Control glucémico intensivo y sobretratamiento en pacientes mayores de 60 años con diabetes mellitus / Intensive glycemic control and overtreatment in diabetic patients older than 60 years

Resumen ANTECEDENTES: existe incremento de la prevalência de diabetes mellitus 2 y del envejecimiento. Así, los riesgos asociados con control glucémico intensivo en esta población vulnerable se incrementan. Por ello, debe considerarse la posibilidad de un sobretratamiento en estos pacientes. OBJETIVO: determinar la prevalencia de control glucémico intensivo y sobretratamiento en pacientes con diabetes mellitus tipo 2 mayores de 60 años. MATERIAL Y MÉTODO: estudio retrospectivo, transversal, observacional y analítico. De 2013 a 2015 se evaluaron pacientes mayores de 60 años de edad con diabetes mellitus tipo 2, hemoglobina glucosilada (HbAlc) <7% y administración de hipoglucemiantes. Los pacientes se clasificaron en control glucémico intensivo (HbAlc 6.6-7%) y sobretratamiento (HbAlc <6.5%). Los porcentajes de ambos grupos y sus complicaciones cardiovasculares y no cardiovasculares asociadas se compararon utilizando una prueba Z. RESULTADOS: se incluyeron 13,229 pacientes con diabetes mellitus tipo 2 mayores de 60 años; en 2013, fueron 4,381, 16% (n=701) en control glucémico intensivo y 6% (n=256) en sobretratamiento; en 2014 fueron 4,383, 16% (n=697) en control glucémico intensivo y 6% (n=252) en sobretratamiento; en 2015 fueron 4,465, 16% (n=708) en control glucémico intensivo y 6% (n=260) con sobretratamiento. El control glucémico intensivo causó 5, 3 y 1% de complicaciones durante 2013, 2014 y 2015, respectivamente. En el grupo con sobretratamiento el porcentaje de complicaciones fue de 4% en 2013 y de 6% en 2015. Se obtuvo un valor Z de -2.90 (p<0.05), mostrando mayor número en sobretratamiento. CONCLUSIONES: de la población estudiada, 16% estaba en control glucémico intensivo y 6% en sobretratamiento, con incremento significativo de complicaciones en el grupo con sobretratamiento, la hipoglucemia fue la más frecuente.

Abstract BACKGROUND: Due to increasing prevalence of type 2 diabetes mellitus (T2DM) and the overall aging of the population, the number of elderly patients with T2DM is continuously growing. Given the risks associated with intensive glycemic control of those patients, the possibility of overtreatment must be considered. OBJECTIVE: To determine the prevalence of intensive glycemic control and overtreatment in individuals >60 years with T2DM. MATERIAL AND METHOD: An observational, cross-sectional, retrospective and analytical study was done from 2013 to 2015. Individuals >60 years old with T2DM, glycated hemoglobin (HbA1c) <7%, and use of hypoglycemic agents were included. Patients were divided into two groups: intensive glycemic control (HbA1c 6.6-7%) and overtreatment (HbA1c <6.5%). Cardiovascular and non-cardiovascular complications associated with treatment were compared by Z-test. RESULTS: There were included 13,229 patients older than 60 years with T2DM; 4,381 in 2013, 16% (n=701) was classified as intensive glycemic control and 6% (n=256) as overtreatment; 4,383 in 2014, 16% (n=697) as intensive glycemic control and 6% (n=252) as over-treatment; 4,465 in 2015, 16% (n=708) as intensive glycemic control and 6% (n=260) as overtreatment. By this period, adverse outcomes were reported in 5%, 3% and 1% during 2013, 2014 and 2015, respectively; referring to intensive glycemic control group. Likewise, adverse outcomes were reported in 4% and 6% during 2013 and 2015, respectively; referring to overtreatment group. A value of Z-test -2.90 (p<0.05) was obtained, which was increased in overtreatment group. CONCLUSIONS: All data collected during the study highlights a significant increase of cardiovascular and non-cardiovascular adverse outcomes in patients with strict glycemic management, being hypoglycemia the most frequent; 16% are in intensive glycemic control and 6% in overtreatment.

Causes for an Incomplete Donation Process at a Tertiary Care Hospital.

INTRODUCTION: This study aims to identify the causes for the incomplete donation process at a tertiary care hospital. MATERIALS AND METHODS: A descriptive, retrospective study was performed; all potential donors reported to the Transplant Service within the period of 2005 to 2014 were included. Descriptive statistics were used across frequencies and proportions for categorical variables, central tendency, and dispersion for continuous variables. RESULTS: The total number of deaths reported at the University Hospital (HU) was 8472, of which 815 (n = 815) were reported to COETRA ("Consejo Estatal de Trasplantes"). Among organ or tissue donors, the main known cause of death was head trauma (HT) in 26% (72). Cardiac arrest (CA) as cause of death provided the largest number of donations (141, 57%); of these, 102 (41%) were male and 39 (16%) were female. In comparison, brain death (BD) provided 104 (43%); of these, 65 (27%) were male, and 39 (16%) were female. The age interval was with a higher donation rate was 45 to 49 y (BD 18, CA 22). Donation request was not performed in 359 patients because of medical contraindication 60% (215), rapid deterioration 18% (64), and incomplete donation process 8% (27). Of 452 organ requests, 207 were not accomplished, because of body integrity 28% (57), family disagreement 20% (42), and no acceptance of BE 13% (26). CONCLUSIONS: Opportunity areas: (1) Ensure the notification of all deaths to Transplant Department for identification of potential donors; (2) Reduce rapid deterioration and raise number of completed donation protocols; (3) Increase the donation rate.

