Feasibility and Effectiveness of Electrochemical Dermal Conductance Measurement for the Screening of Diabetic Neuropathy in Primary Care. Decoding Study (Dermal Electrochemical Conductance in Diabetic Neuropathy).

Diabetes mellitus (DM) is the leading cause of polyneuropathy in the Western world. Diabetic neuropathy (DNP) is the most common complication of diabetes and is of great clinical significance mainly due to the pain and the possibility of ulceration in the lower limbs. Early detection of neuropathy is essential in the medical management of this complication. Early unmyelinated C-fiber dysfunction is one of the typical findings of diabetic neuropathy and the first clinical manifestation of dysfunction indicating sudomotor eccrine gland impairment. In order to assess newly developed technology for the measurement of dermal electrochemical conductance (DEC), we analyzed the feasibility and effectiveness of DEC (quantitative expression of sudomotor reflex) as a screening test of DNP in primary health care centers. The study included 197 people (with type 2 diabetes, prediabetes and normal tolerance) who underwent all the protocol tests and electromyography (EMG). On comparing DEC with EMG as the gold standard, the area under the receiver operating characteristic (ROC) curve (AUC, area under the curve) was 0.58 in the whole sample, AUC = 0.65 in the diabetes population and AUC = 0.72 in prediabetes, being irrelevant in subjects without glucose disturbances (AUC = 0.47). Conclusions: In usual clinical practice, DEC is feasible, with moderate sensitivity but high specificity. It is also easy to use and interpret and requires little training, thereby making it a good screening test in populations with diabetes and prediabetes. It may also be useful in screening general populations at risk of neuropathy.

Metabolic syndrome as a cardiovascular disease risk factor: patients evaluated in primary care.

To estimate the prevalence of metabolic syndrome (MS) in a population receiving attention in primary care centers (PCC) we selected a random cohort of ostensibly normal subjects from the registers of 5 basic-health area (BHA) PCC. Diagnosis of MS was with the WHO, NCEP and IDF criteria. Variables recorded were: socio-demographic data, CVD risk factors including lipids, obesity, diabetes, blood pressure and smoking habit and a glucose tolerance test outcome. Of the 720 individuals selected (age 60.3 +/- 11.5 years), 431 were female, 352 hypertensive, 142 diabetic, 233 pre-diabetic, 285 obese, 209 dyslipemic and 106 smokers. CVD risk according to the Framingham and REGICOR calculation was 13.8 +/- 10% and 8.8 +/- 9.8%, respectively. Using the WHO, NCEP and IDF criteria, MS was diagnosed in 166, 210 and 252 subjects, respectively and the relative risk of CVD complications in MS subjects was 2.56. Logistic regression analysis indicated that the MS components (WHO set), the MS components (IDF set) and the female gender had an increased odds ratio for CVD of 3.48 (95CI%: 2.26-5.37), 2.28 (95%CI: 1.84-4.90) and 2.26 (95%CI: 1.48-3.47), respectively. We conclude that MS and concomitant CVD risk is high in ostensibly normal population attending primary care clinics, and this would necessarily impinge on resource allocation in primary care.

Feasibility and effectiveness of electrochemical dermal conductance measurement for the screening of diabetic neuropathy in primary care. DECODING Study (Dermal Electrochemical Conductance in Diabetic Neuropathy). Rationale and design.

Diabetes mellitus is the leading cause of polyneuropathy in the Western world. Diabetic neuropathy is a frequent complication of diabetes and may have great clinical transcendence due to pain and possible ulceration of the lower extremities. It is also a relevant cause of morbidity and mortality in patients with diabetes. Although the cause of polyneuropathy in patients with diabetes is only partially known, it has been associated with chronic hyperglycemia suggesting the possible etiopathogenic implication of advanced glycosylation end products. The strategy of choice in the medical management of diabetic neuropathy is early detection since glycaemic control and the use of certain drugs may prevent or slow the development of this disease. Diabetic neuropathy most often presents with a dysfunction of unmyelinated C-fibers, manifested as an alteration of the sweat reflex of the eccrine glands. This dysfunction can now be demonstrated using a newly developed technology which measures dermal electrochemical conductivity. This noninvasive test is easy and cost-effective. The aim of the present study is to evaluate the feasibility and effectiveness of dermal electrochemical conductance measurement (quantitative expression of the sudomotor reflex) as a screening test for the diagnosis of diabetic neuropathy in patients in primary care.

