Unidades de pie diabético en España: conociendo la realidad mediante el uso de un cuestionario

ObjectiveTo ascertain the number of diabetic foot units (DFUs) in Spain, the specialists working in them, and the population covered by them.Material and methodsThe Spanish Group on the Diabetic Foot (SGDF) prepared and agreed a questionnaire based on the recommendations of the 2011 International Consensus on the Diabetic Foot (ICDF). From October to December 2012, the questionnaire was sent to members of three scientific societies formed by professionals involved in the care of patients with diabetes mellitus. Population coverage of the responding centers and DFUs was estimated using the 2012 population census.ResultsSeventy five questionnaires were received, 64 of them from general hospitals, which accounted for 13% of the general hospitals of the National Health System. It was calculated that they provided coverage to 43% of the population. Thirty four centers answered that they had a DFU. Specialized diabetic foot care was only provided to 25% of the population. The number of different professionals working at diabetic foot units was 6.3 ± 2.7. Classification of DFUs based on their complexity was as follows: 5 basic units (14.7%), 20 intermediate units (58.8%), and 9 excellence units (26.5%).ConclusionsThe number of DFUs reported in this study in Spain is low, and allow for foot care of only one out of every four patients with diabetes. Spanish health system needs to improve diabetic foot care by creating new DFUs and improving the existing ones.     

Índice triglicéridos y glucosa: un indicador útil de insulinorresistencia

IntroductionInsulin resistance assessment requires sophisticated methodology of difficult application. Therefore, different estimators for this condition have been suggested. The aim of this study was to evaluate the triglycerides and glucose (TyG) index as a marker of insulin resistance and to compare it to the triglycerides/HDL cholesterol ratio (TG/HDL-C), in subjects with and without metabolic syndrome (MS).Material and methodsAn observational, cross-sectional study was conducted on 525 adults of a population from Bahia Blanca, Argentina, who were divided into two groups: with MS (n = 89) and without MS (n = 436). The discriminating capacities for MS of the TyG index, calculated as Ln (TG [mg/dL] x glucose [mg/dL]/2), and the TG/HDL-C ratio were evaluated. Pre-test probability for MS was 30%.ResultsThe mean value of the TyG index was higher in the group with MS as compared to the group without MS and its correlation with the TG/HDL-C ratio was good. The cut-off values for MS in the overall population were 8.8 for the TyG index (sensitivity = 79%, specificity = 86%), and 2.4 for the TG/HDL-C ratio (sensitivity = 88%, specificity = 72%). The positive likelihood ratios and post-test probabilities for these parameters were 5.8 vs 3.1 and 72% vs 58% respectively. The cut-off point for the TyG index was 8.8 in men and 8.7 in women; the respective values for TG/C-HDL were 3.1 in men and 2.2 in women.ConclusionsThe TyG index was a good discriminant of MS. Its simple calculation warrants its further study as an alternative marker of insulin resistance.     

¿Cuál es el papel de la valoración geriátrica integral en Oncogeriatría?

The growing increase in world population and generalised aging have been accompanied by an increase in the prevalence of cancer in the elderly. Aging is associated with certain physiological changes, some of which are enhanced by the neoplasm itself. Along with this, the elderly oncology patient usually has more problems than the rest of the elderly, and has a multitude of deficits. These characteristics require a special handling of the older patient with cancer, by using the main tool used in Geriatrics, the comprehensive geriatric assessment. This article analyses the importance of the comprehensive geriatric assessment in this population group, paying special attention to its ability to predict the toxicity of chemotherapy and the survival of the elderly oncology, as well as its ability to classify these patients into groups that help in the decision making process.     

Contribution a la connaissance de la distribution géographique de quelques Chlorophycées en Belgique

Sans résumé     

El papel de la mitocondria en el dolor de la neuropatía diabética

Diabetes is a metabolic disease affecting approximately 300 million people worldwide. Neuropathy is one of its frequent complications, and may affect sensory, motor, and autonomic nerves. Its pathophysiology has not fully been elucidated. Several hypotheses have been proposed, and mitochondria have been suggested to play a significant role. This article reviews the mechanisms involved in mitochondrial dysfunction and development of diabetic neuropathy, consisting mainly of oxidative and inflammatory stress, changes in intracellular calcium regulation, apoptotic processes, and changes in mitochondrial structure and function that may lead to development of diabetic neuropathy.     

