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Contexto: el ácido úrico es el producto final de la degradación de las purinas en los primates, en condiciones normales es un agente antioxidante endógeno y participa en varias vías fisiológicas, sin embargo, cuando los niveles séricos de urato se incrementan, estos participan en el desarrollo de diversas enfermedades. Desde el siglo XIX se conoce de la asociación entre hiperuricemia y daño renal, aunque ninguna guía de manejo recomienda el uso de fármacos hipouricemiantes en pacientes asintomáticos, en algunos casos especiales, el manejo farmacológico beneficiará a pacientes con hiperuricemia, brindando protección al riñón y disminuyendo el riesgo de desarrollar enfermedad renal terminal. Objetivo: describir la relación entre hiperuricemia y daño renal, y analizar los casos en los que el manejo de esta condición con medicamentos resultará en un beneficio para el riñón de los pacientes. Metodología: revisión de la literatura sobre la participación de la hiperuricemia en el daño renal y análisis de los artículos revisados. Resultados: el manejo de la hiperuricemia asintomática puede proteger el riñón en algunas situaciones específicas. Conclusiones: hay situaciones específicas para la disminución de los niveles séricos de ácido úrico.

Background: Uric acid is the end product of purine degradation in primates, under normal conditions it is an endogenous antioxidant agent and participates in several physiological pathways. However, when serum urate levels are increased, they participate in the development of various diseases. Since the nineteenth century, the association between hyperuricemia and kidney damage has been known. Although no management guideline recommends the use of hypouricemic drugs in asymptomatic patients, in some special cases pharmacological management will benefit patients with hyperuricemia, providing protection to the kidney and decreasing the risk of developing end-stage renal disease. Purpose: To describe the relationship between hyperuricemia and kidney damage, and to analyze the cases in which the management of this condition with medications will result in a benefit for the kidney of patients. Methodology: Review of the literature on the involvement of hyperuricemia in kidney damage, analysis of the reviewed articles. Results: Management of asymptomatic hyperuricemia may protect the kidney in some specific situations. Conclusions: There are specific situations for the decrease of serum uric acid levels.

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Background An increase in epicardial fat thickness (EFT) has been associated with increased cardiovascular risk and the development of atherosclerosis. Transthoracic echo-cardiography provides a reliable measurement of EFT. We evaluated the relationship of EFT with carotid intima-media thickness (CIMT) and ankle-brachial index (ABI), in patients with metabolic syndrome. Methods We assessed 80 patients with metabolic syndrome who underwent echocardiography; EFT was measured by two cardiologists. The CIMT (B-mode colour imaging of extracranial carotid arteries using high-resolution ultrasound) was also measured by a certified ultrasonographer, and ABI was measured by the main researcher. Results We did not find any correlation between ABI with EFT (r=0.0103, p=0.93) or with CIMT (r=-0.1625, p=0.15). However, we found a significant correlation between EFT and CIMT (r=0.2718, r2=0.074, p=0.015). When we evaluated the risk for a CIMT >0.9 mm in patients with an EFT >3 mm, we found a statistically significant association (p=0.039). Interestingly, only 1 patient with an EFT <3 mm had a CIMT >0.9 mm. Conclusion We found that the EFT correlates with CIMT in patients with metabolic syndrome, which explains, at least in part, the higher risk of atherosclerosis in them. Measurement of EFT should be part of the cardiovascular risk evaluation in patients with metabolic syndrome.

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Resumen: OBJETIVO: Demostrar si el índice neutrófilo/linfocito predice la mortalidad en pacientes con neumonía tipo influenza. MATERIAL Y MÉTODO: Estudio de casos y controles, observacional, analítico, transversal, retrospectivo y retrolectivo que incluyó pacientes con neumonía por influenza que padecieron neumonía aguda grave de 2009 a 2017. Se calculó APACHE II, SMART COP y el índice neutrófilo/linfocito (INL). Se determinó supervivencia mediante Kaplan y Meier, para la asociación entre INL y mortalidad, APACHE II, SMART COP y comorbilidades se usó χ2 y razón de momios (RM), así como correlación entre APACHE II, SMART COP e INL. RESULTADOS: Se incluyeron 69 pacientes. La RM entre el INL y la mortalidad fue de 0.174 (p = 0.533; IC95% 0.274 a 2.08). Hubo asociación significativa entre el INL y componentes del síndrome metabólico en pacientes vivos. No hubo diferencia en la supervivencia entre INL mayor o menor de 7. Correlación positiva entre APACHE II e INL de 0.4295 (p = 0.0002; IC95% 0.00 a 0.063). CONCLUSIONES: Existe asociación entre el INL y el síndrome metabólico en pacientes vivos, así como correlación positiva con APACHE II. No hay asociación entre el INL y mortalidad. El punto de corte del INL se desplazó cuatro puntos comparado con otras poblaciones.

