Título del artículo:

Lessons learned from two large epidemiological studies of cardiovascular and cerebrovascular diseases in which Colombia took part

Two recent large-scale epidemiological studies, INTERHEART and INTERSTROKE in which Colombia took part, demonstrated that in Latin America in general and particularly in Colombia, the main risk factor for the presentation of acute myocardial infarction and ischemic, and hemorrhagic stroke was the abdominal obesity in contrast to the rest of the world where the main risk factor was increase in plasma concentrations of total cholesterol and LDL-cholesterol for myocardial infarction, and hypertension for stroke . These data give support to the proposal that in Latin America the rapid transition in economic models experienced in the last years together with the fast urbanization has led to an explosive increase in abdominal obesity, diabetes mellitus type 2, and cardiovascular and cerebrovascular diseases.

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Revista Colombiana de Cardiologia

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Is there an increase risk of cancer, reproduction complications and toxic events in workers exposed to antineoplastic agents?

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Enfermeria Clinica

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Malignant peripheric nerve sheath tumor of the orbit: First description of orbital location in a patient with NF1

Introduction. The malignant peripheric nerve sheath tumor (MPNST), is a malignant neoplastic lesion originated in Schwann cells of the lining sheath of peripheral nerves. This neoplasia may appear with benign or malignant heterologous components, with divergent differentiation, as the glandular one. Aim. To describe for the first time in the literature, a case of a glandular MPNST, located at the orbit and to revise the literature on this tumoral lesion. Clinical case. Nine year old male, with a base diagnosis of NF1, who had exophthalmos, retro-ocular pain, headache, facial asymmetry and descent of the right eyeball, that started 1 year earlier. This patient showed in the Computed Tomography an Magnetic Resonance, a well delimited, lobulated, solid mass at the eyeball, which extended to the fontal and temporal brain parenchyma. A right Fronto-temporal craniotomy was made with fronto -orbital- zygomatic resection of the tumoral lesion. Later, a dural plasty and reconstruction with titanium mesh was made at the skull base. At present, the patient is asymptomatic after 4 months of follow up. A malignant biphasic neoplastic lesion was observed, reactive in the mesenchymal elements S100, PGP 9.5, neurofilaments and vimentin. The glandular component was positive for AE1/AE3, EMA, CEA and focally for CD57. There was also reactivity to cromogranin, synaptophysin, serotonin and somatostatin. The diagnosis of Glandular MPNST was made. Conclusion. For the first time in the literature a case of Glandular MPNST located at the orbit, which occurred in child with NF1, is described. This extremely uncommon neoplasia must be taken into account, in the study of biphasic malignant lesions, as its diagnosis is of great importance because of the bad prognosis of the affected patients.

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Neurocirugia

Título del artículo:

Intensive and critical care nursing perspectives

The essential characteristic traits of a professional were first explored by Flexner [1] and others in the early 1900s. Researchers attempted to refine the traits of the true professions of law, medicine, and the clergy, and began comparing other groups of workers to these professions [2, 3]. In 1969, Etzioni [4] labelled nursing a semiprofession concurrent with changes in conceptualization of the nature of professions by others [5-6]. However, contemporary opinion is that nursing has since achieved full professional status in many countries [7]. Kimball\'s comprehensive historical analysis identified that expertise, service, and associations were the three essences of a profession [8]. Nursing is now well recognized as a profession and intensive and critical care nursing is regarded as a subspecialty of the nursing profession. © 2009 Springer-Verlag Milan.

