), PAD 18.5 mmHg (17.69%) y PAM 20.9 mmHg (17.0%) y 8pm PAS 22.5 mmHg (15.15%), PAD 18 mmHg (18.1%) y PAM 21.8 mmHg (18.5%). La magnitud de la respuesta antihipertensiva de la NLPM fue numéricamente mayor con 60 mgrs que con 30 mgrs, pero la velocidad de respuesta fue mayor con 30 mgrs probablemente debido a que las cifras tensionales al inicio del estudio eran mayores en el grupo que requirió 60 mgrs, (p < 0.05) llegándose al final del estudio (6ta. semana) a cifras tensionales normales y similares en ambos grupos (p > 0.05). La FC en el grupo de 30 mgrs (8am y 8pm) mostró una disminución significativa luego del tratamiento (p < 0.05), en cambio en el grupo de 60 mgrs éstas se mantuvieron inalteradas (p > 0.05). En conclusión NLPM demostró ser eficaz para el manejo de los pacientes con hipertensión leve a moderada, obteniéndose con la dosis de 60 mgrs mayor magnitud en el efecto hipotensor que con la dosis de 30 mgrs, exhibiendo esta última mayor velocidad de respuesta antihipertensiva.

The magnitude, velocity and antihypertensive effectiveness of the nifedipine liberation programmed in microgranules (NLPM) was evaluated in patients with moderate to severe hypertension. A total of one hundred and thirty five patients were evaluated during six weeks in a prospective, open, comparative and crossed study. Of that group, 25.9% (n = 35) were normal patients, the remainder of them were hypertensive patients, 40% (n = 54 patients) received 30 mgrs (8am or 8pm) of NLPM and 20.7% (n = 28 patients) received 60 mgrs (8am or 8pm) of NLPM, 13.3% of the admitted patients (n = 18) were considered as failures of the medication. Both doses at different schedules of the taking diminished the arterial pressures significantly (p <0.05). There were patients that reached the end point a 30 mgrs dose, this achievement was obtained from the 3rd week of medication keeping on these pressure levels until the end of the study, being the highest magnitude of reduction were: 8am PAS 15.5 mmHg (12.2%), PAD 12 mmHg (12.6%), PAM 12.2 mmHg (10.9%) and 8pm of: PAS 14.1 mmHg (9.7%), PAD 9.5 mmHg (10.6%) and PAM 11.2 mmHg (10.05%), on the other hand, in those who achieved the end point with the administration of 60 mgrs, reductions were observed from the 3rd week obtaining the maximum effect at the 6th week being the highest magnitude of reduction of: 8am PAS 26.3 mmHg (16.34%), PAD 18.5 mmHg (17.69%) and PAM 20.9 mmHg (17.0%) and 8pm PAS 22.5 mmHg (15.15%), PAD 18 mmHg (18.1%) and PAM 21.8 mmHg (18.5%). The magnitude of the antihypertensive response of the NLPM was numerically bigger with 60 mgrs than with 30 mgrs, but the response velocity was bigger with 30 mgrs maybe because the blood pressure at the beginning of the study were bigger in that group that required 60 mgrs, (p <0.05) arriving at the end of the study (6th week) to normal pressure figure, similar in both groups (p> 0.05). The heart rate in the group of 30 mgrs (8am and 8pm) showed a significant decrease after the treatment (p <0.05), on the other hand in the group of 60 mgrs these stayed unaffected (p> 0.05). In conclusion NLPM demonstrated to be effective for the managing of patients with light to moderate hypertension, obtaining a bigger magnitude in the blood pressure effect with a dose of 60 mgrs than with a dose 30 mgrs, however, with this last dose, the antihypertensive response was more fast.