Abstract: OBJECTIVE: To demonstrate if neutrophil/lymphocyte index predicts mortality in patients with influenza-like pneumonia. MATERIAL AND METHOD: A case-control, observational, analytical, cross-sectional, retrospective and retrolective study with patients with influenza like pneumonia who developed severe acute pneumonia from 2009 to 2017. APACHE II, SMART COP and neutrophil lymphocyte index (INL) were calculated. Survival was determined by Kaplan and Meier, for the association between INL and mortality, APACHE II, SMART COP and comorbidities was used χ2 and odds ratio (OR), as well as correlation between APACHE II, SMART COP and INL. RESULTS: There were included 69 patients. OR between the INL and mortality was of 0.174 (p = 0.533, IC95% 0.274-2.08). There was significant association between INL and components of the metabolic syndrome in living patients. There was no difference in survival between INL greater or less than 7. Positive correlation between APACHE II and INL of 0.4295 (p = 0.0002, IC95% 0.00 to 0.063). CONCLUSIONS: There is an association between INL and metabolic syndrome in liv- ing patients, as well as a positive correlation with APACHE II. There is no association between INL and mortality. The cutoff point of the INL shifted 4 points compared to other populations.

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AIMS: To evaluate the clinical accuracy of novel indices visceral adiposity index (VAI) and body adiposity index (BAI) to identify patients with impaired fasting glucose (IFG) and compare with its individual components and other obesity indicators. METHODS: A cross-sectional study was conducted in Mexican population. Body mass index (BMI), waist circumference, hip circumference, triglycerides (TG), High density lipoprotein cholesterol (HDL-C), VAI, BAI, waist to hip ratio (WHR) and waist to height ratio (WHtR) were determined. We plotted a receiver operating characteristic curves to assess the abilities to discriminate subjects with IFG from those with normal glucose tolerance (NGT) of the measurements. A binary logistic regression analysis was performed to determine the strength of association with IFG. RESULTS: A total of 280 individuals were included, from which 144 (51.3%) have IFG; the mean age was 47.14 years and 164 (55.5%) were females. Compared with NGT subjects, the participants with IFG had significantly higher levels of BMI, WHtR, VAI, BAI and TG. The measurements with highest area under the curve were TG, (0.631, 95% confidence interval [CI] 0.566-0.697) VAI (0.628, 95% CI 0.563-0.693) and WHtR (0.622, 95% CI 0.557-0.688) and in the adjusted binary logistic regression model, were found to be independently associated with IFG, Odds Ratio of 2.665, (95% CI 1.567-4.533) 2.567 (95% CI 1.527-4.317) and 2.171 (95% CI 1.102-4.276) respectively. CONCLUSIONS: Our data provide evidence that TG, VAI and WHtR could be considered potential tools for the risk assessment of type 2 diabetes mellitus (T2DM) in this population.

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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.