Tratamiento de la hiperglucemia en el hospital. Impresiones y conocimientos del médico residente

Background and objectiveIn many hospitals, adequate glycemic control is not achieved despite implementation of new insulin therapy protocols. Our aim was to assess resident physician’ attitudes toward inpatient hyperglycemia, barriers to achieve optimum control, and impact on them of an insulin training programMaterial and methodsA questionnaire was used to assess understanding and standard management of hyperglycemia before and six months after implementation of an inpatient insulin treatment program.ResultsTwenty-five interns completed the questionnaire. Glycemic control was considered “very important” in all admission situations, but was only considered “very important” in conventional hospitalization by 36% of interns. Most of these felt “comfortable” using sliding scales, but not with the basal/bolus regimen, which was the least commonly used. Perception of number of well-controlled patients and comfort and use of basal/bolus therapy increased at six months, but use of “sliding scales” remained high. The greatest difficulty reported for adequate management of hyperglycemia was the lack of knowledge.ConclusionsMost residents are aware of the importance of adequate glycemic control, but cannot achieve it because of inadequate knowledge. The insulin training program led to an improved perception and applicability of basal-bolus insulin regimens. However, despite all efforts, use of sliding scales remains high. Training programs should emphasize management of hyperglycemia.     

Anemia: ¿cuál es su relación con el síndrome de fragilidad en el anciano?

Anaemia is often unexpectedly found, or in a context of investigations into a chest pain, dyspnoea, or weakness. This disorder can be considered an indicator of health status in elderly patients, and has been related to the frailty syndrome. A systematic review was conducted on the studies published in PubMed and Google Scholar databases in the period from January 1999 to May 2019. The search was limited to those studies published regarding anaemia and its relationship to the frailty syndrome. Anaemia seems to be part of the immunosenescence process that can explain frailty syndrome in association with other metabolism, endocrine, and inflammatory disorders. It was unable to be determined if anaemia is responsible for frailty or a result of it.     

Tratamiento de la diabetes mellitus tipo 1 con implante pancreático de células madre adultas autólogas

Background and objectiveType 1 diabetes results from the autoimmune destruction of β cells in the pancreas. Several studies have discussed the ability of adult stem cells to differentiate and function effectively. The aim of this study was to attain fasting glycemia of < 100 mg/dl, or any glycemic value of < 200 mg/dl at any time in the course of the day, and a decrease of at least 50% in the dose of exogenous insulin administration up to 180 days after implantation, as well as C-peptide normalization.Patients and methodTwelve patients with type 1 diabetes mellitus were recruited for autologous bone marrow adult stem cell transplantation through an arterial catheter between October and December 2005. The catheterization was performed through the femoral artery, selectively to the inferior pancreatic artery with a microcatheter, and the implant was delivered to the distal segment. Age ranged between 21 and 60 years. Islet-cell and/or glutamic acid decarboxylase antibodies were negative, C-peptide levels were < 0.05 mg/ml, fasting glycemia was < 180 mg/dl, and glycosylated hemoglobin was < 9%.ResultsThe procedure was carried out uneventfully in all patients. Eleven patients (92%) discontinued the use of rapid-acting insulin and four patients managed total suppression of insulin therapy and showed normal C-peptide, glucose, and glycosylated hemoglobin values. Four patients received less than 66% of the initial total daily insulin dose with an increase in basal C-peptide values. Three patients received less than 50% of the initial total daily dose, with no changes in basal C peptide levels. Of these, two patients resumed initial insulin requirements. Only one patient showed no significant changes after transplantation. After 180 days, no adverse events had occurred.ConclusionsThe procedure is feasible and safe and recovery of gland function was obtained after stem cell implantation.     

Tratamiento con equinocandinas en un paciente crítico sometido a técnica continua de reemplazo renal

BackgroundCritically ill patients with invasive candidiasis (IC) often suffer renal failure, which sometimes requires continuous renal replacement techniques (CRRT). Echinocandins are the first line treatment for IC in critically ill patients with mild or severe illness. Their elimination during CRRT should be negligible due to their pharmacokinetic and pharmacodynamic (PK/PD) profile, and dose adjustment are not needed, as suggested by the few reported clinical studies.Clinical caseThis is the case of a 66 year old male who underwent surgery due to peritonitis secondary to intestinal suture dehiscence. The patient was admitted to ICU with septic shock symptoms and multiple organ dysfunction syndrome (MODS), and CRRT was started. Anidulafungin was prescribed at the usual dosage due to the IC risk factors present, and the observation of yeasts in the peritoneal fluid. Anidulafungin was selected due to the hepatic failure suffered by the patient. An isolate of Candida albicans susceptible to fluconazole was cultured from peritoneal fluid and rectal exudates. However, anidulafungin was maintained due to the MODS and observing the clearance of fluconazole during CRRT. The patient's condition improved favourably, being moved to the surgical ward 20 days after the surgery.ConclusionsEchinocandins, due to their PK/PD profile, could be safely given at usual doses to critically ill patients undergoing CRRT. However, new studies are required to strengthen this recommendation. Its extrahepatic metabolism makes anidulafungin a more attractive option among echinocandins and other antifungals when used in patients with different degrees of hepatic failure     