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Intensive and Critical Care Medicine: WFSICCM World Federation of Societies of Intensive and Critical Care Medicine

Título del artículo:

Functional neurological evaluation of the brainstem. Part I: The blink reflex

The blink reflex is the neural response elicited in the orbicular oculi muscle after single or paired supraorbital nerve stimulation, by either electrical, mechanical, acoustic, thermal, chemical or magnetic stimulation. It is made up of three responses called R1, R2 and R3. R1 is an early response that follows A beta fibers, and does not habituate. R2 is a middle-latency response that follows A beta and A delta fibers, tends to habituate and is modulated by sensorimotor suprasegmental structures. R3 is a long-latency response, generated by stimulation of a multisynaptic chain of neurons that involve type C fibers belonging to a complex pontothalamic-amigdalo-cerebellar pathway. It is also possible to record three silent periods if the blink reflex is obtained while the subject makes a voluntary facial muscle effort. The functional study of this reflex allows to define with certainty whether the lesion is in afferent or efferent pathways or if it involves an abnormal sensorimotor integration due to disorders of the central, autonomic or peripheral nervous systems. A correct execution of these studies, and their appropriate interpretation, based on the underlying mechanisms of neural plasticity, will guide toward better neurorehabilitation protocols.

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Iatreia

Título del artículo:

Appropriate prenatal care system: The best way to prevent preeclampsia in Andean countries

The main cause of maternal mortality in Colombia is preeclampsia; even though it is a major public health problem its etiology and physiopathology remain unknown. However it is believed that endothelial dysfunction plays a central role in the development of this disease. Many clinical trials have been carried out to demonstrate the effect of certain interventions to prevent preeclampsia and improve pregnancy outcomes. Our hypothesis is that the reduction of preeclampsia risk could be achieved through an appropriate health system that would provide an opportune and effective prenatal care to pregnant women allowing early diagnosis and treatment of frequent nutritional and health related problems. © 2009 Universidad del Valle, Facultad de Salud.

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Colombia Medica

Título del artículo:

Inflammation but not endothelial dysfunction is associated with the severity of coronary artery disease in dyslipidemic subjects

Introduction. Endothelial dysfunction and inflammation play a key role in the development of atherosclerosis. The present study evaluated endothelial function, inflammatory parameters, and carotid intima-media thickness (IMT) in dyslipidemic patients with or without coronary artery disease (CAD). Methods. Metabolic profile and inflammatory parameters were determined in dyslipidemic patients with (+CAD, n = 33) and without (- CAD, n = 69) symptomatic CAD. Endothelial function was evaluated by flow mediated dilatation (FMD) and plasma concentration of nitrites and nitrates. Carotid IMT was measured by ultrasound. Results. No significant differences were observed in anthropometric hemodynamic or metabolic parameters between the groups. After adjusting by age and medication usage, some inflammatory markers were significantly higher in +CAD; however no significant differences in FMD or plasma levels of nitrites were observed. Conclusions. In subjects with dyslipidemia, the presence of CAD is associated with an elevation of certain inflammatory markers and carotid IMT but not with further endothelial dysfunction. © 2009 Christian F. Rueda-Clausen et al.

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Mediators of Inflammation

Título del artículo:

Cardiometabolic Disease in Latin America: The Role of Fetal Programming in Response to Maternal Malnutrition

Latin America is experiencing an epidemic of cardiovascular disease and type-2 diabetes mellitus. The rise in life-expectancy and increasingly rapid urbanization have resulted in a greater prevalence of overweight, obesity and metabolic syndrome. In Latin America, there is a high level of susceptibility to the development of insulin resistance and low-grade inflammation at relatively low levels of abdominal obesity. This susceptibility is associated with the adaptive response of the fetus to deficient fetal nutrition, which results in a loss of anatomical structures such as nephrons, cardiomyocytes and pancreatic beta cells. These adaptations may prove detrimental if food becomes abundant again after birth. In Latin America, the high prevalence of maternal and fetal malnutrition could mean that the resulting fetal adaptations may contribute to an increased risk of cardiometabolic disease. The socioeconomic differences that exist between developed and underdeveloped countries may be reflected in different biological adaptations, which could invalidate the diagnostic criteria and preventive and therapeutic approaches that have been recommended on the basis of research carried out in populations with different characteristics. Clinical studies are needed to evaluate the effectiveness of interventions recommended for preventing and aiding recovery from cardiometabolic disease in Latin America. © 2009 Sociedad Española de Cardiología.