[Pheochromocytoma: more than a decade of experience. Review of the literature]. / Feocromocitoma: más de una década de experiencia. Revisión de la literatura.

OBJECTIVES: We present 18 patients with pheochromocytoma in the past 12 years. MATERIAL AND METHODS: It is a retrospective observational study evaluating the clinical, biochemical and pathological most important. RESULTS: The mean age was 53.5 years with male predominance and monitoring of five years, being the most frequent incidental findings (29%). Four patients had a familial syndrome hereditary. The tumors were equally distributed with a bilateral case. For the clinical study was made and plasma catecholamines and metanephrines in urine for 24h and subjected to control blood pressure before surgery and beta blockers. Until the introduction of laparoscopic surgery in our department in 2003, the treatment of choice was open surgery. Transabdominal subcostal access was more frequent (47%) and average duration of 207 min. No patients showed metachronous tumors and two patients developed distant metastases to death in short time. CONCLUSIONS: Pheochromocytoma in a threatening disease by cardiovascular disease, which needs to perform an analytical and functional. Surgical treatment, by open or laparoscopic surgery, depending on the characteristics of the tumor and the patient, is satisfactory and comparable results.

Severe hypocalcemia secondary to hypomagnesaemia, successfully treated by self-administered subcutaneous magnesium.

We report the case of a patient with recurrent severe hypocalcemia, secondary to hypomagnesaemia, and prerenal renal failure, due to ileostomy losses after a colectomy, who needed several admissions to the hospital through more than one year. Finally, he was successfully treated by self-administered subcutaneous magnesium: he reached and maintained normal levels of serum calcium, magnesium and PTH, no more hospital admission were needed and he resumed a normal life.

Mitochondrial and microsatellite DNA markers reveal a Balkan origin for the highly invasive horse-chestnut leaf miner Cameraria ohridella (Lepidoptera, Gracillariidae).

Biological invasions usually start with a small number of founder individuals. These founders are likely to represent a small fraction of the total genetic diversity found in the source population. Our study set out to trace genetically the geographical origin of the horse-chestnut leafminer, Cameraria ohridella, an invasive microlepidopteran whose area of origin is still unkown. Since its discovery in Macedonia 25 years ago, this insect has experienced an explosive westward range expansion, progressively colonizing all of Central and Western Europe. We used cytochrome oxidase I sequences (DNA barcode fragment) and a set of six polymorphic microsatellites to assess the genetic variability of C. ohridella populations, and to test the hypothesis that C. ohridella derives from the southern Balkans (Albania, Macedonia and Greece). Analysis of mtDNA of 486 individuals from 88 localities allowed us to identify 25 geographically structured haplotypes. In addition, 480 individuals from 16 populations from Europe and the southern Balkans were genotyped for 6 polymorphic microsatellite loci. High haplotype diversity and low measures of nucleotide diversities including a significantly negative Tajima's D indicate that C. ohridella has experienced rapid population expansion during its dispersal across Europe. Both mtDNA and microsatellites show a reduction in genetic diversity of C. ohridella populations sampled from artificial habitats (e.g. planted trees in public parks, gardens, along roads in urban or sub-urban areas) across Europe compared with C. ohridella sampled in natural stands of horse-chestnuts in the southern Balkans. These findings suggest that European populations of C. ohridella may indeed derive from the southern Balkans.

[Motility of the colon: electric and manometric description of the mass movement]. / Motilidad del colon: descripción eléctrica y manométrica del movimiento de masa.

"Mass movement" was described at the beginning of the century by radiologists, who occasionally observed during exploration a sudden transport of barium from one section of the colon to another. In this paper we focused our attention on the electromechanical factors that accompany evacuation through a colostomy, since we thought that these would be the myoelectrical and pressure translation of the "mass phenomenon" described by radiologists. We used an electromyographic recording probe to which a conventional microtransducer probe was affixed by suction. Using this method we made 24-hour recordings in 8 patients with sigmoid colostomy. We observed five large evacuations. When the electrical and pressure phenomena that occurred a few minutes before evacuation were analyzed, two clearly differentiated phases were apparent. The first, which we called the "previous phenomenon", consisted of a succession of contractions and spike potentials over a mean period of 5.6 min. (sigma = 2.22), after which a "large contraction" appeared, with a mean pressure value of 127 mmHg (sigma = 38.77) and a mean electrical value of 10.6 mv. The mean duration of this phenomenon was 24.93 sec (sigma = 6.19) and it was recorded almost synchronically in the three recording points studied. Undoubtedly, these electrical-pressure phenomena resulted from mass transport since in all 5 cases a large discharge through the colostomy was seen.