Relevance of casual undetected hyperglycemia among high-risk individuals for developing diabetes.

To assess the relevance of unrecognized hyperglycemia among high-risk subjects for developing diabetes a cross-sectional study was carried out. Subjects aged 40-75 years with (high-risk group) and without (control group) history of impaired glucose metabolism underwent a 2h-oral glucose tolerance test (OGTT). All individuals with diabetes diagnostic criteria and all controls with glucose abnormalities at OGTT were excluded. An individualized 48-h continuous glucose monitoring (CGM) calibrated by fasting plasma glucose was performed. The microdialysis-based biosensor recordings were computerized in order to identify continuous glucose profiles. Of the 121 monitored subjects, 104 were finally analyzed (56.7% female, 57.8 years, BMI=29.2, A1C=4.9%, HOMA index=2.5). Glucose profiles corresponded to 31 controls (29.8%), 32 high-risk individuals with normal OGTT (30.8%) and 41 (39.4%) with hyperglycemia at OGTT. The recordings defined as hyperglycemia (fasting >or=6.1 mmol/l, non-fasting >or=7.8 mmol/l) appeared during an average of 1.4h, 4.9h and 7.6h (3.9%, 13.9% and 19% of the CGM time), respectively. The highest percentage of impaired CGM registers corresponded to the fasting period. Nevertheless, the longest duration corresponded to the non-fasting period. The CGM evidenced a relevant degree of casual undetected hyperglycaemia among high-risk individuals.

Platos olvidados o de consumo ocasional en la gastronomía española: Castilla-La Mancha / Forgotten dishes or occasional consumption in Spanish gastronomy: Castilla-La Mancha

Casi en el centro de la Península Ibérica, la cocina de Castilla-La Mancha está conformada por gran variedad de platos sencillos, elaborados con ingredientes elementales, como el pan y la carne, o productos de la huerta; y acompañados por sus variados vinos, quesos de oveja y postres. Algunos de sus platos aparecen en la obra Don Quijote de La Mancha. Se trata de una cocina austera y sencilla, de origen humilde y pastoril. influenciada por la cocina de las regiones vecinas, como Andalucía, Extremadura, Levante o Castilla y León. (AU)

Almost in the center of the Iberian Peninsula, the cuisine of Castilla-La Mancha is made up of a wide variety of simple dishes, made with basic ingredients, such as bread and meat, or products from the garden; and accompanied by its varied wines, sheep cheeses and desserts. Some of dishes appear in Don Quixote de La Mancha. It is an austere and simple kitchen, of humble and pastoral origin. influenced by the cuisine of neighboring regions, such as Andalusia, Extremadura, the Levant, or Castilla y León. (AU)

[Continuous glucose monitoring in high-risk subjects for developing type 2 diabetes]. / Registro continuo de glucosa en sujetos con alto riesgo de diabetes tipo 2.

