Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720090011&lang=es vol. 137 num. 11 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<b>Valores normativos de resistencia a la insulina mediante HOMA-IR en adultos mayores de Santiago de Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100001&lng=es&nrm=iso&tlng=es Background: The homeostasis assessment model for insulin resistance (HOMA-IR) estimates insulin resistance using basal insulin and glucose values and has a good concordance with values obtained with the euglycemic clamp. However it has a high variability that depends on environmental, genetic and physiologic factors. Therefore it is imperative to establish normal HOMA values in different populations. Aim: To report HOMA-IR values in Chilean elderly subjects and to determine the best cutoff point to diagnose insulin resistance. Material and methods: Cross sectional study of 1003 subjects older than 60 years of whom 803 (71% women) did not have diabetes. In 154 subjects, an oral glucose tolerance test was also performed. Insulin resistance (IR) was defined as the HOMA value corresponding to percentile 75 of subjects without over or underweight. The behavior of HOMA-IR in metabolic syndrome was studied and receiver operating curves (ROC) were calculated, using glucose intolerance defined as a blood glucose over 140 mg/dl and hyperinsulinemia, defined as a serum insulin over 60 µU/ml, two hours after the glucose load. Results: Median HOMA-IR values were 1.7. Percentile 75 in subjects without obesity or underweight was 2.57. The area under the ROC curve, when comparing HOMA-IR with glucose intolerance and hyperinsulinemia, was 0.8 (95% confidence values 0.72-0.87), with HOMA-IR values ranging from 2.04 to 2.33. Conclusions: HOMA-IR is a useful method to determine insulin resistance in epidemiological studies. The HOMA-IR cutoff point for insulin resistance defined in thi spopulation was 2.6. <![CDATA[<b>Comparación del efecto de la terapia prolongada con antipsicóticos atípicos o convencionales en la incidencia de diabetes mellitus 2</b>: <b>Revisión sistemática y metaanálisis</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100002&lng=es&nrm=iso&tlng=es Atypical antipsychotic drugs have less extra pyramidal side effects and are more effective to control the clinical manifestations of schizophrenia. However, their use may be associated to a higher incidence of weight gain, dyslipidemia, metabolic syndrome, glucose intolerance and type 2 diabetes mellitus. We performed a systematic literature search to evaluate the risk of type 2 diabetes mellitus incidence associated to the use of atypical antipsychotic drugs, compared to conventional treatment. If users of all types of atypical antipsychotic drugs are compared with users of conventional treatment, no significant differences in the incidence of type 2 diabetes mellitus were observed. If individual drugs are evaluated, clozapine and risperidone are associated with a higher risk of diabetes than haloperidol. Quetiapine is associated with a lower risk of diabetes than conventional treatment. The quality of the evidence found was low; therefore, new studies should been performed. <![CDATA[<b>Clima laboral en una escuela de medicina. </b><b>Estudio de seguimiento</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100003&lng=es&nrm=iso&tlng=es Background: The work environment of an organization has to do with a set of permanent qualities that are experienced by its members. Aim: To assess the work environment perception of faculty members of a Medical School in two different periods (2005 and 2007). Material and methods: A standardized survey was applied to faculty members and Department chairs of the academic units of our Medical School. The survey used the Likert scale from 1 to 5 and included 59 items, distributed in 8 factors. Additionally, there were two groups of statements, indicating the priorities for the School and for the academic departments. Results: In the study performed in year 2005, the survey was answered by a total of 399 faculty members (68%) and in year 2007, it was answered by 408 members (68%). The global climate perceptions were 66% and 68% in 2005 and 2007, respectively (ns). Among the dimensions evaluated, communications (p =0,62) and physical conditions (p =0,008) improved in the two years period. Conclusions: The applied instrument was stable and useful to knowing the requirements of the faculty members and for improving the organizational climate. <![CDATA[<b>Variación