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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

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Resumen OBJETIVO Evaluar si hay diferencias en el grosor de la grasa epicárdica en pacientes con diabetes mellitus 2, prediabetes y sujetos no diabéticos. MATERIAL Y MÉTODO Estudio en el que de enero a agosto de 2017 se evaluaron sujetos divididos en tres grupos: sujetos con diabetes mellitus 2, sujetos con prediabetes y sujetos no diabéticos. En todos se midió el grosor de la grasa epicárdica por ecocardiografía, siguiendo la técnica descrita por Iacobelis, con un equipo Aloka alfa 6, usando un transductor de 3.5 MHz, por dos ecocardiografistas que desconocían los datos clínicos de los pacientes. El método estadístico usado fue ANOVA. RESULTADOS Se incluyeron en el estudio 120 pacientes divididos en los tres grupos (40 pacientes cada grupo); se encontró grosor de la grasa epicárdica de 5.63 mm en el grupo de diabetes mellitus, de 4.43 mm en el grupo de prediabetes y de 4.0 mm en el grupo sin diabetes. No hubo diferencia en el grosor de la grasa epicárdica entre los grupos sin diabetes y prediabéticos (p = 0.09). Sin embargo, sí encontramos diferencia significativa entre el grupo de diabetes mellitus y los grupos prediabetes y sin diabetes (p = 0.00017). CONCLUSIÓN Los pacientes diabéticos tipo 2 tienen mayor grosor de la grasa epicárdica que los prediabéticos y los sujetos no diabéticos, lo que apoya la relación entre grasa visceral y diabetes mellitus tipo 2.

Abstract OBJECTIVE To evaluate the differences in epicardial fat thickness in subjects with type-2 diabetes, prediabetes or non-diabetic. MATERIAL AND METHOD A study was done from January to August 2017 evaluating subjects divided into 3 groups: group with type-2 diabetic patients, group with subjects with prediabetes and group with nondiabetic subjects. In all of them the epicardial fat thickness was measured with an Aloka alfa 6 equipment, by 2 cardiologists who were unaware of the clinical data. Statistical analysis was performed with ANOVA. RESULTS There were included 120 patients divided into three groups of 40 patients each. Epicardial fat thickness was of 5.63 mm in diabetes mellitus group, 4.43 mm in prediabetes group and 4 mm in nondiabetic group. We did not find difference in epicardial fat thickness between nondiabetes and prediabetes groups (p = 0.09). However, we found significantly differences in epicardial fat thickness between diabetes group and groups of prediabetes and nondiabetes (p = 0.00017). CONCLUSION Type-2 diabetic patients have greater nondiabetes than prediabetic and nondiabetic subjects; this fact supports the relationship between visceral fat and the risk of type-2 diabetes.

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Hypertension is a major preventable risk factor for atherosclerosis and ischemic heart disease. Although modern and effective antihypertensive drugs are available, most patients remain with a suboptimal blood pressure control. Most hypertensive patients will need a combination of antihypertensive agents to achieve the therapeutic goals - recent guidelines recommend initiating treatment with two drugs in those patients with a systolic blood pressure >20 mmHg and/or a diastolic blood pressure >10 mmHg above the goals, and in those patients with high cardiovascular risk. In addition, approximately 25% of patients will require three antihypertensive agents to achieve the therapeutic targets. In this review, we analyse the latest information available regarding the treatment of hypertension with combination therapy.

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The present study aimed to compare echocardiography measurements of epicardial adipose tissue (EAT) thickness and other risk factors regarding their ability to predict adverse cardiovascular outcomes in patients with coronary artery disease (CAD). Outcomes of 107 patients (86 males, 21 females, mean age 63.6 years old) submitted to diagnostic echocardiography and coronary angiography were prospectively analyzed. EAT (measures over the right ventricle, interventricular groove and complete bulk of EAT) and left ventricle ejection fraction (LVEF) were performed by echocardiography. Coronary complexity was evaluated by Syntax score. Primary endpoints were major adverse cardiovascular events (MACE's), composite of cardiovascular death, myocardial infarction, unstable angina, intra-stent re-stenosis and episodes of decompensate heart failure requiring hospital attention during a mean follow up of 15.94 ± 3.6 months. Mean EAT thickness was 4.6 ± 1.9 mm; and correlated with Syntax score and body mass index; negatively correlated with LVEF. Twenty-three cases of MACE's were recorded during follow up, who showed higher EAT. Diagnostic ability of EAT to discriminate MACE's was comparable to LVEF (AUROC > 0.5); but higher than Syntax score. Quartile comparison of EAT revealed that measurement of the complete bulk of EAT provided a better discrimination range for MACE's, and higher, more significant adjusted risk (cutoff 4.6 mm, RR = 3.91; 95% CI 1.01-15.08; p = 0.04) than the other risk factors. We concluded that echocardiographic measurement of EAT showed higher predicting ability for MACE's than the other markers tested, in patients with CAD. Whether location for echocardiographic measurement of EAT impacts the diagnostic performance of this method deserves further study.

