Improving diabetes care among patients with severe mental illness: A systematic review of the effect of interventions.

BACKGROUND AND AIM: Individuals with severe mental illness (SMI) who suffer from type 2 diabetes (T2DM) are likely to be sub-optimally treated for their physical condition. This study aimed to review the effect of interventions in this population. METHODS: A systematic search in five databases was conducted in July 2017. RESULTS: Seven studies on multi-faced interventions were included. These comprised nutrition and exercise counselling, behavioural modelling and increased disease awareness aiming to reduce HbA1c, fasting plasma glucose, body mass index and weight. CONCLUSION: Non-pharmacologic interventions in individuals with SMI and T2DM could possibly improve measures of diabetes care, although with limited clinical impact.

Reflexology and polysomnography: Changes in cerebral wave activity induced by reflexology promote N1 and N2 sleep stages.

BACKGROUND: Several studies have shown the effectiveness of reflexology in different health problems as well as obtaining a high degree of relaxation during its application. A previous study suggested a possible relation between the relaxation obtained during the reflexology session and the sleep. However, the design of the study did not provide evidence for this hypothesis. In this study, we use a polysomnogram to investigate the effects during its application. METHOD: Prospective experimental study conducted in a sleep laboratory. Twelve healthy adults were enrolled. Two groups were created based on whether or not they had knowledge of reflexology. Reflexology was applied for 35 min and their sleep effects were measured by means of polysomnography. A descriptive and bivariate analysis was performed. A bivariate analysis conducted through chi-square test or ANOVA was considered appropriate. RESULTS: After controlling for baseline data, nine of the participants did move toward N1 (p = 0.833) and N2 (p = 0.227) stages, remaining in these states between 4 min and 25.5 min. No significant differences were found between the two groups. CONCLUSIONS: The application of reflexology induces changes in the activity of brain waves in correspondence with the appearance of a high degree of sleepiness and sleep (N1 and N2 NREM sleep). There is a gradual transition and an orderly progression from wakefulness to sleep, which could explain the effects of relaxation and well being obtained with this method, as well as many other benefits.

Long-term mortality of persons with severe mental illness and diabetes: a population-based cohort study in Denmark.

BACKGROUND: Persons with severe mental illness (SMI) have excess mortality, which may partly be explained by their high prevalence of diabetes. METHOD: We compared the overall and cause-specific mortality in persons with SMI and diabetes with that of the general Danish population between 1997 and 2009 by linking data from Danish national registries. RESULTS: The cohort counted 4 734 703 persons, and during follow-up 651 080 persons died of whom 1083 persons had SMI and diabetes. Compared with the background population, the overall mortality rate ratios (MRRs) for persons with SMI and diabetes were 4.14 [95% confidence interval (CI) 3.81-4.51] for men and 3.13 (95% CI 2.88-3.40) for women. The cause-specific MRRs for persons with SMI and diabetes were lowest for malignant neoplasms (women: MRR = 1.98, 95% CI 1.64-2.39; men: MRR = 2.08, 95% CI 1.69-2.56) and highest for unnatural causes of death (women: MRR = 12.31, 95% CI 6.80-22.28; men: MRR = 7.89, 95% CI 5.51-11.29). The cumulative risks of death within 7 years of diabetes diagnosis for persons with SMI and diabetes were 15.0% (95% CI 12.4-17.6%) for those younger than 50 years, 30.7% (95% CI 27.8-33.4%) for those aged 50-69 years, and 63.8% (95% CI 58.9-68.2%) for those aged 70 years or older. Among persons suffering from both diseases, 33.4% of natural deaths were attributed to diabetes and 14% of natural deaths were attributed to the interaction between diabetes and SMI. CONCLUSIONS: Long-term mortality is high for persons with SMI and diabetes. This calls for effective intervention from a coordinated and collaborating healthcare system.

Angioma en penacho congénito regresivo / Congenital Self-Limiting Tufted Angioma

No disponible

No disponible

A case of vulvar pyoderma gangrenosum associated with collagenous colitis.

Pyoderma gangrenosum is a reactive inflammatory dermatosis which belongs to the spectrum of neutrophilic dermatoses. Due to a lack of diagnostic criteria, pyoderma gangrenosum is mainly a diagnosis of exclusion. It is rarely observed on the perineum, and vulvar involvement is even less frequent. Collagenous colitis is an idiopathic inflammatory colonic disease that is included in the microscopic colitides. The colonic mucosa and the crypt architecture are preserved but histologic alterations are found. We describe a case of collagenous colitis associated with vulvar pyoderma gangrenosum that improved spectacularly with cyclosporine 3 mg/kg/day and the twice-daily application of topical tacrolimus 0.1%.