estacional del tricograma en residentes chilenos</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100004&lng=es&nrm=iso&tlng=es Background: Human hair follicle experiments cyclical transformations throughout its life. These are rest (telogen phase), growth (anagen phase) and regression mediated by apoptosis (catagen). During summer the percentage of telogen increases and the percentage of anagen decreases. Aim: To determine the seasonal changes of scalp hair follicle phases among Chilean subjects. Material and methods: Retrospective analysis of 514 differential trichograms of normal scalps from subjects aged 36±14 years, obtained between 1998 and 2008. Results: During summer and winter, the mean percentage of telogen was 20%±10% and 16%±10%, respectively (p <0.01). The figures for anagen in the same periods were 80%±10% and 83%±10%, respectively. Conclusions: This study confirms the presence of seasonal variations in normal trichogram. <![CDATA[<b>El punto de vista de los pacientes sobre la seguridad clínica de los hospitales</b>: <b>Validación del Cuestionario de Percepción de Seguridad</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100005&lng=es&nrm=iso&tlng=es Background: Approximately 10% of hospitalized patients suffer an adverse event during their hospital stay. An important proportion of subjects also feel that they have a high risk of suffering such an event during an eventual hospitalization. Aim: To determine the perception on clinical safety among patients discharged from a hospital. Material and methods: A questionnaire about hospital safety was mailed to 1300 patients discharged from a hospital. The questionnaire was analyzed using construct validity predictive validity and Cronbach Alpha for internal consistency Results: The questionnaire was answered by 384 patients, yielding a response rate of 29%. Of these, 77 incomplete answers were discarded. Thirty-one subjects (10%) reported a possible adverse event. In 19 cases (5.8%), it was due to medication errors and in 19 (6.1%), to surgical procedures. In seven cases (2.3%), both errors coincided (2.3%). According to the predictive validity of the questionnaire, if a patient reports an adverse event, the confidence in the hospital and in the professionals is reduced (p <0.001), communication with the physician is considered inappropriate (p =0.0001) and risk perception increases (p =0.003). Unsatisfied patients are those that believe that they have higher risks of suffering a medical error (p =0.005). Conclusions: Risk perception for adverse events increases after having suffered such an event. Patient satisfaction minimizes the effects of adverse events on their confidence and attitude. <![CDATA[<b>Evolución del estado nutricional en una cohorte de escolares chilenos: ¿Un cambio real o ficticio?</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100006&lng=es&nrm=iso&tlng=es Background: Considering the high prevalence of obesity among children attending elementary schools, it is important to know the evolution of body weight when these children reach adolescent. Aim: To analyze the changes in nutritional status of children between the first year of elementary school and the first year of high school. Material and methods: A historical cohort of children that were assessed when they started elementary school in 1997 was evaluated again eight years later Weight and height were measured and body mass index (BMI) was calculated. Obesity was considered as a BMI over percentile 95 of Center for Disease Control (CDC) references. The concordance between nutritional assessment in both periods and the risk of obesity during adolescence, based on previous weight were also calculated. Results: Data from 117,815 children were analyzed. The prevalence of obesity in the first year of elementary school and the first year of high school was 14.6% and 7%, respectively. The mean weight increase during the eight years period was 32.6±8.4 kg corresponding to 108%±28.1% of the expected increase. There was a low diagnostic concordance between both assessment periods. There was a reduction of under and overweight and a higher proportion of subjects with normal weight in the second assessment period. The risk for being obese in the first year of high school was 6.4 times greater for children that were obese in the first year of elementary school (confidence intervals 6.1-6.9. Conclusions: There was an important reduction in the proportion of obesity between the age of 6 and 14 