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Revista Espanola de Cardiologia

Título del artículo:

New scheme for hydrotreating of heavy oil fractions. Joint analysis for sullur, nitrogen and aromatic compounds

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8th World Congress of Chemical Engineering: Incorporating the 59th Canadian Chemical Engineering Conference and the 24th Interamerican Congress of Chemical Engineering

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Mutations in the BRCA1 gene (185delAG and 5382insC) are not present in any of the 30 breast cancer patients analyzed from eastern Colombia

Introduction: Breast cancer is considered a worldwide public health problem, and, in Santander Province, Colombia, it is the first leading cause of morbidity and mortality by cancer in women. All cancers are considered genetic diseases, and mutations in BRCA (BReast CAncer) genes raises the risk for breast cancer by 60%-80%. The current study searched for the two most frequent BRCA1 mutations reported in the Breast Cancer Core Information database. Objective: The presence of specific mutations (185delAG, exon 2 and 5382insC, exon 20) was determined for the BRCA1 gene in women with familial/hereditary breast cancer. Materials and methods: The sample included 30 female patients using the oncology services in Bucaramanga, eastern Colombia; an informed consent, a questionnaire and a blood sample were obtained from each. The molecular analysis was done with PCR-Mismatch, to detect the insertion or eliminatation of a restriction site, and enzymatic digestion methods (HinfI or DdeI). Results: Two of the most frequent BRCA1 mutations in the international database were not found in the 30 patients studied. Conclusion: Additional mutation screening techniques are necessary involving the entire BRCA1 gene, are necessary in order to better characterize the molecular epidemiology of breast cancer in Bucaramanga, Santander, Colombia.

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Biomedica

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A report of two cases of disseminated cutaneous leishmaniasis in Santander, Colombia

Leishmaniasis is a zoonosis produced by the transmission of the protozoan leishmania caused by the bite of sand-flies from the Lutzomya specie. Several clinical manifestations present themselves, depending on the infecting strain and the host\'s immune response; the most frequent variety is localised cutaneous leishmaniasis. Atypical forms sometimes develop, such as the diffuse variety, in which the number of ulcers is greater than 10, thereby affecting several body areas requiring special considerations in its diagnosis and management. This article reports two cases of patients from endemic areas of Santander suffering from diffuse cutaneous leishmaniasis produced by the L. panamensis strain. Protocols for the active search of this type of case in endemic areas throughout Colombia should be implemented.

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Revista de Salud Publica

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Study of the internal consistency and factor structure of the Impact of Event Scale among Colombian women victim of violence

BACKGROUND: The Impact of Event Scale is used to identify possible cases of Post-Traumatic Stress Disorder in clinical settings. However, among Colombians its psychometric properties are unknown. OBJECTIVE: To establish the internal consistency and factor structure of the Impact of Event Scale among women referred for forensic examination due to violence in Bucaramanga, Colombia. METHODS: A group of 310 women between 18 and 65 years participated in this research. The mean age was 31.6 years (SD = 10.7); the mean scholarship was 8.8 years (SD = 4.4); 59.1% were half or full-time employees; 58.7% were married; 60.6% lived in low-class neighbourhood; and 52.3% reported having been victim of physical assault. Cronbach\'s alpha coefficient was calculated and the factor structure was explored for the Impact of Event Scale. RESULTS: The Cronbach coefficient was 0.80 and three-dimensional structure (reexperiencing, avoidant behaviors and restricted affect) that accounted for roughly 50% of the variance. CONCLUSIONS: The Impact of Event Scale shows acceptable internal consistency and three factors explain significant percentage of the variance.

