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Examines the association between serum magnesium levels and C-reactive protein in non-diabetic, non-hypertensive obese subjects. Patient characteristics; Link of hypomagnesemia and inflammatory response to the development of glucose metabolic disorders; Inverse correlation of serum magnesium and body mass index.

Objetivo. Determinar la asociación entre apoyo familiar (AF) y apego al tratamiento de la hipertensión arterial esencial (HAS). Material y métodos. Estudio de casos y controles al que se integraron 80 sujetos con diagnóstico establecido de HAS, con 40 pacientes en cada grupo. Se consideró como casos a los pacientes con apego y como controles a los pacientes sin apego al tratamiento. El estudio se realizó de mayo a diciembre de 1999, en el Hospital Regional del IMSS, en la ciudad de Durango, Durango, México. La edad, género, duración de la HAS, escolaridad y estado civil fueron criterios de pareamiento. Las diferencias se establecieron con las pruebas ji cuadrada y t de student. Se calculó la razón de momios para estimar la fuerza de asociación. El diagnóstico de hipertensión arterial secundaria, o de otras enfermedades crónicas fueron criterios de exclusión. Resultados. No hubo diferencias entre los grupos respecto a las variables sociodemográficas, modalidad de tratamiento ni conocimiento que el enfermo tenía sobre su enfermedad. Tenían control de la presión arterial 31 (77.5%) pacientes con apego y 11 (27.5%) sin apego, p= 0.003. El AF se asoció de manera independiente con apego al tratamiento, RM 6.9, IC 95% 2.3-21.1. Conclusiones. El apego se vincula de forma significativa con el apoyo que los familiares otorgan al enfermo. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.html

Objetivo. Determinar cuáles son las alteraciones del ritmo y la conducción cardiaca más frecuentes en pacientes con diabetes tipo 2 sin cardiopatía previa y establecer su asociación con los factores de riesgo cardiovascular. Material y métodos. Se incluyeron pacientes con diabetes tipo 2 sin presencia o antecedentes de cardiopatía. Se determinaron los factores de riesgo cardiovascular, el índice de masa corporal y los niveles séricos de glucosa, colesterol y triglicéridos. Se registró electrocardiograma convencional en reposo. La asociación de las variables en estudio con la ocurrencia de arritmias se calculó con un modelo de análisis multivariado ajustado por sexo. Resultados. Se integraron 199 pacientes: 113 mujeres (56.8%) y 86 hombres (43.2%), y se identificó algún tipo de alteración electrocardiográfica en 29.1% de los sujetos. El hemibloqueo fascicular anterior (HFA) y el bloqueo completo de rama derecha del Haz de His (BRDHH), constituyeron 75.9% de las alteraciones identificadas. Los pacientes con trastornos del ritmo y la conducción tienen niveles más elevados de colesterol y triglicéridos. La aparición de arritmias se relaciona directamente con el incremento de la edad (r= 0.75, p= 0.01). En el análisis multivariado ajustado por sexo la hipercolesterolemia y la edad se asociaron significativamente con las alteraciones del ritmo y la conducción: RM 1.5, IC95% 1.1-4.6, p< 0.05 y RM 1.3, IC95% 1.0-5.2, p< 0.05, respectivamente. Conclusiones. Las alteraciones del ritmo y la conducción cardiaca más frecuentes en la diabetes tipo 2 son el HFA y el BRDHH; la hipercolesterolemia y la edad son los factores asociados a su presencia.