years. The risk of obesity at 14 years of age was strongly influenced by the presence of obesity at 6 years of age. The broader BMIranges for normality for high school children could give a false image of the nutritional status of teenagers . <![CDATA[<b>La disincronía cardíaca se correlaciona con el remodelado ventrícular izquierdo postinfarto agudo al miocardio</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100007&lng=es&nrm=iso&tlng=es Background: Cardiac dyssynchrony is common in advanced heart failure (HF), but the changes in cardiac synchrony after myocardial infarction (MI) have not been adequately descríbed. Aim: To study the relationship between cardiac synchrony and left ventricular remodeling after acute myocardial infarction. Material and methods: Forty nine patients aged 59±10 years (77% men) with a first episode of a ST segment elevation MI, were studied. Scintigraphic left ventricular function and synchrony analyses were performed at baseline and after a six months follow-up. Determinations were compared with 33 healthy subjects. Results: At baseline, patients with MIhad a decreased left ventricular ejection fraction (LVEF) and significant dyssynchrony, when compared with controls. LVEF was 36.4%±10%, left ventricular end-diastolic volume (LVEDV) 127±38 mL, interventricular delay (IEV) 29±35 miliseconds (ms), and intraventricular delay (IAV), 234±89 ms. After 6 months, LVEF significantly improved (38%±10%, p =0.042) without significant changes in LVEDV (129±32 mL, p =0.97), IEV (24±17, p =0.96) or IAV (231±97, p =0.34). At baseline there were significant correlations between IAV and LVEF, and between IAV and LVEDV (r =0.48, p =0.001 and r =0.41, p =0.004, respectively). These correlations remained significant after 6 months. There was a positive correlation between IAV and LVEDV changes at six months (r =0.403, p =0.04). Conclusions: The development of cardiac dyssynchrony correlates with adverse left ventricular remodeling after MI . <![CDATA[<b>Validez y confiabilidad de la versión chilena del <i>Alcohol Use Disorders Identification Test </i>(AUDIT)</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100008&lng=es&nrm=iso&tlng=es Background: AUDIT is a self-reported questionnaire used to detect problem drinkers. It must be translated into Spanish and validated in order to be used in Chile. Aim: To assess the validity of a Chilean version of the AUDIT questionnaire. Material and methods: The English version of the questionnaire was translated into Spanish and adapted to the Chilean cultural environment. Using the Delphi method, an expert group examined the text and then decided on which would be the definitive version. This test was translated to English again and was approved by one of the original authors. It was then applied to 93 subjects aged 37 ± 12 years (60% males) consulting at a primary health care center These subjects also answered the Composite International Diagnostic Interview (CIDI), version 2.1 that was used as the gold standard for the diagnosis of hazardous drinking and alcohol dependence. Cronbach alpha and test-retest validity were analyzed. Sensitivity and specificity were determined using receiver operating (ROC) curves. Results: The internal consistency of AUDIT was 0.93, its test re-tests reliability was 0.97 (95% confidence intervals 0.96-0.98). Using a cutoff point of 6 for hazardous consumption, its sensitivity and specificity were 83% and 88%, respectively. The figures for dependence and harmful consumption, using a cutoff point of 9, were 87% and 85%, respectively. Conclusions: AUDIT is a valid questionnaire to detect problem drinkers. <![CDATA[<b>Miocardiopatía dilatada secundaria a enfermedad celíaca</b>: <b>Caso clínico</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100009&lng=es&nrm=iso&tlng=es There is an increased incidence of celiac disease in patients with idiopathic dilated cardiomyopathy. We report a 4 7 year-old female presenting with heart failure secondary to dilated cardiomyopathy of unknown etiology. During the five months following the first hospitalization the patient had multiple hospital admissions due to decompensate heart failure. Due to a history of intermittent diarrhea and weight loss, a celiac disease was suspected. Antiendomysial antibodies were positive and there was a villous atrophy in duodenal mucosa. A gluten free diet was started with a concomitant recovery of her functional capacity. After one month of gluten free diet a new echocardiogram showed a normal left