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Vertex (Buenos Aires, Argentina)

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Use of aspirin in the prevention of cardiovascular diseases

During the last few years multiple studies have demonstrated that aspirin administration is effective in reducing the risk of coronary artery disease and ischemic cerebrovascular disease in men and women respectively. The benefit of receiving low-dose aspirin (75-160 mg/d) clearly overcomes the risk of hemorrhagic complications in subjects with a coronary heart disease risk of >=1% per year (>=10% in 10 years). Despite this evidence, the use of low-dose aspirin as a primary prevention strategy is not fully established yet. The application of the current recommendations of aspirin use in primary prevention could be beneficial in the Colombian population, especially because evidence shows a greater susceptibility to present high levels of chronic low-degree inflammation associated to a greater cardiovascular risk in our population. However, further studies are needed to confirm this hypothesis.

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Revista Colombiana de Cardiologia

Título del artículo:

Cardiovascular prevention in high-risk patients with type 2 diabetes mellitus: When to start it?

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European Heart Journal

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Subclinical infection as a cause of inflammation in preeclampsia

Preeclampsia, a pregnancy-exclusive hypertensive disorder, is the major cause of maternal and perinatal mortality, with a greater importance in developing countries. The role of inflammation in the pathogenesis of preeclampsia has been the object of recent studies by our group. We have described elevated levels of inflammatory markers (tumor necrosis factor alpha, interleukin-6, and C-reactive protein) in preeclamptic patients and demonstrated that Latin-American women present a higher degree of inflammation than women from developed countries. We have results that suggest that chronic subclinical infections and insulin resistance are the most probable causes of the increased inflammation in preeclampsia. Moreover, we showed that early treatment of urinary and vaginal infections decreased the incidence of preeclampsia. We also have evidence that suggests that inflammation leads to endothelial dysfunction, predisposing women to develop preeclampsia. Increased levels of inflammation markers and endothelial dysfunction are found in the early stages of pregnancy in women who later on develop preeclampsia. Appropriate prenatal care programs, including screening and treatment of urinary, vaginal, and periodontal infections in early pregnancy and prevention of factors that predispose to insulin resistance, such as excessive weight gain during pregnancy, may reduce the incidence of preeclampsia in Latin-American women. © 2008 Lippincott Williams & Wilkins.

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American Journal of Therapeutics

Título del artículo:

Are nutrition-induced epigenetic changes the link between socioeconomic pathology and cardiovascular diseases?

The prevalence of cardiovascular diseases (CVD) and diabetes mellitus type 2 (DM 2) is decreasing in developed countries despite the increase in the percentage of subjects with obesity and other well-recognized cardiovascular risk factors. In contrast, the recent transition of the economic model experienced by developing countries, characterized by the adoption of a Western lifestyle, that we have named \"socioeconomic pathology,\" has led to an increase in the burden of CVD. It has been demonstrated that conventional cardiovascular risk factors in developed and developing countries are the same. Why then does the population of developing countries currently have a higher incidence of CVD than that of developed countries if they share the same risk factors? We have proposed the existence of a higher susceptibility to the development of systemic inflammation at low levels of abdominal obesity in the population of developing countries and the consequent endothelial dysfunction, insulin resistance, DM 2, and CVD. In contrast, an important percentage of obese people living in developed countries have a healthy phenotype and low risk of developing CVD and DM 2. Human epidemiologic studies and experimental dietary interventions in animal models have provided considerable evidence to suggest that nutritional imbalance and metabolic disturbances early in life may later have a persistent effect on an adult\'s health that may even be transmitted to the next generations. Epigenetic changes dependent on nutrition could be key in this evolutionary health behavior, acting as a buffering system, permitting the adaptation to environmental conditions by silencing or increasing the expression of certain genes. © 2008 Lippincott Williams & Wilkins.

