Papers by Freddy Contreras
Diabetes patients are at increased risk in this pandemic. A multidisciplinary team is required to... more Diabetes patients are at increased risk in this pandemic. A multidisciplinary team is required to treat patients with Covid-19 as well as monitoring as outpatients such as outpatients and the severe patients. Especially the obese patient with metabolic syndrome has a disbalance as he has adiponectin and leptin are elevated. In diabetics, there is a decrease in the number of T cells regulating pro-inflammatory cytokines. Adipose tissue is resistant to T lymphocytes and promotes pro-inflammatory Cytokines. All of this promotes death of pancreatic cells with decreased insulin release and glucose deregulation. Diabetes patients have an increased risk of infectious diseases. Steroids are diabetogenic and decrease immunity. It is important that the diabetic patient monitor glycemia either with monitoring or with telemedicine. Medicines such as next-generation empagliflozin can increase ketosis and the risk of vaginal infections. Hydration of the diabetic patient is very important. Medical-based evidence has suggested that the risk of infectious diseases in the diabetic has weak evidence. This association with isolated observations promotes the existing possibility that glycemia could be an important factor in patients with Covid. Insulin glycemia monitoring is important in patients with type one diabetes as the risk of insulin glycemia is ketoacidosis. Ketosis, basal insulin. The use of sulphonylureas in COVID decreases its potency as well as metformin that of Dpp4 the patient should be well hydrated since suspending hydration decreases effectiveness. Is ketosis a threat? Ketosis and ketoacidosis, which are dangerous entities, may occur in type 1 diabetes. Diabetes is always there on the lookout for attack. We have to keep an eye on it. If the patient has precordial pain, the doctor should be consulted for the emergency or performed by telemedicine. In COVID-19, hypoglycemia may be seen in patients with type one diabetes and with the presence of ketosis, beta cells are attacked by the beta crown in the pancreas through the receptors made producing apoptosis in pancreatic cells. The patient should follow their medical treatment and vaccination as long as they are not hospitalized. Washing hands make the rules dictated by the global health organization and biosecurity protocols. Complications have been reported in obese patients with CPAP positive ventilation for apnea in patients with Covid-2.
The conventional stethoscope was invented by Professor Laennec in the Necker-Maladies Hospital of... more The conventional stethoscope was invented by Professor Laennec in the Necker-Maladies Hospital of Paris, France in 1816, two hundred years ago until our days. The conventional stethoscope was used under auscultation in all body. This methodology requires auscultation as we use the stethoscope to rule out cardiac problems such as aortic stenosis, mitral insufficiency, aortic insufficiency, mitral stenosis etc. We call these murmurs rash, musical, holosystolic, systolic, diastolic, continuous like persistent conduct arteriosus, auricular ventricular fistula, rupture of sinus of Valsalva, or irradiation to the left axial in mitral insufficiency irritation to the neck in aortic stenosis. We can also detect murmurs in the ocular system.
We need more information, but the evidence shown that the virus is not neurotrophic.
Revista Digital de Postgrado, 2012
La disfuncion endotelial (DE) se considera en la actualidad una de las primeras manifestaciones d... more La disfuncion endotelial (DE) se considera en la actualidad una de las primeras manifestaciones de la enfermedad vascular y de la arteriosclerosis. Dado que los metodos diagnosticos de DE cada dia son mas numerosos e imprecisos se plantean la siguiente interrogante: Son utiles las hormonas endoteliales: Endotelina, Oxido nitrico (NO), Leptina, Proteina C Reactiva (PCR) y Moleculas de adhesion endotelial VCAM-1, como indicadores bioquimicas de DE en sujetos sanos, hipertensos y diabeticos tipo 2. Objetivo: 1-. Comprobar la utilidad de hormonas endoteliales, como indicadores bioquimicas de disfuncion endotelial en sujetos sanos, hipertensos y diabeticos tipo 2. A los efectos, se diseno una investigacion observacional de tipo analitico, correlacional y, transversal. La poblacion objeto del estudio fue de 75 pacientes seleccionados mediante criterios clinicos, los cuales se distribuyeron en 3 grupos de 25 pacientes, a saber: Sanos, diabeticos e hipertensos. A todos los pacientes se les ...