ventricle and systolic function. <![CDATA[<b>Linfangioleiomiomatosis pulmonar</b>: <b>Caso clínico</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100010&lng=es&nrm=iso&tlng=es Lymphangioleiomyomatosis (LAM) is a rare interstitial lung disease, of unknown etiology, affecting almost exclusively women. Microscopically LAM consists of a diffuse proliferation of smooth muscle cells. LAM can occur without evidence of other diseases (sporadic LAM) or in conjunction with tuberous sclerosis complex (TSC). It presents with progressive breathlessness or with recurrent pneumothorax or chylothorax. We report a 33 year-old woman with a history of recurrent pneumothorax. Computed tomography (CT) scans showed numerous thin-walled cysts throughout the lungs, a characteristic finding in LAM. A pulmonary biopsy was compatible with the diagnosis and HMB-45 monoclonal antibodies were positive. Treatment with Sirolimus was started). <![CDATA[<b>Infarto agudo al miocardio en un hombre joven sin ateromatosis coronaria, como forma de presentación de síndrome antifosfolípido primario</b>: <b>Caso clínico</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100011&lng=es&nrm=iso&tlng=es Coronary thrombosis as a manifestation of the antiphospholipid syndrome is very uncommon. We report a 25 year-old male without known cardiovascular risk factors that suffered an acute myocardial infarction as the initial manifestation of the antiphospholipid syndrome. His coronary angiogram demonstrated a single thrombotic lesion in the anterior descending artery without coronary atheromatosis. Anticardiolipin, anti B2 Glycoprotein I antibodies, and lupus anticoagulant were all positive. Besides the usual management of the coronary thrombosis, the patient was treated with permanent oral anticoagulation. Three months later, a CT coronary angiogram showed complete reperfusion of the involved artery . <![CDATA[<b>Atrofia cortical posterior</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100012&lng=es&nrm=iso&tlng=es Posterior cortical atrophy (PCA) is a neurodegenerative syndrome, usually due to Alzheimer's disease. The first symptoms are progressive impairment of visuo spatial (Balint's and Gertsmann's syndromes) or visuo perceptive (visual agnosia, alexia) function. Episodic memory and executive function are spared until later stages. We report two males aged 51 and 55years and three females aged 50, 54 and 56 years, with posterior cortical atrophy. Ophthalmologic study was normal in all. Presenting signs and symptoms were visual ataxia, simultagnosia, agraphia, acalculia, spatial disorientation and unilateral neglect (Balint's and Gerstmann's syndromes). Apperceptive visual agnosia, aphasia, apraxia and alexia were also observed. One female had cortical blindness. Structural images were inconclusive, but PET scan and SPECT disclosed functional impairments in occipitotemporal or occipitoparietal areas. <![CDATA[<b>Síndrome de Ehlers-Danlos con especial énfasis en el síndrome de hiperlaxitud articular</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100013&lng=es&nrm=iso&tlng=es There is an urgent need to increase the awareness on the Joint Hyper mobility Syndrome QHS). This is a congenital and prevalent emergent condition that is frequently undiagnosed and that causes significant health problems. Besides recurrent muscular-skeletal problems and signs and symptoms derived from tissue fragility, adolescents and young adults may develop osteoporosis, early osteoarthritis or dysautonomia, that are common in the disease, and deteriorate quality of life. Many JHS patients have signs and symptoms suggestive of fibromyalgia and are usually misdiagnosed. Physicians should be able to differentiate the less severe form of JHS from the Vascular Ehlers-Danlos Syndrome, to diagnose it before the appearance of serious complications and even death. The study of these diseases is a promising area for genomic and rheumatologic research. <![CDATA[<b>Factores modificables de riesgo cardiovascular</b>: <b>¿Cuáles estamos realmente modificando?