Objetivo. Valorar la asociación de la deficiencia de folatos y otros factores de riesgo con la ocurrencia de defectos de cierre del tubo neural (DCTN), en la población rural del norte de México (Chihuahua, Durango y Zacatecas). Material y métodos. Se hizo un estudio multicéntrico de casos y controles. Se consideraron como casos a los recién nacidos vivos (RNV) y a los muertos con DCTN, y como controles, a los RNV sanos, no malformados. Se determinó la exposición a factores de riesgo conocidos, estableciendo su asociación con los DCTN, con un modelo de análisis múltiple de regresión logística. Resultados. Los factores de riesgo asociados a DCTN fueron: la deficiencia de folatos (RM 11.1; IC95% 1.2-106.2, p= 0.04); el antecedente, en embarazos previos, de productos con DCTN (RM 3.3; IC95% 1.1-18.8, p= 0.05), y óbitos (RM 7.1; IC95% 1.1-46.3, p= 0.04). Conclusiones. La deficiencia de folatos constituye uno de los principales factores de riesgo asociado a los DCTN en la población rural del norte de México. Es necesario llevar a cabo más investigaciones para determinar la contribución de otros factores de riesgo y establecer las medidas preventivas adecuadas.

Objetivo. Determinar la prevalencia y los factores asociados a la hipertensión arterial sistémica (HAS) en la población rural marginada de Durango, México. Material y métodos. Se realizó un estudio transversal comparativo en 627 comunidades rurales, de las que aproximadamente 90% tiene 250 o menos habitantes. Se determinaron las cifras de presión arterial y las variables sociodemográficas. Resultados. Se estudiaron 5 802 sujetos, es decir, 4 452 mujeres (76.7%) y 1 350 hombres (23.3%). Se identificó HAS en 1 271 individuos (21.9%; IC95% 20.8-23.0), de los cuales 1 011 eran mujeres (22.71%; IC95% 21.5-23.9), y 260, hombres (19.26%; IC95% 17.2-21.4). Del total de la población blanco, 3 018 personas (52.0%) viven en comunidades con menos de 250 habitantes, 2 080 (60.9%) mujeres y 938 (31.1%) hombres; en ésta se identificó HAS en 445 casos (14.74%; IC95% 13.5-16.0), de los cuales 326 son mujeres (15.7%; IC95% 14.1-17.3), y 119, hombres (12.7%; IC95% 10.6-14.9). Los principales factores de riesgo relacionados con la HAS fueron la obesidad, el diagnóstico de diabetes tipo 2 y el consumo de alcohol y tabaco. Conclusiones. Al parecer la prevalencia de HAS en la población rural marginada se relaciona con el grado de desarrollo de las comunidades.

Objetivo. Determinar la importancia del apoyo familiar en el control de la glucemia en diabéticos no insulino dependientes. Material y métodos. Se diseñó un estudio de casos y controles, considerando como casos a los pacientes con glucemia o = 140 mg/dl. El apoyo familiar se determinó con el cuestionario Environmental Barriers to Adherence Scales, que estima el apoyo otorgado para que el paciente siga las indicaciones terapéuticas. Se incluyeron 32 casos y 50 controles. Resultados. El apoyo familiar que recibe el paciente se asocia significativamente a la presencia de glucemia

Objetivo. Determinar la frecuencia de cardiopatía isquémica (CI) y su asociación con los niveles séricos de colesterol (NSC), en pacientes con diabetes mellitus no insulinodependiente (DMNID) en el primer nivel de atención médica. Material y métodos. Se estudiaron 411 pacientes y se determinaron indicadores sociodemográficos, NSC y glucemia. Se registró electrocardiograma de 12 derivaciones. Se consideró como CI la presencia, en dos o más derivaciones, de desnivel ST, T isquémica u ondas Q patológicas; se excluyeron los pacientes con antecedentes de CI. Resultados. Predominó el sexo femenino con una proporción de 1.5:1. Se identificó CI en 90 pacientes (22%), con predominio ligeramente mayor en el hombre (0.85:1, mujeres: hombres). En el análisis estratificado, la CI fue más prevalente cuando los NSC fueron ³ 200 mg/dl. La frecuencia de CI en pacientes con NSC de 200-239 mg/dl fue de 24.6% (oportunidad relativa [OR] 2.04; IC 95% 1.03-4.07, p= 0.04) y de 24.2% (OR 1.99; IC 95% 1.02-3.96, p= 0.04) en los pacientes con NSC de 240-300 mg/dl; cuando los NSC fueron >300 mg/dl la CI se incrementó a 38.7% (OR 3.95; IC 95% 1.52-10.30, p= 0.002). Conclusiones. En pacientes con DMNID la CI es más prevalente cuando los NSC son > o = 200 mg/dl, por lo que deberían de considerarse como de alto riesgo para la enfermedad coronaria.