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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.

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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.

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Resumen Estar bien hidratado se relaciona con un estado adecuado de salud y bienestar; sin embargo ¿qué pasa en los pacientes adultos que tienen algún padecimiento como obesidad, diabetes mellitus tipo 2, hipertensión arterial, cardiopatía isquémica e insuficiencia cardiaca, alteraciones nefrológicas (insuficiencia, poliquistosis y litiasis renal), enfermedad pulmonar obstructiva crónica, dislipidemia, hiperuricemia o, bien, en adultos mayores y en el periodo perioperatorio, en donde hay pérdida del estado de salud o una necesidad diferente de hidratación y que requieren consumir bebidas no alcohólicas para tener un buen estado de hidratación sin alterar la evolución natural de estas condiciones? Algunos puntos y recomendaciones son: la carbonatación de las bebidas ofrece el beneficio de aumentar la saciedad y disminuir la ingesta energética, lo que puede contribuir a la pérdida de peso; el agua simple es la mejor fuente de hidratación en los pacientes diabéticos, sin embargo, otras fuentes de hidratación pueden ser el agua mineralizada, el agua mineral, la leche (de preferencia descremada), café y té sin azúcar o con edulcorantes no calóricos o bajos en calorías, así como cualquier bebida que los contenga; en pacientes con litiasis renal se recomienda ingerir 2.5 a 4 L de agua al día; las bebidas para deportistas pueden ser consumidas por pacientes hipertensos, siempre y cuando no excedan la cantidad de sodio recomendada por la Organización Mundial de la Salud. En conclusión, la hidratación juega un papel importante en la evolución de las enfermedades mencionadas.

Abstract Being well hydrated is related to an adequate state of health and well-being; however, what happens in those adult patients having some pathological conditions such as obesity, type 2 diabetes mellitus, high blood pressure, ischemic heart disease and heart failure, kidney diseases (renal failure, polycystic renal disease and renal lithiasis), chronic obstructive pulmonary disease, dyslipidemia, hyperuricemia, or in the elderly and in the perioperative period, where there is loss of health or a different need for hydration and require the use of non-alcoholic beverages in order to have a good state of hydration without altering the natural evolution of these conditions? Some key points and recommendations are: carbonation of beverages offers the benefit of increasing satiety and decreasing energy intake, which can contribute to weight loss; simple water is the best source of hydration in diabetic patients; however, other sources of hydration may be mineralized water, mineral water, milk (preferably non-fat), coffee and tea without sugar or non-caloric sweeteners or low-calorie, as well as any beverage containing them; in patients with renal lithiasis it is recommended to take 2.5 to 4 L of water per day; sports drinks can be consumed by hypertensive patients as long as they do not exceed the amount of sodium recommended by the World Health Organization. In conclusion, hydration plays an important role in the evolution of the pathologic conditions mentioned above.

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Resumen En noviembre de 2017, la American Heart Association y el American College of Cardiology emitieron nuevas guías de práctica clínica para la prevención, detección, evaluación y tratamiento de la hipertensión en adultos, con cambios relevantes en la clasificación y el abordaje terapéutico. Este documento analiza las aportaciones de la guía y da los puntos de vista del autor respecto a ellas.

Abstract In November 2017, the American College of Cardiology/American Heart Association Hypertension published new guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults, with changes in the recommendations of the classification and therapeutic approach. This manuscript analyzes their key recommendations and some author's comments about the new guidelines.

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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.