Revista Digital de Postgrado, Jan 3, 2020
La diabetes mellitus (DM) se considera como un conjunto de trastornos metabolicos relacionados co... more La diabetes mellitus (DM) se considera como un conjunto de trastornos metabolicos relacionados con la hiperglucemia, que requiere cambios en estilos de vida, en virtud de que no solo se afecta el estado fisico, sino que requiere cambios que pueden influir en el estado emocional y psicosocial. Las personas con diabetes requieren de cuidados continuos orientados al control metabolico centrados en el empoderamiento, autocuidado y en la educacion terapeutica para alcanzar metas y resultados orientados a minimizar la aparicion de las complicaciones cronicas. Objetivo: analizar la importancia de la educacion terapeutica en los pacientes con trastornos afectivos como depresion y ansiedad, asociados a la diabetes. Conclusion: la educacion terapeutica como parte integral del tratamiento de la DM ha demostrado mejorar los sintomas asociados a depresion y ansiedad, lo cual podria adquirir un valor importante en el manejo de este grupo de pacientes.
Archivos Del Hospital Vargas, 2000
Journal of hypertension. Supplement : official journal of the International Society of Hypertension, 2002
The neutrotransmitter dopamine, precursor of noradrenaline, induces a variety of cardiovascular a... more The neutrotransmitter dopamine, precursor of noradrenaline, induces a variety of cardiovascular and renal physiological responses, including an increase in myocardial contractility and cardiac output without changes in heart rate, passive and active vasodilatation, diuresis and natriuresis. These responses result from its interaction with the dopamine receptors D1, D2, D3, D4 and D5. In addition, recent findings suggest the existence of D6 and D7 receptors. In some types of hypertension dopamine is known to influence the control of arterial pressure by influencing the central and peripheral nervous system and target organs such as the kidneys and adrenal glands. Since dopamine and its derivatives have been shown to have antihypertensive effects, it is important to review the physiological and pharmacological aspects of dopamine and its receptors, and the clinical uses that they could have in the therapy of arterial hypertension.
En el presente trabajo se estudió 30 sujetos divididos en grupos de a 10, 10 sanos, 10 hipertenso... more En el presente trabajo se estudió 30 sujetos divididos en grupos de a 10, 10 sanos, 10 hipertensos y 10 diabeticos tipo II. El análisis de los resultados en los sujetos diabeticos revela que la metoclopramida, bloqueante dopaminérgico DA 2 , reduce la presión arterial sin alterar significativamente la frecuencia del pulso; cuando se añadió dopamina (1 mcg/kg/min) la presión arterial sistólica no se modificó significativamente pero el pulso cardiaco aumentó aunque en menor grado que en los sanos y en los hipertensos. Presumimos que esta respuesta menor en los diabeticos podría estar en relación al cuadro de disautonomía que se observa en los pacientes diabeticos.
... Contreras, Freddy 1 ; Rivera María 1 ; de la Parte, María A 2 ; Rodríguez, Solangel 3 ; Olly ... more ... Contreras, Freddy 1 ; Rivera María 1 ; de la Parte, María A 2 ; Rodríguez, Solangel 3 ; Olly Méndez 4 ; Papapietro, Ana K 5 ; Serrano ... La renografìa por captopril tiene una sensibilidad de 93% y una especificidad de 95% según Pickering y Mann (20) y el señalamiento mas ...
... 1990; 5(3): 251-257. 14. Szathmari M, Steczekk L, Szucs J, Hollo T. Cin Kurites Osteoporosis ... more ... 1990; 5(3): 251-257. 14. Szathmari M, Steczekk L, Szucs J, Hollo T. Cin Kurites Osteoporosis Nokben. Orv-Hetil. 1993; 134(7): 911-4. 15. Mataran L, González J, Rodríguez M, Rodrigo D,Abellán M, Salvatierra D. Zinc y osteoporosis. Ann Med Intern. 1992; 9(7): 331-3. 16. ...
