Quality of care in patients with diabetic kidney disease in Asia: The Joint Asia Diabetes Evaluation (JADE) Registry.

AIMS: Diabetic kidney disease independently predicts cardiovascular disease and premature death. We examined the burden of chronic kidney disease (CKD, defined as an estimated GFR < 60 ml/min/1.73 m(2) ) and quality of care in a cross-sectional survey of adults (age ≥ 18 years) with Type 2 diabetes across Asia. METHODS: The Joint Asia Diabetes Evaluation programme is a disease-management programme implemented using an electronic portal that systematically captures clinical characteristics of all patients enrolled. Between July 2007 and December 2012, data on 28 110 consecutively enrolled patients (China: 3415, Hong Kong: 15 196, India: 3714, Korea: 1651, Philippines: 3364, Vietnam: 692, Taiwan: 78) were analysed. RESULTS: In this survey, 15.9% of patients had CKD, 25.0% had microalbuminuria and 12.5% had macroalbuminuria. Patients with CKD were less likely to achieve HbA1c < 53 mmol/mol (7.0%) (36.0% vs. 42.3%) and blood pressure < 130/80 mmHg (20.8% vs. 35.3%), and were more likely to have retinopathy (26.2% vs. 8.7%), sensory neuropathy (29.0% vs. 7.7%), cardiovascular disease (26.6% vs. 8.7%) and self-reported hypoglycaemia (18.9% vs. 8.2%). Despite high frequencies of albuminuria (74.8%) and dyslipidaemia (93.0%) among CKD patients, only 49.0% were using renin-angiotensin system inhibitors and 53.6% were on statins. On logistic regression, old age, male gender, tobacco use, long disease duration, high HbA1c , blood pressure and BMI, and low LDL cholesterol were independently associated with CKD (all P < 0.05). CONCLUSIONS: The poor control of risk factors, suboptimal use of organ-protective drugs and high frequencies of hypoglycaemia highlight major treatment gaps in patients with diabetic kidney disease in Asia.

[HIV mother to child transmission: report of nine Cuban fatal cases in ten years]. / Infección por VIH en Cuba por transmisión vertical: Reporte de nueve casos fatales en 10 años.

Vertical transmission of HIV infection constitutes one of the most sensitive pillars of the current pandemic of this disease. This article carries out a report of the nine Cuban children who acquired this way the infection and died between 1986 and 2006. Prophylactic management of the cases and the clinical and anatomic pathological manifestations of those in whom autopsy was performed are described. The average gestational age was of 37.6 weeks, four of the pregnancies were captured late. Six children were born by caesarean section and in all transmission were presumably intrauterine. The average birth weight was 2786 grams. Four mother-sibling binomial received prophylaxis with AZT. The autopsy was carried out only in 4 children.

[Impact of the Friend of Child and Mother hospital program in a hospital in the Mexican Institute of Social Security]. / Impacto del Programa Hospital Amigo del Niño y de la Madre en un hospital del Instituto Mexicano del Seguro Social.