Esquema de abordaje en la consulta primaria de los trastornos del sueño más frecuentes / How to deal with the most frequent sleep disorders in primary medicine

Se calcula que el porcentaje de población adulta con problemas de sueño es cercano al 35-45%, y cada vez es más intensa la demanda del médico de atención primaria para atender a estos pacientes. Para ello el médico precisa disponer de formación adecuada en medicina de sueño, tiempo suficiente para dedicar a los pacientes, recursos materiales y humanos, y posibilidad de administrar tratamientos. Los pacientes habitualmente presentan uno de los siguientes síntomas: excesiva somnolencia en su esperado tiempo de vigilia, incapacidad para dormirse o mantenerse dormidos (insomnio) y conductas anómalas inmediatamente antes o durante el sueño. En el primer caso, por su potencial gravedad, se deberá sospechar síndrome de apnea-hipopnea de sueño, narcolepsia, hipersomnia idiopática o síndrome del sueño insuficiente, por lo que se debe solicitar el estudio de sueño oportuno y administrar el tratamiento adecuado. Si se considera necesario, se remitirá al paciente a un experto en sueño. En el caso del insomnio, se deberá investigar y tratar el trastorno subyacente y, en caso de ser necesario, solicitar la ayuda del especialista correspondiente. En el supuesto de que existan conductas anómalas inmediatamente antes o durante el sueño (síndrome de piernas inquietas, movimientos periódicos de las extremidades, sonambulismo, epilepsia, síndrome de comportamiento alterado del sueño REM, etc.) es aconsejable, especialmente en caso de duda, recurrir a un experto en sueño. En cualquier otra sintomatología el médico debería realizar sistemáticamente preguntas simples referentes a la cantidad y calidad del sueño para tener la máxima seguridad de que éste es correcto (AU)

The percentage of adult population with sleep disorders is approximately 35%-45%, and the demand of the primary care physician to attend these patients is becoming progressively more intense. To accomplish this task, primary physicians should receive proper education in sleep medicine, should have enough time to spend with the patients, should have material and human resources and should have the possibility of administering treatments. Patients usually complain of one of the following symptoms: excessive sleepiness in the suppossed waking time, inability to fall asleep or to remain asleep (insomnia) and abnormal behaviour prior or during the sleep time. In the first case, due to potential serious consequences, sleep apnea-hypopnea syndrome, narcolepsy, idiopathic hypersomnia or insufficient sleep syndrome should be suspected, the appropiate sleep study should be performed and the proper treatment must be administered. When considered necessary, the patient will be sent to the sleep expert. In insomnia the underlying disorder will be investigated and treated and, when necessary, the physician will apply to the help of the corresponding specialist. When an abnormal behaviour appears prior or during the sleep time (restless legs syndrome, periodic limb movements, sleepwalking, epilepsy, REM behaviour disorder, etc.) it is advisable, especially if there is any doubt, to turn to the sleep expert. In any other symptomatology the physician should systematically ask easy and simple questions related to the quantity and quality of the patient’s sleep in order to have the greatest security that the sleep is correct (AU)

Calendario de sueño combinado con la escala de somnolencia de Stanford. Una mayor aproximación al estudio del ritmo circadiano sueño-vigilia / Sleep log combined with the Stanford sleepiness scale. A greater approximation to the sleep-wake circadian rhythm

Para la evaluación de los ritmos circadianos y sus trastornos los estudios polisomnográficos son costosos y laboriosos y los estudios actigráficos poco concretos. Un calendario de sueño puede aportar abundante información objetiva y subjetiva. Se describe la estructura de un calendario de sueño que se combina con la escala de somnolencia de Stanford y que está basado en el diseñado por Metrodesign Associates-Charles Pollak. Se comenta el análisis numérico y gráfico y se describe el "corredor de máxima vigilia" y las "zonas de tendencia al sueño"; se concluye que con estos análisis se obtiene información acerca del tiempo de sueño que ha precisado cada persona día a día, del ritmo circadiano sueño-somnolencia-vigilia, de la latencia para conseguir la máxima vigilia (inercia de sueño), del promedio de la somnolencia, de los promedios correspondientes a tiempo de acostarse, latencia de sueño, número de despertamientos, hora final de despertar, de levantarse, tiempo total de sueño nocturno, tiempo que ha precisado para estar plenamente vigil tras el inicio del sueño y número y duración de las siestas. Todo ello permite conocer las horas más probables de máxima vigilia y de máxima tendencia al sueño y sirve de base para aconsejar la hora aproximada en que se debe iniciar y terminar el sueño de forma espontánea y adecuada al propio ritmo circadiano. Se comenta su posible utilidad individual y colectiva (AU)