… de Farmacología y …, 2011
... P. Valmore, Cano P Clímaco, Souki R Aida, Medina R Mayerlim, Lemus A Miguel, Leal G ... Merly... more ... P. Valmore, Cano P Clímaco, Souki R Aida, Medina R Mayerlim, Lemus A Miguel, Leal G ... Merlyn, Núñez P Maryluz, Andrade G John, Arria B Melissa, Bermúdez A Fernando, Contreras Freddy ... Hafner S; Gonzalez C; Miettine H; Kennedy E; Dtern M. "A prospective analysis of the ...
Diabetes Research and Clinical Practice, 2000
American Journal of Therapeutics, 2008
Dopamine agonists play an important role in the regulation of the central nervous-cardiovascular,... more Dopamine agonists play an important role in the regulation of the central nervous-cardiovascular, renal, and hormonal systems through stimulation of dopaminergic (DA 1 and DA 2) and aand b-adrenergic receptors. Several studies have shown that in fat and diabetic mice. The aim of the present study was to evaluate the interaction of the dopaminergic and endocrine systems by determining the effect of the dopaminergic antagonist, metoclopramide, and dopamine on insulin secretion and cardiovascular response by blockade and activation of dopamine receptors in healthy and type 2 diabetic subjects. Healthy subjects (n =15) and subjects with type 2 diabetes (n = 15) of both genders, aged 18 to 60 years, were recruited into this study. A comparative experimental design of 90 minutes was performed in which placebo (0.9% saline) was infused intravenously for the first 30 minutes followed by metoclopramide (7.5 mg/kg/min), a dopamine receptor antagonist for 30 minutes, and then metoclopramide (7.5 mg/kg/min) plus dopamine (0.5-3 mg/kg/min) for 30 minutes. The following clinical and biochemical parameters were measured at the beginning and then every 30 minutes of the experimental period (30#, 60# and 90#): systolic-diastolic and mean arterial blood pressure, heart rate, serum glucose, insulin, triacylglycerides, and total cholesterol. Baseline glycosylated hemoglobin was measured and homeostasis model assessment for insulin resistance was calculated from insulin and glucose levels. Twelve-lead electrocardiograms were also obtained at these points. Dopamine infusion induced an increase in serum insulin, systolic blood pressure, and heart rate in healthy subjects but not in subjects with type 2 diabetes. Infusion of metoclopramide induced a hypotensive effect in healthy subjects, which was blunted by inclusion of dopamine in the infusion mixture. In subjects with diabetes, metoclopramide had no effect on blood pressure, but addition of dopamine raised systolic blood pressure. Neither metoclopramide nor dopamine altered significantly the lipid profile in healthy or diabetic subjects. Dopaminergic drugs increase serum insulin probably by interacting with dopaminergic receptors, but stimulation of b-adrenergic receptors cannot be ruled out. Stimulation of cardiovascular dopamine receptors also caused modifications of hemodynamic parameters in healthy subjects, but apparently these receptors are attenuated in patients with type 2 diabetes probably as a result of endothelial dysfunction and alterations in the sympathetic nervous system sensitivity.
American Journal of Therapeutics, 2008
Leptin, a 167-amino acid peptidic hormone secreted by adipose tissue, acts mainly in the arcuate ... more Leptin, a 167-amino acid peptidic hormone secreted by adipose tissue, acts mainly in the arcuate hypothalamus nucleus as a satiety signal, but given its closed connections with inflammatory and endothelial systems, a probable regulatory role in blood pressure (BP) control by interaction with nitric oxide (NO) and C-reactive protein (CRP) has also been described. The cold pressor test (CPT) is a simple test that indirectly determines endothelial dysfunction. In this work, biochemical indicators (CRP, leptin, and NO) and hemodynamic indicators (systolic and diastolic BP) were performed and evaluated in patients with hypertension, patients with type 2, and control subjects during a single CPT for assessment of endothelial dysfunction. A total of 43 subjects aged 25 to 60 years were divided into three groups: 15 healthy volunteers, 13 patients with hypertension, and 15 patients with type 2 diabetes were included in the study. A complete clinical history was obtained from each subject and a complete physical examination, including an electrocardiogram, was carried out. During the 30-minute assay, 0.9% saline solution was infused intravenously. CPT was performed to assess the cardiovascular reactivity at 15 minutes. The cardiovascular variables (systolic and diastolic BP) were measured at 0, 16, and 30 minutes. In addition, serum variables were extracted at the beginning and at the end of the experiment and statistical analysis was performed. CPT caused in all subjects a significant increase in BP and pulse. There were no significant differences in CRP or leptin in all groups, although we observed significant differences for NO (P , 0.05). Sensibility and specificity for all biochemical variables resulted in nonsignificant statistical or clinical importance as markers of endothelial dysfunction; however, a positive association was found when leptin and NO were evaluated together (sensibility, 0.2; specificity, 0.8). CRP, leptin, and NO did not show any direct or significant association with the hemodynamic variables in this study, although a relationship was observed in NO according to group and among biochemical variables when studied together.
