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Patients with atrial fibrillation (AF) at risk of stroke are not always anticoagulated with vitamin K antagonists (VKA) despite lack of contraindication. Dabigatran, an oral direct thrombin inhibitor, is a new option with proven safety and effectiveness in these patients. The advantages of dabigatran are its more predictable response, obviating coagulation monitoring and possible lower frequency of bleedings. Its drawbacks are cost, lack of antidote and long-term data, frequency of dyspepsia and the twice daily dosage. © 2011 Elsevier España, S.L. All rights reserved. Source

Cano-Cuenca N.,University of Castilla - La Mancha | Del Pozo J.E.S.-G.,Servicio de Medicina Interna | Jordan J.,University of Castilla - La Mancha | Jordan J.,Institute Investigacion en Discapacidades Neurologicas UCLM
Journal of Alzheimer's Disease | Year: 2014

Over the last few years, latrepirdine, a démodé antihistamine drug, has been proposed to be useful for treating neurodegenerative disorders such as Alzheimer's and Huntington's diseases, and more recently schizophrenia. The mechanisms and pharmacological targets that are responsible for the beneficial effects on neurodegenerative diseases remain unknown. But it has been proposed that latrepirdine may modulate several targets including voltage-gate Ca+2 channels, mitochondrial permeability pore transition, or several neurotransmitter receptors. Herein, we present a meta-analysis of randomized controlled trials to ascertain the efficacy and safety of latrepirdine on cognitive function. By doing a search in electronic databases, we found five clinical trials in which the effect of latrepirdine on cognition function has been studied, and this was evaluated using MMSE, ADAS-cog, ADCS-ADL, and NPI scores. Latrepirdine generally presented a good safety profile; it was well tolerated when given alone or in combination with a variety of other drugs. We observed heterogeneous results between trials; latrepirdine failed to exert a significant beneficial effect although it tended to improve cognitive scores. The only significant benefit that we found was for the NPI score in Alzheimer's disease patients. © 2014 A IOS Press and the authors. All rights reserved. Source

Perez-Castrillon J.L.,Servicio de Medicina Interna
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral | Year: 2012

The telmisartan is an angiotensin II receptor blocker (ARB) with a few own characteristics that it allows us to obtain a few additional benefits. It displays the ability to act as a partial agonist of PPARgamma. On the other hand, PPAR gamma intervenes in the control of bone remodelling though with not concordant results. The objective of this study to value the effect of telmisartan on bone markers in hypertensive patients. A sample of 31 hypertensive patients with hypertension were included. The dose of telmisartan was of 80 mg/24 h and the period of follow-up was 12 weeks. The control group included 32 hypertensive patients treated before with IECA (enalapril-20 mg/24 h - or quinapril - 40 mg/24 hours). The following parameters were determined P1NP, β-CTX, 25OHD and PTH , osteocalcin, insulin and adiponectin. The patients treated with Telmisartan shown a significantly decrease in systolic blood pressure (156 ± 19 mmHg vs 133 ± 15 mmHg, p = 0.001) and diastolic blood pressure (92 ± 9 mmHg vs 82 ± 6 mmHg, p = 0.01) . Changes were not observed in other parameter, PTHi (48 ± 22 pg/ml vs 45 ± 22 pg/ml, p > 0.05) and 25-vitamin D (21 ± 10 ng/ml vs 25 ± 8 ng/ml, p > 0.05), CTX (0.195 ± 0.12 ng/ml vs 0.221 ± 0.13 ng/ml, p > 0.05), PINP (39 ± 20 ng/ml vs 40 ± 19 ng/ml, p > 0.05), osteocalcin (11 ± 9 ng/ml vs 11 ± 5 ng/ml, p > 0.05), glucose, adiponectin, insulin and HOMA. When the patients divided in two groups depending on the levels of vitamin D (insufficient and not insufficient), with a cut of 20 ng/ml, there was changes on bone markers but a decrease of the glucose was observed in patients with levels of vitamin D over 20 ng/ml (135 ± 53 mg/dl vs 119 ± 39 mg/dl, p = 0.01). The patients treated with IECAS decreases the systolic blood pressure but the diastolic blood pressure values of arterial systolic does not show changes. Telmisartan has a neutral effect to level of the bone markers of bone remodelling. Source

Pale-Torres L.J.,Servicio de Medicina Interna
Revista médica del Instituto Mexicano del Seguro Social | Year: 2011

both, the ankle-brachial index < 0.9, and microalbuminuria are considered markers of endothelial dysfunction. Our objective was to evaluate if there is a correlation between the ankle-brachial index (ABI) and the degree of albuminuria in diabetic normotensive patients. we included 32 diabetic normotensive patients and measured their ABI, and their 24-h urinary albumin excretion by nephelometry; the ABI and albuminuria were correlated with the Spearman correlation coefficient. we did not find overall correlation between the ABI and albuminuria (r = 0.21, 95 % CI = -0.14-0.52, p = 0.12); However, when we measured the correlation of an ABI < 0.9 with any degree of albuminuria, we found a significant correlation (r = -0.32 ± 0.11, 95 % CI = 0.027 to -0.6, p = 0.03); and when the correlation of ABI with albuminuria > 300 mg, we also found a significant correlation (r = -0.45 ± 0.11, 95 % CI = -0.015 to -0.76, p = 0.3). our results suggest that ABI < 0.9 is a useful marker to estimate microalbuminuria in diabetic normotensive patients. Source

Valdivielso P.,University of Malaga | Ramirez-Bueno A.,Servicio de Medicina Interna | Ewald N.,Justus Liebig University
European Journal of Internal Medicine | Year: 2014

Severe hypertriglyceridemia (HTG) is a well established and the most common cause of acute pancreatitis (AP) after alcohol and gall stone disease. It is alleged to account for up to 10% of all pancreatitis episodes. Studies suggest that in patients with triglyceride (TG) levels > 1000 mg/dL (> 11.3 mmol/L), hypertriglyceridemia-induced acute pancreatitis (HTGP-AP) occurs in approximately 15-20% of all subjects referred to Lipid Clinics. Until now, there is no clear evidence which patients with severe HTG will develop pancreatitis and which will not. Underlying pathophysiological concepts include hydrolysis of TG by pancreatic lipase and excessive formation of free fatty acids with inflammatory changes and capillary injury. Additionally hyperviscosity and ischemia may play a decisive role. The clinical features of HTG-AP patients are supposed to be no different from patients with AP of other etiologies. Yet, there are well-conducted studies suggesting that HTG-AP is associated with a higher severity and complication rate. Therapeutic measurements in HTG-AP include dietary modifications, different antihyperlipidemic agents, insulin and/or heparin treatment. The beneficial use of plasmapheresis is repeatedly reported and suggested in many studies. Yet, due to the lack of randomized and controlled trials, it is currently unknown if plasmapheresis may improve morbidity and mortality in the clinical setting of HTG-AP. Since there are no commonly accepted clinical guidelines in the management of HTG-AP, there is a definite need for an international, multicenter approach to this important subject. © 2014 European Federation of Internal Medicine. Source

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