Biomedical subjects

Ursulo Juárez Herrera

Publications and source records attributed to Ursulo Juárez Herrera.

5 recordsLinked to original sources

PubMedDate not supplied

[Rational treatment of hypertensive crises].

The Hypertensive Crisis can be divided into Emergencies and Urgencies. Hypertension may be unknown at presentation. The Emergencies have acute or ongoing end-organ damage (neurological, renal or cardiovascular). It is crucial to recognize one from another already at the emergency room evaluation. There is no arbitrary level of blood pressure separating hypertensive emergencies and urgencies. Ideally, this patients must be treated in an intensive care unit. The level to which the blood pressure should be lowered and the election of the treatment, parenteral versus oral, depends on the patient's general condition and should be individualized. The general recommendation is to reduce the mean arterial pressure gradually in the first 48 hours by no more than 20 percent or to a diastolic blood pressure not lower than 100 mmHg. A relatively asymptomatic patient, even with high diastolic lectures does not need to be treated with parenteral drugs. The patient should be evaluated for possible factors that may have contributed to the high of blood pressure and the progression of hypertension.

Emergencies↗

PubMedDate not supplied

[Decrease of total hemorrhage with reduced doses of enoxaparin in high risk unstable angina. ENHNFAI study. (Enoxaparin vs non-fractionated heparin in unstable angina). Preliminary report].

UNLABELLED: In this prospective, randomized and controlled study, we compare complications in 2 groups of patients: group 1, enoxaparin 0.8 mg/kg, subcutaneous every 12 hours during 5 days, and group 2, intravenous unfractionated heparin during 5 days, by infusion treated to activate partial tromboplastin time 1.5-2 the upper limit of normal. Blood samples were obtained at 4, 12, 24 hours and at day 5 of treatment, to measure anti-Xa levels, and also, evaluated end points at 30 days, between groups. Univariate and multivariate logistic regression analyses were performed with clinical and angiographic variables between groups, with p < 0.05. RESULTS: 203 consecutive patients, average age of 60.5 +/- 11.2 years, and 80% men, were included. There were no differences in clinical and angiographic characteristics. All patients with enoxaparin had therapeutic levels of anti-Xa, of 0.5 to 0.67 U/mL. There was increasing risk of total bleeding in group 2 (18.7%) than in group 1 (5.6%), with RR = 1.72 (95% CI 1.29, 2.29), p = .003. Also, there was 33.3% of MACE in group 2, and only 17.8% in group 1, with RR = 1.88 (CI 95% 1.29, 2.29), p = .011. CONCLUSIONS: 1) Low doses of enoxaparine achieve therapeutic levels, since the first 4 hours of treatment. 2) A significant reduction of total bleeding occurred with the low doses of enoxaparin, with the same efficacy to reduce MACE during follow-up.

Aged↗

PubMedDate not supplied

[The target of reperfusion in acute coronary ischemic syndrome with ST segment elevation. The major paradigm: "Beyond TIMI 3 flow: the TIMI 4 or myocardial tissue-level perfusion"].

Treatment for ST- elevation acute coronary syndromes (acute myocardial infarction: AMI) has advanced rapidly in the last decade with major improvements in early fibrinolytic therapy (FT), primary percutaneous interventions (PCI) with the aid of platelet glycoprotein IIb/IIIa inhibitors. Recent interest has shifted from infarct related artery (IRA) patency to microvascular perfusion in the evaluation of patients with AMI. It is well known that establishing epicardial patency after AMI (TIMI 3 E) is not synonymous with tissue-level perfusion (TIMI 4M). Microvascular dysfunction due to the roles of platelet and inflammatory mediators in the no-reflow phenomenon occurs in a substantial proportion of patients despite thrombolytic therapy or PCI procedures. Techniques are now available that measure real tissue-level perfusion and also therapy is directed to optimize myocardial perfusion in patients with AMI. Despite advances, contemporary FT strategies with the combination of platelet glycoprotein IIb/IIIa inhibitors restore normal coronary flow (TIMI 3) in the IRA in only 50-75% and PCI achieves TIMI 3 flow rates in 90-95%, but only with modest reductions in mortality, but with significant reductions in rethrombosis of the IRA or stents, reinfarctions and in some patients with benefits in ventricular dysfunction. Therefore moving beyond the importance of TIMI 3 flow, the TIMI 4 flow, or improving tissue-level perfusion in the setting of AMI seems to be the paradigm for the treatment of ST-elevation acute coronary syndromes.

Acute Disease↗

PubMedDate not supplied

[Troponins and the indication for treatment with IIb/IIa inhibitors in acute coronary syndromes without ST-segment elevation. Is it time for an "INR" value of troponins?].

At the present time non-ST elevation acute coronary syndromes are the most important cause of hospital admissions. Troponin determination in clinical practice is a key element of diagnosis, risk evaluation and prognosis, and now, defines the population that will benefit from IIb/IIIa inhibitors treatment. Probably a "universal standard value of Troponins" is needed to uniform our therapeutic criteria. The "minor elevations" for troponin-I are considered < 0.4 ng/dL and 0.5 ng/dL for troponin-T. The treatment of non ST elevation acute myocardial infarction with IIb/IIIa inhibitors may reduce the total amount of troponins and myocardial damage.

Acute Disease↗

PubMedDate not supplied

[ST elevation acute coronary syndromes. Pharmaco-mechanic strategy is the universal treatment future?].

The main objective in the medical treatment of the ST elevation acute myocardial infarction, must have the intention to reperfuse the culprit involved artery. In order to reduce this time, the pharmaco-invasive strategy may offer rapid flow recanalization in the culprit artery and reduce the damage of the myocardium. The new pharmacologic combinations includes half dose of fibrinolytics, alone or in combination with IIb/IIIa inhibitors, this combination may offer advantages of the flow. This concept involves the that PCI (Percutaneous Coronary Interventions), can be done in a subsequent time. The risk of bleeding is increased with this strategy, and some evaluation or bleeding risk must be done in all patients, as in patients with 75 years and older.

Acute Disease↗