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American Journal of Therapeutics

Título del artículo:

Inter-relationships between body mass index, C-reactive protein and blood pressure in a hispanic pediatric population

Background: The link between inflammation, obesity, and cardiovascular disease (CVD) has been described in adult populations but few data are available with respect to children. The aim of this study was to describe the inter-relationships between adiposity, C-reactive protein (CRP) plasma concentrations, and blood pressure levels in a Hispanic pediatric population. Methods: We included 325 schoolchildren (mean age, 10.0 years) selected from the school population of Bucaramanga, Colombia. Blood pressure, lipid profile, glucose, and CRP plasma concentration were measured using standard procedures. Body mass index (BMI) was used for evaluating the children\'s nutritional condition. Correlation coefficients were calculated for all the variables using Spearman\'s test. Results: As expected, a positive correlation was found between BMI and systolic blood pressure (SBP) in both genders, and between CRP and SBP levels in boys. After a multivariate regression analysis, the association between adiposity and blood pressure remained significant, whereas the CRP concentrations were no longer associated with SBP. Conclusions: The results obtained in our study of Hispanic school-age children show that adiposity is correlated with CRP concentrations and SBP values as has been earlier described in Caucasian populations. However, we failed to find a significant relationship between low-grade inflammation and SBP levels. Further studies are needed in order to explore alternative pathophysiological mechanisms linking obesity and high blood pressure in children and to define the impact of these associations on the cardiovascular risk of our pediatric population. © 2008 American Journal of Hypertension, Ltd.

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American Journal of Hypertension

Título del artículo:

The role of the L-arginine-nitric oxide pathway in preeclampsia

Preeclampsia (PE) is a major cause of maternal and perinatal mortality, especially in developing countries. Its etiology involves multiple factors, but no specific cause has been identified. Evidence suggests that clinical manifestations are caused by endothelial dysfunction. Nitric oxide (NO), which is synthesized from L-arginine in endothelial cells by the endothelial nitric oxide synthase (eNOS), provides a tonic dilator tone and regulates the adhesion of white blood cells and platelet aggregation. Alterations in the L-arginine-NO pathway have been associated with the development of PE. Various studies, reporting decreased, elevated or unchanged levels of nitrite (NO2) and nitrate (NO3), two end products of NO metabolism, have been published. Our group contributed to those contradictory reports describing cases of PE with both elevated and decreased levels of NO2 and NO3. Apparently, diminished levels of NO could be related to deficiencies in the ingestion of dietary calcium associated to low levels of plasma ionic calcium, which is crucial to the eNOS\' activity. Also, low levels of NO could be associated with the presence of eNOS polymorphisms or the presence of increased levels of ADMA, the endogenous inhibitor of NO. High levels of NO associated to low levels of cGMP suggest a decreased bioactivity of NO, which is probably related to an increased degradation of NO caused by a high production of superoxide in states of infection and inflammation. The present article analyses and reviews the reported paradoxical roles of the L-arginine-NO pathway in PE and gives a possible explanation for these results. © 2008, SAGE Publications. All rights reserved.

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Therapeutic Advances in Cardiovascular Disease

Título del artículo:

Defining the research priorities to fight the burden of cardiovascular diseases in Latin America

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Journal of Hypertension

Título del artículo:

Double blind, randomized, placebo controlled clinical trial for the treatment of diabetic foot ulcers, using a nitric oxide releasing patch: PATHON

