Rol de la figura de enlace en el modelo e transición en endocrinología. Experiencia en el ámbito público / Role of the liaison person in the transition model in Endocrinology. Experience in the public setting

Un proceso de transición planificado entre los sistemas de salud pediátricos y de adultos es necesario para poder garantizar una continuidad en la atención de los adolescentes. El objetivo del trabajo fue evaluar la población de pacientes del Servicio de Endocrinología del Hospital Garrahan en fase de transición y sus familias, desarrollar un protocolo para la transición de los adolescentes con patología endocrinológica crónica al Hospital de Clínicas José de San Martin y evaluar el rol de la "figura de enlace" en este proceso. Materiales y Métodos: Estudio observacional, transversal/prospectivo. Se obtuvieron datos sobre la consulta ambulatoria de 72 adolescentes mayores a 15 años con patología endocrinológica a los cuales se los acompañó en el proceso de transición. Se realizaron entrevistas y encuestas a los adolescentes, sus familias y a 16 endocrinólogos intervinientes en el seguimiento (9 pediátricos- 7 adultos). Resultados: La mayoría de los adolescentes evidenciaron falta de autonomía general, con mayor afectación en el área de "seguimiento de los problemas de salud". Esto, junto al paternalismo del pediatra y la sobreprotección familiar representaron inconvenientes para la transición. La mitad de los adultos entrevistados consideraron falta de autonomía o preparación en sus hijos considerando la edad ideal para la transición entre los 18-21 años. Las sensaciones referidas por los pacientes como sus acompañantes incluyen principalmente el miedo y ansiedad, y llamativamente en los pacientes la vergüenza. La creación de un consultorio de transición en el centro de adultos y el acompañamiento de la "figura de enlace", permitieron una mejor articulación y continuidad en el cuidado de la salud (AU)

TA planned transition process between pediatric and adult health systems is necessary to ensure continuity of care for adolescents. The aim of this study was to evaluate the patient population of the Endocrinology Service at Garrahan Hospital during the transition phase, along with their families, to develop a protocol for transitioning adolescents with chronic endocrinological disorders to Hospital de Clínicas José de San Martín, and to evaluate the role of the "liaison person" in this process. Materials and Methods: This observational, cross-sectional/ prospective study obtained data from outpatient consultations of 72 adolescents over 15 years of age with endocrinological disorders who were accompanied during the transition process. Interviews and surveys were conducted with the adolescents, their families, and 16 endocrinologists involved in the follow-up (9 pediatricians and 7 adult physicians). Results: Most of the adolescents showed a general lack of autonomy, with greater challenges in the area of "follow-up of health problems." This, combined with the paternalism of the pediatrician and the overprotection of the family, represented obstacles to the transition. Half of the parents interviewed perceived a lack of autonomy or preparation in their children, considering the ideal age for transition to be between 18-21 years old. The primary feelings reported by the patients and those who accompanied them included fear and anxiety, with patients also feeling embarrassment. The creation of a transition clinic in the adult center and the support of a "liaison person" allowed for better coordination and continuity in health care (AU)

Pregnancy in patients with mild thyroid abnormalities: maternal and neonatal repercussions.

A prospective study was undertaken during pregnancy in 120 euthyroid women presenting with mild thyroid abnormalities (TA): 11 with a past history of thyroid disorder, 44 with goiter, 20 with nodules, and 45 with thyroid autoantibodies. The aims of the study were to assess whether the pattern of thyroid alterations during gestation was different in women with TA compared to that in healthy control pregnant subjects and to evaluate possible obstetrical and neonatal repercussions. The overall prevalence of underlying subtle thyroid abnormalities in the cohort was 17%, probably as the result of the environmental moderately low iodine intake. Despite the intrinsic heterogeneity of the four groups of women with TA, the adaptation of the thyroid to the stress of pregnancy was different from that of the control subjects. Noteworthy were 1) the marked elevation of serum thyroglobulin in women with past history of thyroid disorder, goiter and thyroid nodules; 2) the increase in goiter size in a third of the goitrous women, associated with biochemical evidence of functional stimulation of the gland; 3) the indirect evidence of partial thyroidal autonomy in goitrous patients; and 4) the increase in the number and size of thyroid nodules during gestation. Taken together, the data indicated that pregnancy was associated with a greater thyroidal risk in patients with TA compared to healthy subjects. In relation to thyroid autoimmunity, most patients remained euthyroid during gestation, but in a few cases, TSH was elevated at delivery, suggesting diminished thyroidal reserve. Also, 40% of newborns from mothers with thyroid autoimmunity had elevated thyroid peroxidase antibody titers at birth, and there was a highly significant correlation between maternal and neonatal thyroid peroxidase antibody titers. Finally, thyroid autoimmunity was clearly associated with an increased risk of spontaneous abortion (13.3 vs. 3.3%; P less than 0.001). Thyroid function in newborns from mothers with TA was normal and not different from that in controls; similarly, obstetrical features were similar in patients with TA and control subjects. In conclusion, pregnancy is associated with a greater thyroidal risk in women with TA, thereby emphasizing a potential link between pregnancy and thyroid disorders. It is recommended that patients with known, even subtle, thyroid abnormalities be closely monitored during pregnancy, in particular those with a goiter, nodules, or thyroid autoimmunity, especially in areas with a moderately low iodine intake, where the prevalence of mild thyroid disturbances is high.

Water intoxication associated with nephrogenic diabetes insipidus secondary to lithium: case report.

In the psychiatric population, psychogenic polydipsia leading to water intoxication and nephrogenic diabetes insipidus secondary to lithium therapy are both well-recognized entities. A case is reported of the apparently unusual combination of these two conditions, where lithium probably not only has caused the nephrogenic diabetes insipidus, but might also have contributed to the state of psychogenic polydipsia.

Relación entre educación, envejecimiento y deterioro cognitivo en una muestra de adultos mayores de Arequipa / Relationship between education, aging and cognitive impairment in a sample of older adults in Arequipa

Los estudios epidemiológicos muestran una clara relación entre el nivel educativo y la presencia de deterioro cognitivo en poblaciones envejecidas. En nuestro medio no existen investigaciones que aborden esta problemática por lo que pretendemos realizar una primera aproximación a las consecuencias del envejecimiento y el bajo nivel educativo sobre los procesos cognitivos. Para esto evaluamos a 280 sujetos adultos mayores de tres distritos de la ciudad Arequipa con el Examen Mental Abreviado (Mini Mental) y un cuestionario de variables sociodemográficas. Nuestros resultados muestran una relación significativa entre la edad y el deterioro cognitivo observándose puntajes más bajos en sujetos con mayor edad; además observamos que los sujetos con mayor nivel educativo muestran puntajes más altos. Estas primeras aproximaciones al deterioro cognitivo en nuestro medio ponen de relieve la importancia de la implementación de políticas socioeducativas eficaces que permitan el acceso a la educación a la mayoría de nuestra población.

The epidemiologic studies of cognitive decline show a clear relationship between the educational level and the presence of cognitive deterioration in aged populations. In our city there are not investigations that approach this problem for what we try to carry out a first approach to the consequences of the aging and the educational low-level on the cognitive processes. For this we evaluated 280 old age fellows of three districts of the city of Arequipa with the Mini Mental State Examination and a questionnaire of sociodemographic variables. Our results show a significant relationship between the age and the cognitive deterioration being observed in lower score in subject with more age; we also observe that those subject with more educational level show higher score. These first approaches to the cognitive deterioration in our city put of relief the importance of the implementation of effective political programs that allow the access to the education to most of our population.