American Journal of Therapeutics, 2003
Pregnancy-induced hypertension is one of the complications that obstetricians fear most due to it... more Pregnancy-induced hypertension is one of the complications that obstetricians fear most due to its sudden appearance, its changing clinical presentation, its rapid evolution, and its association with high fetal and maternal morbidity and mortality. Because of these reasons, preeclampsia has been studied widely. But although the search for answers to many questions about its etiopathogenesis and physiopathology has led to numerous researches, after many years of studies and efforts there still exist obscure and enigmatic aspects about them. Today, various risk factors for the development of this entity have been identified, and a combination of different hypotheses has been proposed to try to find an approximation to the real solution for this problem, which could probably lead to better therapeutic management.
American Journal of Therapeutics, 2010
Recently, it has been suggested that non-high-density lipoprotein (non-HDL) cholesterol measure i... more Recently, it has been suggested that non-high-density lipoprotein (non-HDL) cholesterol measure is a useful evaluation tool to assess heart disease death risk. The non-HDL cholesterol is defined as the value between total cholesterol and HDL - total cholesterol, and it involves the different fractions of lipoproteins: low-density lipoprotein, intermediate-density lipoprotein, and very low density lipoprotein, including highly atherogenic lipoproteins as very low density lipoprotein remnants. The purpose of this study was to compare the values of non-HDL cholesterol as a cardiovascular risk marker in a control population, and one diabetic and hypertensive. It was demonstrated that the mean values of non-HDL cholesterol in the diseased groups were higher than the values from the control group, whereas the low-density lipoprotein showed no marked difference in high-risk patients. Non-HDL cholesterol has shown to be a quick and simple way to estimate the risk of developing cardiovascular disease.
American Journal of Therapeutics, 2010
The objective is to determine cardiovascular and insulin release effects under metoclopramide (MT... more The objective is to determine cardiovascular and insulin release effects under metoclopramide (MTC) and dopamine (DA) infusion by using an acute comparative design with the intravenous infusion of both drugs. We evaluated 15 normal (normotensive and normoglycemic) subjects, 13 hypertensive, and 15 type 2 diabetic subjects. Subjects were submitted to an experimental design in which we first gave them a 0.9% saline solution for 30 minutes, and then administered MTC at 7.5 microg kg min through an intravenous infusion during a period of 30 minutes. Although subjects were receiving MTC, we added an intravenous infusion of DA at 1-3 microg kg min during 30 minutes. Blood pressure, heart rate, serum lipid profile, and insulin levels were measured. Sympathetic reactivity by the cold pressor test was also measured. In normotensive subjects, there was a systolic blood pressure and heart rate increase during MTC plus DA infusion. In subjects with diabetes mellitus there was a heart rate increase without changes in blood pressure during the MTC plus DA infusion period. In hypertensive subjects, MTC induced a significant decrease of systolic and diastolic blood pressure. During MTC plus DA period there was an increase of heart rate but no significant changes in blood pressure. During cold pressor test in both diabetic and hypertensive subjects, there were significant increases of both blood pressure and heart rate. Insulin serum levels increased in normotensive and hypertensive subjects but were attenuated in subjects with diabetes mellitus. We conclude that there is a pharmacologic interaction between MTC and DA, that the pressor effects of DA are due to activation to beta and alpha adrenergic receptors, and that the cardiovascular effects of DA in type 2 diabetic subjects are attenuated by a probable defect in sympathetic system and to endothelial dysfunction.
Uploads
Papers by Freddy Contreras