</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100014&lng=es&nrm=iso&tlng=es While efforts to identify the underlying mechanisms that lead to endovascular atherogenesis continue, the clinical management of the modifiable cardiovascular risk factors should depend on the most advantageous risk-benefit and cost-effective therapies. However these efforts probably will not have a significant impact in the population at risk unless an improvement in the socioeconomic factors of cardiovascular risk occurs. The ongoing global obesity epidemic reinforces the need for these changes. Public and privately sponsored programs and policies to improve education and access to health resources are important components of this process . <![CDATA[<b><i>Un mensaje desde Norteamérica</i></b>: <b><i>El zorro en nuestro patio trasero -Ciencia, "Serendipia " y Sorpresa</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100015&lng=es&nrm=iso&tlng=es The story of how Charles Darwin composed The Origin of Species, published in November of 1859, has been told many times during the bicentennial of Darwin s birth and the sesquicentennial of the publication of the book. It is a history well known to biologists and historians of science. The heated debate that accompanied the demonstration of natural selection as a mechanism of speciation and continues to the present is surprising. Human beings do not welcome surprise: "the emotion aroused by something unexpected." The history of science and human intellect, however, illustrate the creative stimulus of surprise and serendipity in the development of human knowledge and the evolution of culture. The lives of Homo sapiens would not change if our intellect was unable or unwilling to respond to the unexpected and to make connections between surprising and commonplace events. The rich diversity of South American life was surprising to the European travelers of the 18th and 19th centuries: surprising by its beauty and profusion, but also by its similarities to the creatures of Europe and Africa. Darwin s curiosity sought and welcomed surprise).<hr/>La historia sobre cómo escribió Charles Darwin 'El origen de las especies", publicado en noviembre de 1859, ha sido relatada muchas veces durante el bicentenario del nacimiento de Darwin y el sesquicentenario de la publicación del libro. Es una historia bien conocida por los biólogos y los historiadores de la ciencia. La demostración de la selección natural como mecanismo de formación de las especies generó un acalorado debate que continúa hasta el presente. Los seres humanos no acogemos con simpatía la sorpresa, concebida como "la emoción despertada por algo inesperado". La historia de las ciencias y del intelecto humano, sin embargo, ilustran el estímulo creativo de la sorpresa y la "serendipia" en el desarrollo del conocimiento y la evolución de la cultura. La vida del Homo sapiens no cambiaria si nuestro intelecto fuera incapaz o adverso para responder ante lo inesperado y de hacer conexiones entre los eventos sorprendentes y los rutinarios. La rica diversidad de formas de vida en Sudamérica fue sorprendente para los viajeros europeos de los siglos XVIII y XIX: sorprendente por su belleza y profusión, pero también por sus similitudes con las creaturas de Europa y África. La curiosidad de Darwin buscó y dio su bienvenida a la sorpresa. <![CDATA[<b>Sobre el uso de epónimos en medicina</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100016&lng=es&nrm=iso&tlng=es A distinctive feature of medical language is the use of eponyms or denominations constructed using the names of real or imaginary persons. Some consider this practice as inappropriate, because eponyms are sometimes more a reflection of influence and power rather than the real authorship of discoveries. On the other hand, others consider valid the use of eponyms since they are a part of a scientific domain used to name objects and diseases. The fact is that tradition and use have finally imposed eponyms in medical language and demonstrated its usefulness. They facilitate the communication between peers and are also a tribute to the clinical sagacity and observational skills of their discoverers. A reasonable practice is to favor the use of those classical eponyms that have endured the pass of time due to their clinical importance, specificity diagnostic significance or historical relevance. Moreover, the knowledge of the biography or historical environment of discoverers of signs, syndromes or diseases gives us a historical perspective of medicine and sheds light on the past, evolution and present knowledge and practice of medicine. <![CDATA[<b>Cómo enfrenta el hinduismo un dilema ético-clínico</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100017&lng=es&nrm=iso&tlng=es It is indispensable for physicians to understand and recognize the fusion of different cultures, to deliver the best possible service to patients with different cultural backgrounds, especially when