Etude de la symbiose Rhizobium-legumineuse: Préparation de cellules isolées pour l'étudein vitro

Résumé En vue d'une étude, au laboratoire, de la nodulation et de la symbiose plante-bactérie des préparations de protoplastes de mésophylle et de nodule racinaire ont été effectuées chez le haricot (Phaseolus vulgaris variété Constant). Pour chaque préparation, les conditions opératoires et les concentrations optimales de cellulase et de pectinase en solution, dans du mannitol 0,6M ont été définies.Áprès 15 jours, 10 à 15% des protoplastes de mésophylle mis en culture dans le milieu B5 de Gamborg se divisent 2 à 3 fois. Des essais de fusion réalisés avec des faibles densités cellulaires entre protoplastes de mésophylle et protoplastes de nodule ont, donné des taux de fusion de l'ordre de 2,43%.

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Study of the symbiosis Rhizobium-legume: Preparation of isolated cells forin vitro study

Summary With a view to studyin vitro the processes of nodulation and plant-bacteria symbiosis, preparation of mesophyll protoplasts and root nodule protoplasts have been realized fromPhaseolus vulgaris (Constant var.).For every preparation the process of experimentation and optimum concentrations of cellulase and pectinase diluted in mannitol 0,6M have been defined.After a 15 days' period, 10 to 15% of mesophyll protoplasts divided twice or even three times in B5 Gamborg's medium. Although we used low rate cell concentrations, root nodule protoplasts and mesophyll protoplasts have been able to fuse in the proportion of 2,43%.

     

Les nappes alluviales de la Basse Somme revisitées

The new approach of the fluviatile sequence preserved downstream of Abbeville from Port-le-Grand to Saint-Valery, brings together two sets of complementary data in a same canvas. The first set combines the field records of V. Commont and A. Briquet slightly above the basal cravels. The second set encompasses the data gained for the high and very high terraces mapped in the eighties. They point to a succession of ten main terraces and two second order ones, occurring in continuity with the Abbeville terrace system. The upper terrace being related to Jaramillo, we are dealing with one million year strong regional record with a high-resolution palaeoenvironmental signature fitting in with the ODP 677 marine isotopic record and with the Chinese loess record. In this way, the laminar tool-kit of Croix-l’Abbé could be positioned in the middle part of MIS 8, around 250 ka.     

Espasticidad tras ictus: ¿la edad es un factor de riesgo? Estudio observacional de la espasticidad en pacientes neurovasculares en una serie retrospectiva de dos centros

ObjectiveApproximately one third of patients who have suffered a stroke develop spasticity. Since clinical observations that spasticity in the elderly population is lower after stroke, and disagreement about risk factors between different authors, an analysis is performed on the variables that influence the development of spasticity.The objective of the study is to determine the how many factors influence spasticity outcome, and the prevalence of spasticity in patients who have suffered a stroke and require intensive rehabilitation treatment.MethodA retrospective assessment was carried out on a total of 554 patients from two neurorehabilitation centres. A record was made of sociodemographic data, aetiology, type and location of stroke, motor and sensory deficits, language and swallowing impairment, incontinence, cognitive and mood state. Spasticity levels at admission and at the third month were studied in 462 patients using the Ashworth scale. Multivariate regression analyses were used to assess the risk factors for spasticity present at the third month after stroke.ResultsThe mean age of the patients was 67.3 years, of which 67.1% were men, and with ischemic aetiology in 76.5%. On admission 31.4% of patients had spasticity, and this increased to 54.8% at the 3^rd month. The absolute risk factor for spasticity was motor index (OR 1.04; 95% CI 1.03-1.05). When this factor was omitted, the variables with predictive ability were: age less than 75 years (OR 0.52; 95% CI 0.30-0.90), sensory impairment (OR 0.66; 95% CI 0.37-1.20), and lower Barthel index score (OR 1.02; 95% CI 1.01-1.03). There was no significant relationship for gender, physiopathological mechanism (ischaemic/haemorrhagic), stroke location, aphasia, or cognitive impairment.ConclusionThe prevalence of spasticity in stroke at third month of follow-up was 54.8%. Motor index is the independent predictor of spasticity. Patients younger than 75 years old, with sensory impairment and low Barthel index score are more likely to develop spasticity.