RESUMO
Diabetes is a disease of concern due to its increasing frequency and high cost of care. This cross-sectional study evaluated the types of care provided to diabetes patients in primary care for management of the condition. Between December 2010 and March 2011, 54 general practitioners (CPs) in health centres in Khouribga province were asked to complete a pretested questionnaire on their care of diabetes patients. For type 2 diabetes, 46% of the CPs would prescribe diet and lifestyle treatment alone. The practice setting influenced how treatment was managed for typel diabetes patients: 88.5% of rural doctors prescribed premixed insulin versus 58.3% of urban GPs (P = 0.02). Insulin analogues were prescribed by 20.8% of urban GPs as against 3.8% of rural GPs (P = 0.09). There are several shortcomings in the quality of care for diabetes patients. Training GPs could be a solution, especially with the lack of specialists in our country.
Assuntos
Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Medicina Geral/métodos , Atenção Primária à Saúde/métodos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adulto , Estudos Transversais , Dieta/métodos , Composição de Medicamentos , Feminino , Medicina Geral/normas , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Marrocos , Atenção Primária à Saúde/normas , Serviços de Saúde Rural/normas , Serviços de Saúde Rural/estatística & dados numéricos , Inquéritos e Questionários , Serviços Urbanos de Saúde/normas , Serviços Urbanos de Saúde/estatística & dados numéricosRESUMO
The cerium γâα transition was investigated using high-pressure, high-temperature angle-dispersive x-ray diffraction measurements on both poly- and single-crystalline samples, explicitly addressing symmetry change and transformation paths. The isomorphic hypothesis of the transition is confirmed, with a transition line ending at a solid-solid critical point. The critical exponent is determined, showing a universal behavior that can be pictured as a liquid-gas transition. We further report an isomorphic transition between two single crystals (with more than 14% of volume difference), an unparalleled observation in solid-state matter interpreted in terms of dislocation-induced diffusionless first-order phase transformation.
RESUMO
An atypical presentation of diabetes mellitus was described in black subjects, initially in adolescents by Winter et al. then, in adult populations. The principal characteristics of "African" diabetes are an acute onset with severe hyperglycemia and ketosis, and a clinical course of type 2 diabetes mellitus. In the subsequent clinical course after initiation of insulin therapy, prolonged remission is often possible with cessation of insulin therapy and maintenance of appropriate metabolic control. In the subsequent clinical course after initiation of insulin therapy, prolonged remission is often possible with cessation of insulin therapy and maintenance of appropriate metabolic control. The molecular mechanisms underlining the insulin secretory dysfunction are still to be understood and may involve glucolipotoxicity processes. The HLA alleles associated with susceptibility to type 1 diabetes were reported of high frequency in some populations with this form of diabetes, in the absence of makers of pancreatic beta cell autoimmunity. The aim of the present review is to discuss two cases of African diabetes and review the specific diagnostic, metabolic, pathogenic and management features of this atypical diabetes.