BACKGROUND AND OBJECTIVE: To assess the relevance of unrecognised hyperglycaemia among high-risk subjects for developing type 2 diabetes. SUBJECTS AND METHOD: Cross-sectional multicentre study in primary care. Subjects aged 40 to 75 years with previous evidence of impaired glucose metabolism were screened according to the World Health Organization rules by means of an oral glucose tolerance test (OGTT). Those with diabetes diagnostic criteria were excluded. An individualized 48-h ambulatory continuous glucose monitoring (CGM) calibrated by plasma values (Glucoday) was performed. Data from biosensor activity were computerized in order to identify hyperglycaemic records. RESULTS: 50 out of 64 screened subjects were included and evaluated; there were 30 female (60%). Mean age was 59 years; body mass index, 30.9; HbA1c, 5.3%, and HOMA, 2.8. Regarding the CGM results, 9 whole registers (18%) were rejected because of technical problems and 41 continuous profiles (72%) were analysed, corresponding to 17 (41.5%) subjects with normal OGTT and 24 (58.5%) with non-diabetic hyperglycaemia on OGTT. Mean CGM time with hyperglycaemia (fasting > or = 6.1 mmol/l or non-fasting > or = 7.8 mmol/l) accounted for 5.8 h, a 17.2% of the effective register per subject (33.8 h). Both groups matched the World Health Organization diabetes diagnostic interval (fasting > or = 7 mmol/l or non-fasting > or = 11.1 mmol/l): 1.1 h of effective register (3.6%) and 1.2 h (3.3%), respectively. CONCLUSIONS: The CGM evidenced a high degree of unrecognised hyperglycaemia among high-risk individuals. Therefore, casual plasma glucose measurements should be recommended to achieve early screening.

El uso psicoterapeútico del CBCL 1 1/2-5 con familias de niños/as atendidos en los centros de atención temprana / CBCL 1 1/2-5 psichotherapeutic use with families of boys and girls assesed in under five centers

El objetivo de este trabajo es reflexionar sobre la utilidad psicoterapéutica del uso, en los centros de atención temprana, del Inventario del comportamiento de niños(as) de 1½-5 años para padres (CBCL 1 ½-5) (Achenbach y Rescorla, 2000). Su justificación viene dada por dos motivos. Primero la escasez de publicaciones sobre el mismo, en comparación a las de su versión para edad escolar. Segundo, y más importante, por las ventajas que tiene en la psicoterapia familiar. Se concluye que si los datos ofrecidos por este instrumento son empleados adecuadamente, pueden dar informaciones útiles para el trabajo psicoterapéutico con las familias atendidas en los centros de atención temprana. Se ilustra esta reflexión con un ejemplo clínico. Finalmente se recomienda su uso en atención temprana (AU)

The goal of this paper is to reflect on the psychotherapeutic advantages of Children Behavior Checklist 1½-5 for parents (CBCL 1½-5) (Achenbach & Rescorla, 2000) in an early childhood care center. Two are the reasons encouraging the development of this work. Firstly, there are less publications about this version in comparison with those about its school version. Second and more important reason is related to its advantages for family psychotherapy. It is concluded that if the information given by this inventory is used in a correct way, it could be useful for family psychotherapeutic intervention in early childhood care centers. Moreover, this conclusion is illustrated through a clinical example.. Finally, the use of this inventory in early childhood care is suggested (AU)

Benign fibrous histiocytoma with indeterminate cells and eosinophils: collision, differentiation, or involution?

This report describes the clinicopathologic, immunohistochemical, and ultrastructural features of a benign fibrous histiocytoma of 3 years' duration situated on the posterior right arm of a 17-year-old woman. To our knowledge, this is the first published description of an association between the histologic features of benign fibrous histiocytoma with proliferating dermal dendrocytes and solid clusters of indeterminate cells and inflammatory infiltrate containing numerous eosinophils. Cell type identification was confirmed by immunohistochemical demonstration of positivity of indeterminate cells for CD1a and S-100 protein, by absence of Birbeck granules in electron microscopy study, and by positivity of fibroblast-like cells for factor XIIIa and negativity for CD34. Mitosis or cytologically atypical cells were absent. The MIB1-measured proliferative index of the tumor cells was less than 5% in spindle cells and approximately 15% in indeterminate cells. Possible pathogenic pathways are discussed that could account for divergent differentiation or a combination of neoplasms of different lineages.