ethical-medical problems are involved. The Hindu community in Chile differs in significant ways with the western culture. This is especially true for some issues such as the belief in reincarnation or gender inequality, among others. These discrepancies can be relevant for the analysis of several bioethical problems. Therefore, it is necessary to understand the different beliefs, traditions and Hindu visions. We hereby present a review of Hinduism, its relation with medical practice and, as an example, a case of abortion in a Hindu family. Reviewing the traditions, beliefs and methods will help to understand and respect the beliefs of different cultures in contemporary and globalized bioethics. <![CDATA[<b>Formación en educación de los docentes clínicos de medicina</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100018&lng=es&nrm=iso&tlng=es Effective clinical teaching is an imperative of medical education. Clinical teachers and faculty development initiatives as well as Medical Schools, need to focus their efforts to pursue common outcomes: effective learning in students, future competent physicians and healthy patients. Excellence in quality of teaching needs scholars in education. To achieve this objective, institutions must recruit a core of medical faculty according to its mission, define the attributes and teaching competences, implement faculty development programs, and finally, support academic vitality. This article describes the three main issues of medical teaching: faculty, faculty development and its organization. <![CDATA[<b>Qué son y cómo se interpretan los <i>outcomes </i>compuestos</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100019&lng=es&nrm=iso&tlng=es Effective clinical teaching is an imperative of medical education. Clinical teachers and faculty development initiatives as well as Medical Schools, need to focus their efforts to pursue common outcomes: effective learning in students, future competent physicians and healthy patients. Excellence in quality of teaching needs scholars in education. To achieve this objective, institutions must recruit a core of medical faculty according to its mission, define the attributes and teaching competences, implement faculty development programs, and finally, support academic vitality. This article describes the three main issues of medical teaching: faculty, faculty development and its organization. <![CDATA[<b>Análisis crítico de un artículo</b>: <b>El tratamiento hipoglicemiante intensivo ¿reduce los eventos cardiovasculares o la mortalidad en diabéticos tipo 2?</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100020&lng=es&nrm=iso&tlng=es Epidemiologic studies have shown a relationship between glycated hemoglobin levels and cardiovascular events in patients with type 2 diabetes. We investigated whether intensive therapy to target normal glycated hemoglobin levels would reduce cardiovascular events in patients with type 2 diabetes who laid either established cardiovascular disease or additional cardiovascular risk factors. Methods: In this randomized study 10,251 patients (mean age, 62.2 years) with a median glycated hemoglobin level of 8.1% were assigned to receive intensive therapy (targeting a glycated hemoglobin level below 6.0%) or standard therapy (targeting a level from 7.0 to 7.9%). Of these patients, 38% were women, and 35% had had a previous cardiovascular event. The primary outcome was a composite of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The finding of higher mortality in the intensive-therapy group led to a discontinuation of intensive therapy after a mean of 3.5 years of follow-up. Results: At 1 year, stable median glycated hemoglobin levels of 6.4% and 7.5% were achieved in the intensive-therapy group and the standard-therapy group, respectively. During follow-up, the primary outcome occurred in 352 patients in the intensive-therapy group, as compared with 371 in the standard-therapy group (hazard ratio, 0.90; 95% confidence interval [CI], 0.78 to 1.04; P=0.16). At the same time, 257patients in the intensive-therapy group died, as compared with 203 patients in the standard-therapy group (hazard ratio, 1.22; 95% CI, 1.01 to 1.46; P=0.04). Hypoglycemia requiring assistance and weight gain of more than 10 kg were more frequent in the intensive-therapy group (P<0.001). Conclusions: As compared with standard therapy, the use of intensive therapy to target normal glycated hemoglobin levels for 3.5years increased mortality and did not significantly