Background: Diabetes Mellitus constitutes one of the most important public health problems due to its high prevalence and enormous social and economic consequences. Diabetic foot ulcers are one of the chronic complications of diabetes mellitus and constitute the most important cause of non-traumatic amputation of inferior limbs. It is estimated that 15% of the diabetic population will develop an ulcer sometime in their lives. Although novel therapies have been proposed, there is no effective treatment for this pathology. Naturally produced nitric oxide participates in the wound healing process by stimulating the synthesis of collagen, triggering the release of chemotactic cytokines, increasing blood vessels permeability, promoting angiogenic activity, stimulating the release of epidermical growth factors, and by interfering with the bacterial mitochondrial respiratory chain. Topically administered nitric oxide has demonstrated to be effective and safe for the treatment of chronic ulcers secondary to cutaneous leishmaniasis. However, due to their unstable nitric oxide release, the topical donors needed to be applied frequently, diminishing the adherence to the treatment. This difficulty has led to the development of a multilayer polymeric transdermal patch produced by electrospinning technique that guarantees a constant nitric oxide release. The main objective of this study is to evaluate the effectiveness and safety of this novel nitric oxide releasing wound dressing for the treatment of diabetic foot ulcers. Methods and design: A double-blind, placebo-controlled clinical trial, including 100 diabetic patients was designed. At the time of enrollment, a complete medical evaluation and laboratory tests will be performed, and those patients who meet the inclusion criteria randomly assigned to one of two groups. Over the course of 90 days group 1 will receive active patches and group 2 placebo patches. The patients will be seen by the research group at least every two weeks until the healing of the ulcer or the end of the treatment. During each visit the healing process of the ulcer, the patient\'s health status and the presence of adverse events will be assessed. Should the effectiveness of the patches be demonstrated an alternative treatment would then be available to patients. © 2007 Silva et al; licensee BioMed Central Ltd.

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Trials

Título del artículo:

Hiroshima, mon amour: An inner pilgrimage to catharsis

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Pilgrimages and Spiritual Quests in Japan

Título del artículo:

A global view of population health in Columbia: Role of social macro-determinants

Introduction. The social environment is an important determinant of population and individual health. However, its impact is often not considered in national health policies and generally its attributes are considered as constants. For this reason, contemporary health policies place greater emphasis on individual risk factors. Objective. Colombia\'s position in the world ranking is described with respect to several social macro-determinants of health, previously characterized as components of class/welfare regime model. Materials and methods. The exploratory study included all countries with comparable data including the following: (1) economic development [gross domestic product per capita adjusted for purchasing power parity], (2) income inequality [Gini coefficient], (3) social capital [corruption perceptions index and generalized trust], and (4) political regime [index of freedom]. First, correlations between these macro-determinants were estimated, and second, the relationship between them and life expectancy at birth was explored. Finally, the position of Colombia in global context was determined. Results. Important correlations occurred among the macro-determinants. Colombia tended to have intermediate to low positions in the global context in all macro-determinants, with the exception of gross domestic product per capita adjusted for purchasing power parity. Conclusion. The macro-determinant of population health with the highest potential of effecting improvement in health conditions is to modify income inequality.

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Biomedica

Título del artículo:

Periodontal disease severity is related to high levels of C-reactive protein in pre-eclampsia

OBJECTIVE: Recent studies have shown that pre-eclamptic women present a high prevalence of periodontitis, suggesting that active periodontal disease may play a role in the pathogenesis of pre-eclampsia. The present study analysed the effect of periodontal disease in the concentrations of serum high-sensitivity C-reactive protein (hs-CRP), and its association with pre-eclampsia. METHODS: A case-control study was carried out in Cali-Colombia, comprised of 398 pregnant women (145 cases and 253 controls) who were believed to have periodontal disease, between 28 and 36 weeks of gestational age. Pre-eclampsia cases were defined as blood pressure ≥140/90 mmHg and proteinuria ≥0.3 g/24 h. Controls were pregnant women with normal blood pressure, without proteinuria, matched by maternal age, gestational age and body mass index. Sociodemographic data, obstetric risk factors, periodontal state, subgingival microbial composition and hs-CRP levels were determined in both groups. RESULTS: The case and control groups were comparable for sociodemographic characteristics. In women with pre-eclampsia and confirmed periodontal disease (n = 138), hs-CRP levels increased according to the severity of the disease (gingivitis median 4.14 mg/dl; mild periodontitis median 4.70 mg/dl; moderate/severe periodontitis median 8.8 mg/dl; P = 0.01). A similar tendency was observed in controls with periodontal disease (n = 251), but it did not reach statistical significance (gingivitis median 5.10 mg/dl; mild periodontitis median 5.12 mg/dl; moderate/severe periodontitis median 6.90 mg/dl; P = 0.07). A significant difference in hs-CRP levels was observed in pre-eclamptic women with moderate/severe periodontitis compared to controls (P = 0.01). CONCLUSION: These findings suggest that chronic periodontitis may increase hs-CRP levels in pregnant women and lead to complications such as pre-eclampsia. © 2007 Lippincott Williams & Wilkins, Inc.