Abstract Background Recent studies have demonstrated that low and high birth-weight at birth are risk factors of developing diabetes. The aim of this study was to determine if the abnormal birth-weight is related with hyperinsulinemia and elevated index of the Homeostasis Model assessment for Insulin Resistance (HOMA-IR) at birth, in at term newborns. Methods Newborns with gestational age between 38 and 41 weeks, products of normal pregnancies of healthy mothers aged 18 to 39 years, were eligible to participate. Small-for-gestational age (SGA) and large-for-gestational age (LGA) newborns were compared with appropriate-for-gestational (AGA) age newborns. Incomplete or unclear data about mother’s health status, diabetes, gestational diabetes, history of gestational diabetes, hypertension, pre-eclampsia, eclampsia, and other conditions that affect glucose metabolism were exclusion criteria. Hyperinsulinemia was defined by serum insulin levels ≥13.0 μU/mL and IR by HOMA-IR ≥2.60. Multiple logistic regression analysis was used to determine the odds ratio (OR) that computes the association between birth-weight (independent variable) with hyperinsulinemia and HOMA-IR index (dependent variables). Results A total of 107 newborns were enrolled; 13, 22, and 72 with SGA, LGA, and AGA, respectively. Hyperinsulinemia was identified in 2 (15.4%), 6 (27.3%), and 5 (6.9%) with SGA, LGA, and AGA (p=0.03), whereas IR in 3 (23.1%), 8 (36.4%), and 10 (13.9%) newborns with SGA, LGA and AGA (p=0.06). The LGA showed a strong association with hyperinsulinemia (OR 5.02; CI 95%, 1.15-22.3; p=0.01) and HOMA-IR (OR 3.54; CI 95%, 1.03-12.16; p=0.02); although without statistical significance, the SGA showed a tendency of association with hyperinsulinemia (OR 2.43; CI 95%, 0.43-17.3 p=0.29) and HOMA-IR (OR 1.86; CI 95%, 0.33-9.37; p=0.41). Conclusions Our results suggest that LGA is associated with hyperinsulinemia and elevated HOMA-IR at birth whereas the SGA show a tendency of association.

Obesity, type 2 diabetes, arterial hypertension, decrease in immune response, cytokine storm, endothelial dysfunction, and arrhythmias, which are frequent in COVID-19 patients, are associated with hypomagnesemia. Given that cellular influx and efflux of magnesium and calcium involve the same transporters, we aimed to evaluate the association of serum magnesium-to-calcium ratio with mortality from severe COVID-19. The clinical and laboratory data of 1064 patients, aged 60.3 ± 15.7 years, and hospitalized by COVID-19 from March 2020 to July 2021 were analyzed. The data of 554 (52%) patients discharged per death were compared with the data of 510 (48%) patients discharged per recovery. The ROC curve showed that the best cut-off point of the magnesium-to-calcium ratio for identifying individuals at high risk of mortality from COVID-19 was 0.20. The sensitivity and specificity were 83% and 24%. The adjusted multivariate regression model showed that the odds ratio between the magnesium-to-calcium ratio ≤0.20 and discharge per death from COVID-19 was 6.93 ( 95% CI 1.6-29.1) in the whole population, 4.93 ( 95% CI 1.4-19.1, p = 0.003) in men, and 3.93 ( 95% CI 1.6-9.3) in women. In conclusion, our results show that a magnesium-to-calcium ratio ≤0.20 is strongly associated with mortality in patients with severe COVID-19.