reduce major cardiovascular events. These findings identify a previously unrecognized harm of intensive glucose lowering in high-risk patients with type 2 diabetes. (ClinicalTrials.govnumber, NCT00000620.). <![CDATA[<b>El enfoque de la salud mental</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100021&lng=es&nrm=iso&tlng=es Epidemiologic studies have shown a relationship between glycated hemoglobin levels and cardiovascular events in patients with type 2 diabetes. We investigated whether intensive therapy to target normal glycated hemoglobin levels would reduce cardiovascular events in patients with type 2 diabetes who laid either established cardiovascular disease or additional cardiovascular risk factors. Methods: In this randomized study 10,251 patients (mean age, 62.2 years) with a median glycated hemoglobin level of 8.1% were assigned to receive intensive therapy (targeting a glycated hemoglobin level below 6.0%) or standard therapy (targeting a level from 7.0 to 7.9%). Of these patients, 38% were women, and 35% had had a previous cardiovascular event. The primary outcome was a composite of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The finding of higher mortality in the intensive-therapy group led to a discontinuation of intensive therapy after a mean of 3.5 years of follow-up. Results: At 1 year, stable median glycated hemoglobin levels of 6.4% and 7.5% were achieved in the intensive-therapy group and the standard-therapy group, respectively. During follow-up, the primary outcome occurred in 352 patients in the intensive-therapy group, as compared with 371 in the standard-therapy group (hazard ratio, 0.90; 95% confidence interval [CI], 0.78 to 1.04; P=0.16). At the same time, 257patients in the intensive-therapy group died, as compared with 203 patients in the standard-therapy group (hazard ratio, 1.22; 95% CI, 1.01 to 1.46; P=0.04). Hypoglycemia requiring assistance and weight gain of more than 10 kg were more frequent in the intensive-therapy group (P<0.001). Conclusions: As compared with standard therapy, the use of intensive therapy to target normal glycated hemoglobin levels for 3.5years increased mortality and did not significantly reduce major cardiovascular events. These findings identify a previously unrecognized harm of intensive glucose lowering in high-risk patients with type 2 diabetes. (ClinicalTrials.govnumber, NCT00000620.). <![CDATA[<b>BICENTENARIO DE LAMARCK (1809)</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100022&lng=es&nrm=iso&tlng=es Epidemiologic studies have shown a relationship between glycated hemoglobin levels and cardiovascular events in patients with type 2 diabetes. We investigated whether intensive therapy to target normal glycated hemoglobin levels would reduce cardiovascular events in patients with type 2 diabetes who laid either established cardiovascular disease or additional cardiovascular risk factors. Methods: In this randomized study 10,251 patients (mean age, 62.2 years) with a median glycated hemoglobin level of 8.1% were assigned to receive intensive therapy (targeting a glycated hemoglobin level below 6.0%) or standard therapy (targeting a level from 7.0 to 7.9%). Of these patients, 38% were women, and 35% had had a previous cardiovascular event. The primary outcome was a composite of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The finding of higher mortality in the intensive-therapy group led to a discontinuation of intensive therapy after a mean of 3.5 years of follow-up. Results: At 1 year, stable median glycated hemoglobin levels of 6.4% and 7.5% were achieved in the intensive-therapy group and the standard-therapy group, respectively. During follow-up, the primary outcome occurred in 352 patients in the intensive-therapy group, as compared with 371 in the standard-therapy group (hazard ratio, 0.90; 95% confidence interval [CI], 0.78 to 1.04; P=0.16). At the same time, 257patients in the intensive-therapy group died, as compared with 203 patients in the standard-therapy group (hazard ratio, 1.22; 95% CI, 1.01 to 1.46; P=0.04). Hypoglycemia requiring assistance and weight gain of more than 10 kg were more frequent in the intensive-therapy group (P<0.001). Conclusions: As compared with standard therapy, the use of intensive therapy to target normal glycated hemoglobin levels for 3.5years increased mortality and did not significantly reduce major cardiovascular events. These findings identify a previously unrecognized harm of intensive glucose lowering in high-risk patients with type 2 diabetes. (ClinicalTrials.govnumber, NCT00000620.). <![CDATA[<b>¿ES RELEVANTE EL ESTUDIO SYNTAX PARA LA TOMA DE DECISIONES EN CARDIOLOGÍA?