Breast feeding frequency in our country is between 13 and 80% and it is diminishing. One of the purposes of the Program called Hospital Friend of the Child and the Mother is to favor breast feeding but this has not been evaluated as yet. Frequency of breast feeding among the mothers who received the program, and the ones without it, in the influence area of HGZ 1-A; and the ones factors that could influenced for breast feeding. An analytic transversal study, was carried out, in mothers with a child between 6 and 12 months of age who assisted to the Outpatient consultation at HGZ 1-A and MME 10, 15 and 43, during the study period. The were invited to participate to have an interview, to know the mother's age, civil status, socioeconomical level, schooling and amount of sons. The place where her last delivery took place, was asked for. It was asked if breast feeding took place during the adequate time; the causes for not do it, and other points about breast feeding. The questionnaire in a first phase was prepared in order to be easily understood at the time of its application, and it was carried out by only one person. At the time of interview it was not known if the mother had used breast feeding or not. The amount in the sample was 261 mothers. The statistical analysis was of a descriptive type, for comparison of averages; it was used for comparison of square chi and calculations of reason of momios with IC at 95%. Two hundred and sixty two mothers were interviewed. The interview was done in 211/262, (80.5%) in the UMF and the rest at HGZ. Average age 26 years, 78.6% were married; average schooling, 8 years (74; good socioeconomical level, 70%, home labor. Amount of children was 1 to 6, 48% had only one child; average age of the last child at the time of interview, 11 moths. The resolution of the last pregnancy occurred in 73% of the cases in a IMSS hospital; 15.3% in a private hospital, and the rest in another institution. The program was given, more frequently at the IMSS, than in the rest 232/262; (88%) were breast fed. Average of time of breast feeding, 9 moths. There were no difference of sociodemographic variables in the group with breast feeding, and the one without breast feeding. The common causes (75%) for no breast feeding, were of maternal origin (infections, lack of milk production, work, etc.); the rest mentioned rejection to breast feeding. There was a better knowledge of breast feeding among the mothers who used it. The factors statistically associated to breast feeding were: conjoint lodging; to offer breast during the first hour of life; and have received information about this Program. The Program in the influence area of HGZ 1-A favors breast feeding. The factors for this were: improvement of mother-Child relation and the better knowledge of the advantages of breast feeding.

Estimulação magnética transcraniana e aplicabilidade clínica: perspectivas na conduta terapêutica neuropsiquiátrica / Transcranial magnetic stimulation and clinical applicability: perspectives in neuropsychiatric therapeutics

Estimulação magnética transcraniana (EMT) é uma técnica conhecida desde o começo dos anos 90 e que atualmentetem ganhado destaque devido a sua segurança e possível aplicabilidade para tratar diversas patologias neuropsiquiátricas refratárias. A fim de clarificar os possíveis usos da EMT e suas variações no campo da clínica como forma de tratamento, procedemos à revisão da literatura selecionando os artigos nas áreas em que a técnica de EMT já tem sido largamente utilizada,a saber: AVC, Dor, Doença de Parkinson e Depressão. Essas doenças possuem elevada morbidade, possuindo grandesimplicações na qualidade de vida devido ao elevado grau de incapacidade associado e ao fato de ainda carecerem de métodos terapêuticos totalmente eficientes. Nesse contexto, a EMT emerge como ferramenta promissora, apresentando bons resultados, os quais fornecem margem para aplicações diretas na prática clínica. É necessário, todavia, o desenvolvimento de mais estudos randomizados, para se padronizar e aperfeiçoar as abordagensdessa técnica no tratamento de tais patologias...

Transcranial Magnetic Stimulation (TMS) is a technique that emerged in the 90s and has currently become recognized for its safety and potential applicability in the treatment of neuropsychiatry diseases. To clarify the possible uses of TMS and its variations in the clinical scope as a treatment, weproceeded a literature review selecting articles in the areas where the technique of TMS has already been widely used: Stroke, Pain, Parkinson’s Disease and Depression. These diseases have high morbidity, with large implications for the quality of life due to the high degree of disability and the fact that we still lack of fully efficient therapeutic methods. In this context, EMT emerges as a promising tool with amazing results, which provide scope for direct applications in clinical practice. However, the developmentof more randomized studies is necessary, in order to standardizeand improve the approaches of this technique in the treatment of such pathologies...

Infección por VIH en Cuba por transmisión vertical: Reporte de nueve casos fatales en 10 años / HIV mother to child transmission: Report of nine Cuban fatal cases in ten years

Vertical transmission of HIV infection constitutes one of the most sensitive pillars of the current pandemic of this disease. This article carries out a report of the nine Cuban children who acquired this way the infection and died between 1986 and 2006. Prophylactic management of the cases and the clinical and anatomic pathological manifestations of those in whom autopsy was performed are described. The average gestational age was of 37.6 weeks, four of the pregnancies were captured late. Six children were born by caesarean section and in all transmission were presumably intrauterine. The average birth weight was 2786 grams. Four mother-sibling binomial received prophylaxis with AZT. The autopsy was carried out only in 4 children.