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BACKGROUND: Hyperuricemia leads to insulin resistance, whereas insulin resistance decreases renal excretion of uric acid. The aim of this study was to evaluate whether there is a correlation between serum uric acid levels with homeostatic model assessment (HOMA) 1 in nondiabetic patients. METHODS: We evaluated 88 nondiabetic patients, in whom uric acid levels were measured, in all of them HOMA of ß-cell function (HOMA 1B) and HOMA of insulin resistance (HOMA 1IR) scores were performed. Uric acid and the HOMA 1 values were correlated using the Pearson coefficient. RESULTS: We did not find any correlation between uric acid levels with both HOMA 1B (r = 0.102, p = 0.343), nor with HOMA 1IR (r = 0.158, p = 0.117). When patients were analyzed by sex, we found a significant correlation with HOMA 1IR (0.278, p = 0.01), but not with HOMA 1B (0.138, p = 0.257) in women. We found a correlation with HOMA 1B in men (r = 0.37, p = 0.044), but not with HOMA 1IR: 0.203, p = 0.283. The analysis performed based on body mass index did not show correlation in the patients with normal weight, (HOMA 1B r = 0.08, p = 0.5, HOMA 1IR = 0.034, p = 0.793), nor in the patients who were overweight (HOMA 1B: r = 0.05, p = 0.76, HOMA 1IR r = 0.145, p = 0.43). However, a significant correlation between uricemia with both HOMA 1B (0.559, p < 0.001), and HOMA 1IR (0.326, p < 0.05), was observed in obese patients. CONCLUSION: Our results suggest that serum uric acid levels seem to be associated with insulin resistance in women, and in obese patients, but not in nonobese men. Uric acid also modifies ß-cell function in men and in obese patients.

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Hyperuricemia leads to endothelial dysfunction and insulin resistance, and has been associated with diseases such as hypertension. Antihypertensive drugs modify serum uric acid levels, however, few data are available about their combinations on uricemia. In this study we evaluate the effect of two combinations of losartan, with amlodipine or with hydrochlorothiazide, on serum uric acid levels in hypertensive patients. METHODS: A total of 60 hypertensive patients were randomized in two groups; group LA received losartan/amlodipine (100/5 mg) once a day, whereas LH group received losartan hydrochlorothiazide (100/12.5 mg) once a day for 3 months. In both groups serum uric acid levels were measured at the beginning and end of the study. Patients were evaluated monthly for blood pressure (BP) and adverse events. Statistical analysis was performed with a two-way analysis of variance (ANOVA) for repeated measures. RESULTS: All patients experienced a significant reduction of BP to the same extent (LA 155/94 to 123/79, LH 157/92 to 124/78 mmHg, p > 0.05). In the LA group, serum uric acid decreased from 6.5 ± 1.6 to 4.6 ± 1.3 mg/ml ( p = 0.0001), whereas in the LH group there was a nonsignificant increase from 5.82 ± 1.4 to 5.85 ± 1.5 mg/ml, ( p = 0.936). When both groups were compared, we found a significant reduction ( p < 0.00013) on serum uric acid levels in the LA group. CONCLUSIONS: Both combinations decrease BP values to the same extent, however, LA combination showed a reduction on serum uric acid levels, which may contribute to a reduction in the metabolic risk in hypertensive patients.

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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.

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Evaluar si hay correlación entre los niveles de adipocitocinas, el índice A/R,con la albuminuria en pacientes diabéticos tipo 2 hipertensos (DM2HTA). Material y Método: se incluyeron 30 pacientes DM2HTA, sin tratamiento antihipertensivo previo, en quienes los niveles de adipokinas fueron medidos por duplicado mediante ELISA(R&D Systems, Minneapolis, MN), en todos ellos de determinó albuminuria de 24 horas por nefelometría. El índice A/R se determinó mediante la fórmula (1+log10 Resistinalog10 Adiponectina), como fue descrito. La relación entre los niveles de adipokinas y del índice A/R con la albuminuria se determinó con el coeficiente de correlación de Pearson. Resultados: no se encontró correlación entre los niveles de adiponectina y el grado de albuminuria (R= -0,09, p > 0,05), ni con los de resistina (R= 0,23 p>0,05),sin embargo encontramos una correlación significativa entre el índice A/R (R= 0,312,p<0,01) y la presencia de albumina en orina de 24 horas. Conclusión: los resultados muestran una mayor asociación del índice A/R con daño renal en el paciente hipertenso con DM2 que los niveles de adipokinas, por lo que puede ser un marcador de riesgo de nefropatía, y a su vez un blanco terapéutico...

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