Background: Results of previous clinical trials evaluating the effect of magnesium supplementation on inflammatory markers are controversial., Objective: A systematic review and meta-analysis of randomized controlled trials (RCTs) were performed to evaluating the effect of oral magnesium supplementation on plasma C-reactive protein (CRP) concentrations., Method: PubMed-Medline, SCOPUS, Web of Science and Google Scholar databases were searched (from inception to August 09, 2016) to identify RCTs, evaluating the effect of magnesium on CRP levels. A random-effects model and a generic inverse variance method were used to compensate for the heterogeneity of studies. Publication bias, sensitivity analysis, and meta-regression assessments were conducted using standard methods., Results: Overall, the impact of magnesium supplementation on plasma concentrations of CRP was assessed in 11 studies. Magnesium treatment was not found to significantly affect plasma concentrations of CRP (WMD: -0.11 mg/L, 95% CI: -0.75, 0.52, p=0.727). When the analysis was stratified to compare subgroups of studies in populations with baseline plasma CRP values of ≤ 3 and > 3 mg/L, a significant reduction of CRP values was observed in the latter subgroup (WMD: -1.12 mg/L, 95% CI: -2.05, -0.18, p=0.019) but not in the former group (WMD: 0.61 mg/L, 95% CI: -0.10, 1.32, p=0.090). The difference between subgroups was statistically significant (p=0.004)., Conclusion: Results of the present meta-analysis indicated that magnesium supplementation reduces CRP levels among individuals with inflammation (CRP levels > 3 mg/dL). This finding suggests that magnesium supplements may have a beneficial role as an adjuvant for the management of low-grade chronic systemic inflammation., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

The 2015 Dietary Guidelines Advisory Committee indicated that magnesium was a shortfall nutrient that was underconsumed relative to the Estimated Average Requirement (EAR) for many Americans. Approximately 50% of Americans consume less than the EAR for magnesium, and some age groups consume substantially less. A growing body of literature from animal, epidemiologic, and clinical studies has demonstrated a varied pathologic role for magnesium deficiency that includes electrolyte, neurologic, musculoskeletal, and inflammatory disorders; osteoporosis; hypertension; cardiovascular diseases; metabolic syndrome; and diabetes. Studies have also demonstrated that magnesium deficiency is associated with several chronic diseases and that a reduced risk of these diseases is observed with higher magnesium intake or supplementation. Subclinical magnesium deficiency can exist despite the presentation of a normal status as defined within the current serum magnesium reference interval of 0.75-0.95 mmol/L. This reference interval was derived from data from NHANES I (1974), which was based on the distribution of serum magnesium in a normal population rather than clinical outcomes. What is needed is an evidenced-based serum magnesium reference interval that reflects optimal health and the current food environment and population. We present herein data from an array of scientific studies to support the perspective that subclinical deficiencies in magnesium exist, that they contribute to several chronic diseases, and that adopting a revised serum magnesium reference interval would improve clinical care and public health., Competing Interests: 4 Author disclosures: RB Costello, RJ Elin, A Rosanoff, TC Wallace, F Guerrero-Romero, A Hruby, PL Lutsey, FH Nielsen, M Rodriguez-Moran, Y Song, and LV Van Horn, no conflicts of interest., (© 2016 American Society for Nutrition.)