</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100023&lng=es&nrm=iso&tlng=es Epidemiologic studies have shown a relationship between glycated hemoglobin levels and cardiovascular events in patients with type 2 diabetes. We investigated whether intensive therapy to target normal glycated hemoglobin levels would reduce cardiovascular events in patients with type 2 diabetes who laid either established cardiovascular disease or additional cardiovascular risk factors. Methods: In this randomized study 10,251 patients (mean age, 62.2 years) with a median glycated hemoglobin level of 8.1% were assigned to receive intensive therapy (targeting a glycated hemoglobin level below 6.0%) or standard therapy (targeting a level from 7.0 to 7.9%). Of these patients, 38% were women, and 35% had had a previous cardiovascular event. The primary outcome was a composite of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The finding of higher mortality in the intensive-therapy group led to a discontinuation of intensive therapy after a mean of 3.5 years of follow-up. Results: At 1 year, stable median glycated hemoglobin levels of 6.4% and 7.5% were achieved in the intensive-therapy group and the standard-therapy group, respectively. During follow-up, the primary outcome occurred in 352 patients in the intensive-therapy group, as compared with 371 in the standard-therapy group (hazard ratio, 0.90; 95% confidence interval [CI], 0.78 to 1.04; P=0.16). At the same time, 257patients in the intensive-therapy group died, as compared with 203 patients in the standard-therapy group (hazard ratio, 1.22; 95% CI, 1.01 to 1.46; P=0.04). Hypoglycemia requiring assistance and weight gain of more than 10 kg were more frequent in the intensive-therapy group (P<0.001). Conclusions: As compared with standard therapy, the use of intensive therapy to target normal glycated hemoglobin levels for 3.5years increased mortality and did not significantly reduce major cardiovascular events. These findings identify a previously unrecognized harm of intensive glucose lowering in high-risk patients with type 2 diabetes. (ClinicalTrials.govnumber, NCT00000620.). <![CDATA[<b>APICE INICIA OFICIALMENTE SUS ACTIVIDADES</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001100024&lng=es&nrm=iso&tlng=es Epidemiologic studies have shown a relationship between glycated hemoglobin levels and cardiovascular events in patients with type 2 diabetes. We investigated whether intensive therapy to target normal glycated hemoglobin levels would reduce cardiovascular events in patients with type 2 diabetes who laid either established cardiovascular disease or additional cardiovascular risk factors. Methods: In this randomized study 10,251 patients (mean age, 62.2 years) with a median glycated hemoglobin level of 8.1% were assigned to receive intensive therapy (targeting a glycated hemoglobin level below 6.0%) or standard therapy (targeting a level from 7.0 to 7.9%). Of these patients, 38% were women, and 35% had had a previous cardiovascular event. The primary outcome was a composite of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The finding of higher mortality in the intensive-therapy group led to a discontinuation of intensive therapy after a mean of 3.5 years of follow-up. Results: At 1 year, stable median glycated hemoglobin levels of 6.4% and 7.5% were achieved in the intensive-therapy group and the standard-therapy group, respectively. During follow-up, the primary outcome occurred in 352 patients in the intensive-therapy group, as compared with 371 in the standard-therapy group (hazard ratio, 0.90; 95% confidence interval [CI], 0.78 to 1.04; P=0.16). At the same time, 257patients in the intensive-therapy group died, as compared with 203 patients in the standard-therapy group (hazard ratio, 1.22; 95% CI, 1.01 to 1.46; P=0.04). Hypoglycemia requiring assistance and weight gain of more than 10 kg were more frequent in the intensive-therapy group (P<0.001). Conclusions: As compared with standard therapy, the use of intensive therapy to target normal glycated hemoglobin levels for 3.5years increased mortality and did not significantly reduce major cardiovascular events. These findings identify a previously unrecognized harm of intensive glucose lowering in high-risk patients with type 2 diabetes. (ClinicalTrials.govnumber, NCT00000620.).