Registro continuo de glucosa en sujetos con alto riesgo de diabetes tipo 2 / Continuous glucose monitoring in high-risk subjects for developing type 2 diabetes

Fundamento y objetivo: Evidenciar la hiperglucemia inadvertida en sujetos con alto riesgo de diabetes tipo 2. Sujetos y método: Estudio transversal multicéntrico en atención primaria. Se seleccionó a sujetos de 40-75 años con antecedentes de hiperglucemia no diabética a los que se cribó mediante una prueba de tolerancia oral a la glucosa (PTOG), excluyendo a aquellos con criterios de diabetes según la Organización Mundial de la Salud. Se desarrolló un registro continuo de la glucosa (RGC) individualizado y ambulatorio de 48 h mediante un biosensor subcutáneo (GlucoDay®) calibrado por la glucemia plasmática. Se informatizó la actividad del biosensor para evidenciar posibles registros de hiperglucemia. Resultados: Se efectuó el RCG a 50 de 64 sujetos seleccionados, de los que 30 eran mujeres. El índice de masa corporal medio fue de 30,9 kg/m2; la hemoglobina glucosilada del 5,3%, y el índice HOMA de 2,8, descartando 9 perfiles completos (18%) por problemas técnicos. Se evaluaron 41 RCG (82%) pertenecientes a 17 sujetos con PTOG normal (41,5%) y a 24 (58,5%) con PTOG alterada. Por término medio, se obtuvieron registros de hiperglucemia (basal é 6,1 mmol/l o no basal é 7,8 mmol/l) durante 5,8 h, un 17,2% del tiempo total de registro efectivo (33,8 h). La hiperglucemia en el intervalo de diabetes (basal é 7 mmol/l o no basal é 11,1 mmol/l) concurrió durante el 3,6% del tiempo (1,2 h) y el 3,3% (1,1 h), respectivamente. Conclusiones: El RCG evidenció índices altos de hiperglucemia no reconocida en sujetos de riesgo. Este hallazgo indica que medir la glucemia en cualquier momento del día incrementaría la detección de anomalías glucídicas

Background and objective: To assess the relevance of unrecognised hyperglycaemia among high-risk subjects for developing type 2 diabetes. Subjects and method: Cross-sectional multicentre study in primary care. Subjects aged 40 to 75 years with previous evidence of impaired glucose metabolism were screened according to the Word Health Organization rules by means of an oral glucose tolerance test (OGTT). Those with diabetes diagnostic criteria were excluded. An individualized 48-h ambulatory continuous glucose monitoring (CGM) calibrated by plasma values (Glucoday®) was performed. Data from biosensor activity were computerized in order to identify hyperglycaemic records. Results: 50 out of 64 screened subjects were included and evaluated; there were 30 female (60%). Mean age was 59 years; body mass index, 30.9; HbA1c, 5.3%, and HOMA, 2.8. Regarding the CGM results, 9 whole registers (18%) were rejected because of technical problems and 41 continuous profiles (72%) were analysed, corresponding to 17 (41.5%) subjects with normal OGTT and 24 (58.5%) with non-diabetic hyperglycaemia on OGTT. Mean CGM time with hyperglycaemia (fasting é 6.1 mmol/l or non-fasting é 7.8 mmol/l) accounted for 5.8 h, a 17.2% of the effective register per subject (33.8 h). Both groups matched the World Health Organization diabetes diagnostic interval (fasting é 7 mmol/l or non-fasting é 11.1 mmol/l): 1.1 h of effective register (3.6%) and 1.2 h (3.3%), respectively. Conclusions: The CGM evidenced a high degree of unrecognised hyperglycaemia among high-risk individuals. Therefore, casual plasma glucose measurements should be recommended to achieve early screening

Nódulo angiomatoso epitelioide cutáneo. ¿Variante superficial y extrafacial de hemangioma epitelioide? / Cutaneous epithelioid angiomatous nodule. Is it a superficial and extrafacial variant of epithelioid hemangioma?