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Journal of Hypertension

Título del artículo:

Socioeconomic pathology as a cause of regional differences in the prevalence of metabolic syndrome and pregnancy-induced hypertension

The epidemic of cardiovascular desease being experienced by developing countries has resulted in a debate about the possible existence of regional differences in etiology and pathophysiology that could be associated with socioeconomic factors. Clear demonstration of these differences is important because there may be a need for different approaches to prevention, diagnosis and treatment. There is some evidence that there are differences between populations in developed and developing countries in the pathophysiologic mechanisms underlying pregnancy-induced hypertension and metabolic syndrome, just as there are in the relative weightings of risk factors that predict the appearance of these conditions. Observations in our country suggest that increasing exposure to changes in lifestyle brought about by the consumer society (e.g., a lack of exercise, and a high-fat, high-calorie diet) results in a natural biological response (e.g., obesity, metabolic syndrome, and diabetes) that increases the risk of cardiovascular disease. We propose that the term socioeconomic pathology should be used to describe these changes associated with modern society so that they can be differentiated and considered in isolation from socioeconomic factors and other risk factors. We regard the interaction between these various factors as the most important cause of the rapidly increasing incidence of cardiovascular disease observed in developing countries in recent years.

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Revista Espanola de Cardiologia

Título del artículo:

A randomized, double blind, cross-over, placebo-controlled clinical trial to assess the effects of Candesartan on the insulin sensitivity on non diabetic, non hypertense subjects with dysglyce mia and abdominal obesity. \"ARAMIA\"

Background: The raising prevalence of type-2 diabetes mellitus and obesity has been recognized as a major problem for public health, affecting both developed and developing countries. Impaired fasting plasma glucose has been previously associated with endothelial dysfunction, higher levels of inflammatory markers and increased risk of developing insulin resistance and cardiovascular events. Besides life-style changes, the blockade of the renin-angiotensin system has been proposed as a useful alternative intervention to improve insulin resistance and decrease the number of new type-2 diabetes cases. The aim of this clinical trial is to study the effect of the treatment with Candesartan, an angiotensin II receptor antagonist, on the insulin resistance, the plasma levels of adipoquines, oxidative stress and prothrombotic markers, in a group of non diabetic, non hypertensive, dysglycemic and obese subjects. Methods and design: A randomized, double blind, cross-over, placebo-controlled, clinical trial was designed to assess the effects of Candesartan (up to 32 mg/day during 6 months) on the Homeostasis Model Assessment (HOMA) index, lipid profile, protrombotic state, oxidative stress and plasma levels of inflammatory markers. The participants will be recruited in the \"Fundación Cardiovascular de Colombia\". Subjects who fullfil selection criteria will receive permanent educational, nutritional and exercise support during their participation in the study. After a 15 days-run-in period with placebo and life-style recommendations, the patients who have a treatment compliance equal or greater than 80% will be randomily assigned to one of the treatment groups. Group A will receive Candesartan during 6 months and placebo during 6 months. Group B will receive placebo during the first 6 months, and then, Candesartan during the last 6 months. Control visits will be programed monthly and all parameters of interest will be evaluated every 6 months. Hypothesis: Treatment with Candesartan, could improve the HOMA index, the response to the oral glucose tolerance test and reduce the plasma levels of adipoquines, oxidative stress and prothrombotic markers, in non diabetic, non hypertense subjects with dysglycemia and abdominal obesity, recruited from a population at high risk of developing insulin resistance. These effects are independent of the changes in arterial blood pressure. Trial registration: NCT00319202. © 2006 López-Jaramillo et al; licensee BioMed Central Ltd.

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Trials