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Poor metabolic control is a constant in patients with diabetes worldwide, despite resources demonstrated to achieve therapeutic targets. The object of this study was to identify causes of poor metabolic control in patients with diabetes treated in Family Medicine Clinics in metropolitan Mexico City at the Instituto Mexicano del Seguro Social.We analyzed 638 of 1,170 patients studied between 2000 and 2006. Anthropometric variables, occurrence of infections, treatment adherence, medical prescriptions, diet, exercise, and laboratory results were recorded.The proportion of patients with HbA1c7% worsened over time: from 38.9% at baseline it decreased to 21.4% (p0.001); LDL cholesterol decreased from 51.9 to 12.2% (p0.001), and controlled blood pressure from 35.6 to 23.3% (p0.001). A diet high in calories was associated with poor metabolic control (OR: 2.36; 95% CI: 1.34-4.13) and treatment intensification with elevated HbA1c (OR: 2.1; 95% CI: 1.14-4.14). Treatment was not intensified in 90% of patients outside targets. Infections, non-adherence, and drugs that interfere with oral hypoglycemic agents were not associated with higher HbA1c.The main factors associated with higher HbA1c were: disease progression, an inadequate diet, and lack of treatment intensification. Any program designed to improve the conditions of these patients must consider these factors.

Uterine cervical cancer (UCC) is one of the main causes of cancer-associated mortality in women. Inflammation has been identified as an important component of this neoplasia; in this context, anti-inflammatory drugs represent possible prophylactic and/or therapeutic alternatives that require further investigation. Anti-inflammatory drugs are common and each one may exhibit a different antineoplastic effect. As a result, the present study investigated different anti-inflammatory models of UCC in vitro and in vivo. Celecoxib, sulindac, nimesulide, dexamethasone, meclofenamic acid, flufenamic acid and mefenamic acid were tested in UCC HeLa, VIPA, INBL and SiHa cell lines. The cytotoxicity of the drugs was evaluated in vitro. Celecoxib, sulindac, nimesulide, mefenamic acid and flufenamic acid presented with slight to moderate toxicity (10-40% of cell death corresponding to 100 µM) in certain cell lines, while meclofenamic acid exhibited significant cytotoxicity in all essayed cell lines (50-90% of cell death corresponding to 100 µM). The meclofenamic acid was tested in murine models (immunodeficient and immunocompetent) of UCC, which manifested a significant reduction in tumor growth and increased mouse survival. It was demonstrated that of the evaluated anti-inflammatory drugs, meclofenamic acid was the most cytotoxic, with a significant antitumor effect in murine models. Subsequent studies are necessary to evaluate the clinical utility of this drug.

The optimal treatment of patients with von Willebrand's disease (vWD) remains to be defined. Moreover, it has not been firmly established which, if any, commonly measured parameters of von Willebrand factor (vWF) protein in the plasma are useful in guiding treatment. To better understand what guidelines physicians follow in the management of vWD, we surveyed 194 North American physicians who are members of the Hemophilia Research Society. Ninety-nine per cent of responding physicians depend on factor VIII (FVIII):C, vWF:RCo activity and vWF:AG to diagnose vWD, while only 49% use the bleeding time. The minimal goals of treatment for patients undergoing major surgery/trauma or central nervous system haemorrhage were FVIII:C and vWF:RCo activity greater than 80% while levels of more than 50% for minor surgery and dental extractions were considered adequate. Treatment of vWD was based on the type of vWD with type 1 patients being treated most often with desmopressin acetate (DDAVP) alone, types 2A and 2B patients with a combination of DDAVP and a vWF-containing FVIII product, type 3 patients with vWF-containing concentrate. Viral infections, including human immunodeficiency virus, hepatitis A, B and C viruses, and parvovirus have been seen in vWD and the efficacy of viral attenuation processes is a major criterion for the selection of treatment by physicians. Based on this survey, prospective studies need to be designed to address the clinical efficacy, safety and predictive value of laboratory monitoring of patients with vWD.