Background: Given that hypomagnesemia is related with hyperglycemia, hypertension, hypertriglyceridemia, and insulin resistance, the objective of this study was to determine whether serum magnesium levels are associated with the metabolically obese normal weight (MONW) and the metabolically healthy obese (MHO) phenotypes., Methods: Population-based cross-sectional study that enrolled 427 subjects, men and non-pregnant women aged 20 to 65years, to participate in the study. Subjects were allocated into groups with and without obesity; among non-obese individuals, the subgroup of MONW subjects was compared with a control group of healthy normal-weight individuals. Among obese individuals, the subgroup of MHO subjects was compared with a control group of obese subjects who exhibited at least one metabolic abnormality. In the absence of obesity, the presence of fasting hyperglycemia, insulin resistance, hypertriglyceridemia, and/or hypertension defined the presence of MONW phenotype. In the absence of hypertension, insulin resistance and metabolic abnormalities of fasting glucose and triglycerides levels, the phenotypically obese subjects were defined as MHO individuals., Results: The sex-adjusted prevalence of MONW and MHO phenotypes was 40.8% and 27.9%. The multivariate logistic regression model adjusted by family history of diabetes, age, body mass index, and waist-circumference, showed a positive association between hypomagnesemia and the MONW phenotype (OR 6.4; 95%CI 2.3-20.4) and negative relationship between serum magnesium and the MHO phenotype (OR 0.32; 95%CI 0.17-0.61)., Conclusions: Our results show that hypomagnesemia is positively associated with the presence of MONW phenotype, and the normomagnesemia negatively with the MHO phenotype., (Copyright © 2013. Published by Elsevier B.V.)

To evaluate the effect of oral supplementation with magnesium chloride on the systemic and hepatic inflammation, 38 non-hypertensive obese women aged 30 to 65 years were allocated into groups with and without hypomagnesemia. Hypomagnesemic women drank 50 mL of 5% solution of MgCl2 equivalent to 450 mg of elemental magnesium. Low-carbohydrate diets and physical activity were indicated for women in both groups. Chronic diarrhea, alcohol intake, use of diuretics, previous oral magnesium supplementation, hepatic disease, and renal damage were exclusion criteria. Hypomagnesemia is defined by serum magnesium concentrationsor=40 U/L, and systemic inflammation by serum high-sensitivity C reactive protein (hs-CRP) concentration>or=3 mg/L. At baseline (p=0.06) and final of follow-up (p=0.80), there were no significant differences by body mass index between the groups in the study. In the same way, at baseline ALT (48.1+/-25.5 and 34.6+/-24.1 U/L, p=0.14) and hs-CRP (9.4+/-6.0 and 7.9+/-5.9 mg/dL, p=0.47) levels were similar in the supplemented and non-supplemented women. In the magnesium group, ALT (24.3+/-10.3 and 34.8+/-13.6 U/L, p=0.02) levels, but not hs-CRP (5.2+/-1.9 and 8.0+/-5.6 mg/L, p=0.08) reached significantly lower levels, in the fourth month of treatment, than in women in the control group. The adjusted odds ratios between the improvement in serum magnesium and reduction in ALT and hs-CRP levels were 0.56 (95% CI: 0.3-0.9) and 0.93 (95% CI: 0.6-29.9), respectively. Results of this study show that in hypomagnesemic obese women, oral supplementation with magnesium chloride reduces plasma ALT levels; hs-CRP levels only show a reduction trend.

Objective: To determine the clinical characteristics of NAFLD in asymptomatic obese women., Methods: A total of 457 asymptomatic obese women were enrolled in a cross-sectional study and allocated into groups with and without NAFLD. Irrespective of ALT levels, diagnosis of NAFLD was established by ultrasonographic findings; irrespective of fibrosis, NASH was defined by hepatic histological changes., Results: One hundred ninety five (42.7%) women had elevated ALT levels. Diagnosis of NAFLD was established in 228 (49.9%) women; among women with NAFLD, 34 (14.9%) have ALT levels within the normal range. On the other hand, based on the healthy range for ALT levels (19 UI/L), 336 (73.5%) women had elevated ALT, but only 2 (0.9%) women with NAFLD exhibited ALT levels within normal healthy values. Furthermore, 93 (41%) women who had AST/ALT levels (3) 1 underwent liver biopsy; of these, 90 (96.8%) had diagnosis of NASH and 3 (3.2%) of hepatic cirrhosis. Women with NAFLD were more obese and have higher fasting plasma glucose, triglycerides, ALT, and AST levels than obese women without NAFLD. Seventy six (16.6%) women had diagnosis of diabetes; of these 47 (61.8) in the NAFLD group., Conclusions: Results of this study support the statement that women with NAFLD have an adverse metabolic profile. Furthermore, our results show that hyperglycemia, hypertriglyceridemia and markers of liver injury such as AST/ALT > or = 1 may be useful for early recognition of NAFLD.