El nódulo angiomatoso epitelioide cutáneo (NAEC), esuna lesión vascular recientemente descrita que muestrahallazgos histológicos distintivos y un curso evolutivobenigno. Clínicamente suele presentarse como un nódulo opápula eritematosa de reciente aparición, predominantementelocalizados en tronco y extremidades; y a pesar, delas aparentes diferencias clínico-patológicas, no es posiblecon certeza descartar que pueda tratarse de una variantepoco usual de hemangioma epitelioide (HE)

Cutaneous epithelioid angiomatous nodule (CEAN), is arecently described vascular lesion with distinct histologicalfeatures and apparently benign behaviour. The lesion is predominantlylocated in the trunk and extremities. It appearsas a small erythematous papule or nodule with a short history.Despite the apparent clinicopathologic differences, thepossibility that CEAN represent a very unusual variant ofepithelioid hemangioma can not absolutely be excluded

Adenoma tubular con diferenciación e inmunofenotipo anexial divergente (hidradenoma túbulo-papilar) / Tubular adenoma with adnexal divergent differentiation and immunophenotype (tubulopapillary hidradenoma)

Hidradenoma túbulo-papilar (HPT) es el término propuestopara designar tumores ductales dérmicos con diferenciacióndivergente ecrina y apocrina, englobando unespectro de lesiones que incluye adenoma tubular apocrino(ATA) y adenoma ecrino papilar (AEP).Presentamos un caso de HPT localizado en la pierna deuna mujer de 81 años de edad. El perfil inmunohistoquímicodemostró la coexistencia de inmunofenotipos secretoresapocrino y ecrino

Tubulopapillary hidradenoma (TPH) is a term describingdermal ductal tumors with both eccrine and apocrinedifferentiation, encompassing a spectrum of lesions includingtubular apocrine adenoma and papillary eccrine adenoma.We report a case of a TPH in a 81-years-old womanlocated on the leg. The immunohistochemical profile revealedthe coexistence of eccrine and apocrine secretory immunophenotypes

Dermatofibroma con empalizadas. Una variante histológica singular / Palisading dermatofibroma: an unusual histologic variant

Se presenta un caso de esta infrecuente variedad de dermatofibromaen un varón de 38 años cuya principal característicaes la disposición en empalizada de los núcleos. Histopatológicamente,la lesión estaba caracterizada por áreasde empalizada nuclear con formación de cuerpos de tipoVerocay, junto a áreas clásicas de dermatofibroma tipofibroso. Esta neoplasia debería ser diferenciada de otrostumores benignos y malignos cutáneos con patrón en empalizada.Patólogos y clínicos deberían conocer la existenciade este tipo de dermatofibroma, que no comporta peor pronósticoni tratamiento adicional

We report a new case of an unusual variant of dermatofibromaof a 38-year-old man in which nuclear palisading isa prominent feature. Histopathologically, the lesions werecharacterized by areas of nuclear palisading with formationof Verocay-like bodies in addition to the more typical featuresof the «fibrous» variant of dermatofibroma. This neoplasmshould be differentiated from benign and malignantskin tumors with a palisading pattern. Pathologists and cliniciansshould know of the existence of this type of dermatofibromaand should avoid overdiagnosis and overtreatment

Hemangioma elastótico adquirido ¿Una entidad infradiagnosticada? / Acquired elastotic hemangioma: an underrecognized entity?

Planteamiento: Describimos una variante clínicopatológica de hemangioma adquirido que aparece en el adulto y que probablemente sea una entidad infradiagnosticada. Material y métodos: Este artículo informa sobre los hallazgos clínicos, histológicos e inmunohistoquímicos de una variante de hemangioma cutáneo llamada hemangioma elastótico adquirido. Resultados: El hemangioma elastótico adquirido se presenta en la piel con daño actínico como placas eritematosas con una apariencia angiomatosa. Histológicamente muestra una proliferación en dermis superficial de capilares que se disponen paralelos a la epidermis. Conclusiones: El hemangioma elastótico adquirido es una variante clínicopatológica de hemangioma diferente de otras proliferaciones vasculares cutáneas (AU)