Purpose: This report presents pooled data from two multicenter studies conducted to assess the efficacy, safety, and tolerance of lower-dose intravenous immune globulin (IVIG) regimens of 250 mg/kg/day, 400 mg/kg/day, and 500 mg/kg/day for 2 days, compared to an established higher-dose regimen of 1 g/kg/day for 2 days, in children with immune thrombocytopenic purpura (ITP). Patients and Methods: A total of 24 children received IVIG (Gammar® I.V.). In Study 1, 10 centers enrolled 12 children between 5 and 12 years old who received IVIG at either 400 mg/kg/day or 1 g/kg/day for 2 days. In Study 2, five centers enrolled 12 infants and children younger than 5 years old who received IVIG at 250 mg/kg/day or 500 mg/kg/day for 2 days. Both studies were prospective and randomized. Results: IVIG treatment was effective (platelets increased at least 30,000/cu mm over baseline) in 94% (16 of 17) of the evaluable patients in the low-dosage group. Platelet increases occurred rapidly: by 48 hours, total platelet counts ranged from 32,000/cu mm to 256,000/cu mm, and peak platelet counts reached 38,000/cu mm to 551,000/cu mm. Adverse events (AEs) were most often mild, lasted less than 3 hours, and were usually those typically associated with immunoglobulin administration-headache, nausea, vomiting, and fever. There were two serious AES-an anaphylactoid reaction in one patient in the 400 mg/kg group and aseptic meningitis in one patient in the 1 g/kg high-dosage group. Both patients recovered without sequelae and were responders. Although the incidence of AEs varied by dosage groups, this difference was not significant. However, the incidence of AEs was affected by age. AEs were significantly lower in patients younger than 5 years of age. Conclusions: In this small, randomized trial, low-dose IVIG in 2-day regimens of 250, 400, or 500 mg/kg/day rapidly reversed thrombocytopenia just as effectively as 1 g/kg/day in infants and young children with ITP. Lower-dosage regimens are safe and well-tolerated; the incidence of AEs is lower in children younger than 5 years of age.

An association between thrombophilic genes and obstetric conditions with early pregnancy termination has been previously proposed. In the present study we attempted to evaluate the possible association between thrombophilic genetic polymorphisms and habitual abortion (HA). Samples from two groups of volunteers were analyzed. The experimental group (n100) was conformed by women attending the Centro Medico de Occidente, IMSS and their male couples, with a reproductive history ofat least three miscarriages. The reference group (n200) was composed by male and female healthy adults living in the state of Jalisco, Mexico. DNA was extracted from peripheral blood, and polymorphisms FII G20210A , FVG1691A, MTHFR C677T, ECA IID y TNF G-308A were typed by PCR-RFLP or -SSP. Genotype proportions in the reference group were in agreement with the HardyWeinberg expectations. Allele, genotype, and phenotype proportion inter-group comparisons did not show statistically significant differences. The present results could not demonstrate that thrombophilic polymorphisms constitute risk factors for HA in Jalisco.

Several epidemiological studies have associated the presence of hepatitis C virus (HCV) with the development of B-cell malignant lymphoma. However, in areas where the prevalence of HCV is low, this association has not been demonstrated. The aim of this study was to established the prevalence of HCV in patients with B-cell malignant lymphoma. The study was performed in 416 patients with new, previously untreated B-cell malignant lymphoma (236 diffuse large cell [DLC], 97 follicular lymphoma, and 83 marginal B-cell zone malignant lymphoma) and 1902 cases (682 first-degree relatives, 832 healthy blood donors, and 408 patients with solid tumors); furthermore, 353 patients with chronic liver disease associated to HCV were the control groups. We found a prevalence of 0.48 positive HCV among malignant lymphoma, 0.12 for healthy blood donors, 0 in first-degree relatives, and 0.56 in patients with solid tumors, that were statistically significant. The odds ratio was 1.86 and its confidence interval included the equality. None of the patients with chronic liver disease and HCV developed malignant lymphoma in a median follow-up of 7.9 yr. We felt that the presence of HCV is not significant in the development of malignant lymphoma, and that reports of high prevalence were associated also to a high prevalence of HCV in the general population and this association will be considered hazardous.