To evaluate the efficacy of adding cognitive behavioural treatment (CBT) to either a low-carbohydrate (LC) diet or a low-fat (LF) diet in the treatment of weight loss of obese women, a randomised clinical intervention study was performed. A total of 105 healthy non-pregnant obese women (average age and BMI of 45.4 (sd 10.4) years and 36 (sd 4.3) kg/m2) were randomly allocated to the CBT or control (C) groups; within each group, women were randomly selected to receive either the LC or LF diet during 6 months. The pre-planned primary trial end-point was the weight loss. Differences between the groups were assessed using one-way ANOVA. There were three women (2.8 %) who dropped out, all of them in the CBT group. No differences in the anthropometric and laboratory characteristics at baseline were noted between women in the CBT (n 52) and control groups (n 50). Intention-to-treat analysis showed that weight loss in the CBT-LC (90 (sd 12.3) to 82.1 (sd 12.1) kg) and C-LC (89.4 (sd 10.0) to 85.8 (sd 9.8) kg) groups reached 8.7 and 4.0 %, respectively (P < 0.0001), and in the CBT-LF (87.9 (sd 11.4) to 79.4 (sd 11.8) kg) and C-LF (88.8 (sd 14.5) to 85.3 (sd 14.3) kg) groups it was 9.7 and 3.9 %, respectively (P < 0.05). Weight loss was higher in the CBT-LF group than in the CBT-LC groups (P = 0.049). The present results showed that adding CBT to either the LF or LC diet produced significantly greater short-term weight loss in obese women compared with diet alone. These finding support the efficacy of CBT in breaking previous dietary patterns and in developing healthier attitudes that reinforce a healthier lifestyle.

Nine cases of multiseptate gallbladder have been reported in the English literature. Another case is presented. We consider cholecystectomy the treatment of choice because it relieves the symptoms and avoids chronic infection and stone formation.

With the help of the Doppler Ultrasound we have measured the radial artery blood flow of 20 healthy volunteers and the fistula flow of 40 uraemic patients. The measurements were made at rest and repeated one, three and five minutes after initiation of hand exercise, and one minute after the exercise had finished. Radial artery mean flow increased significantly with the exercise (p less than 0.001); radial arteries with greater baseline flow had less flow increase (p less than 0.002). However, we were not able to demonstrate any fistula flow increase with the hand exercise. Therefore, we conclude that there is no benefit in advising uraemic patients to squeeze a rubber ball which, otherwise, supposes an unnecessary preoccupation for these patients.

Femoral arteriovenous fistulas (AVF) were constructed in dogs. Fistulas blood flow was measured simultaneously with standard Doppler equipment, with electromagnetic flow probes and by direct timed blood collection. A good correlation was observed between Doppler and direct timed blood collection (r = 0.822, p less than 0.001) and also between Doppler and electromagnetic determinations (r = 0.747, p less than 0.001). These results lead us to suggest that transcutaneous measurement of AVF flow is possible with standard Doppler equipment and we recommend this technique for the management of AVF constructed in uremic patients.

Although heparin has been used extensively to treat Deep Venous Thrombosis (DVT) and arterial ischemia (AI), controversy still exists regarding optimal dosage and the need for monitoring. Different authors have employed various test with variable results. Others, however, persist in giving heparin without laboratory control. This study was made in order to compare, in a prospective, randomized and blind manner, two coagulation tests, namely: Howel Time (HT) and Activated Partial Thromboplastin Time (APTT), in controlling the dose of heparin given by continuous intravenous infusion in DVT and AI. Our results show no significant difference in complications and failures of the therapy with either test, although significantly higher doses of heparin were needed to maintain APTT within therapeutic range than those needed to keep HT within a similar range.