In order to evaluate circadian rhythms and their disorders polysomnographic studies are expensive and time wasting and actigraphic studies are not specific. A sleep log can bring plenty of subjective and objective information.We describe the structure of a sleep log which is combined with the Stanford Sleepiness Scale and is based on the one designed by Metrodesign Associates-Charles Pollak. We comment both numeric and graphic analysis and describe the "maximum wakefulness corridor" and the "sleep trend zones" concluding that with these analysis we can get information about the day by day needed individual sleep time, the sleep-sleepiness-wake circadian rhythm, and the means related to maximum wakefulness latency (sleep inertia), sleepiness value, bedtime, sleep latency, number of awakenings, final wake up time, get up time, total nocturnal sleep time, time needed to become fully awake after sleep onset and number of siestas and their length. All these data allow knowing the most probable maximum alertness hours and the most probable maximum tendency to sleep hours and set the basis to recommend the approximate sleep and wake time in an spontaneous form and according to the own circadian rhythm. The possible individual and collective utility is commented (AU)

XIV Reunión Anual de la Asociación Ibérica de Patología del Sueño. Los síndromes de apnea central del sueño. La respiración de Cheyne Stokes / No disponible

No disponible

[Idiopathic hypersomnia of the central nervous system]. / Hipersomnia idiopática del sistema nervioso central.

Idiopathic hypersomnia of the central nervous system is a cause of excessive diurnal somnolence which affects 5-10% of the patients who attend sleep clinics for this reason. We describe three male patients who consulted for excessive diurnal somnolence. Nocturnal polysomnographic studies followed by tests for multiple latencies of sleep were done. In all cases there was confirmation of lengthening of the time of nocturnal sleep with normal phases of sleep and an increase in the number of sleep spindles in phase II. Similarly there was an average latency of sleep of less than 10 minutes and fewer than two phases of REM in the multiple latencies test. All patients improved with drugs stimulating vigil, two of them with centramine and the third with methilphenidate. We consider the clinical data the polysomnographic criteria which help to establish the diagnosis.

Hipersomnia idiopática del sistema nervioso central / Idiopathic hypersomnia of the central nervous system

La hipersomnia idiopática del sistema nervioso central constituye una causa de excesiva somnolencia diurna que afecta al 5-10 por ciento de pacientes que acuden a un centro de sueño por dicho motivo. Se describen tres pacientes varones que acudieron para estudio de excesiva somnolencia diurna y a los que se les efectuó un estudio polisomnográfico nocturno seguido de un test de las latencias múltiples del sueño. En todos los casos se confirmó un alargamiento del tiempo de sueño nocturno con normalidad de las fases de sueño y un incremento en el número de husos de sueño en fase II.Asimismo, se constató una latencia media de sueño inferior a los 10 minutos y menos de dos fases REM en el test de las latencias múltiples. Todos los pacientes mejoraron con fármacos estimulantes de la vigilia, dos de ellos con centramina y el tercero con metilfenidato. Se comentan los datos clínicos y los criterios polisomnográficos que ayudan a establecer el diagnóstico (AU)

Evaluation of turnaround times as a component of quality assurance in surgical pathology.

OBJECTIVE: As a part of a quality assurance program in anatomic pathology, a study was conducted to determine intralaboratory components of turnaround time according to specimen type, and to compare the present data with results obtained 2 years after implementing the program. DESIGN: Assessment of intralaboratory turnaround times for surgical pathology reports in a sample of 501 biopsies and surgical specimens during 1992. Comparison between the basal data obtained in 1992 and the final determination in 1994 after the implementation of an improvement action. SETTING: Surgical specimens and biopsies accessioned at the Department of Anatomic Pathology of a 913-bed acute-care teaching hospital in the city of Barcelona, Spain. STUDY SAMPLES AND PARTICIPANTS: The sample was selected from the total number of biopsies and surgical specimens accessioned on specific days by applying a table of random numbers. Data were collected from the request forms, final report copies, and laboratory registries of turnaround time-points by two resident physicians. INTERVENTIONS: All relevant information concerning turnaround times was recorded following a standardized questionnaire developed specifically for the study. MAIN OUTCOME MEASURES: The basal determination for turnaround time for pathologic diagnosis in 1992 was 5.7 days. RESULTS: The mean turnaround time for the 501 specimens was 6.24 (SD = 3.16; range = 2-27 days). Turnaround times varied substantially according to specimen type. Endoscopic biopsy samples were completed by 5.19 days (SD = 2.18). Bone biopsies were finalized within a mean of 8.11 days of receipt (SD = 3.18). For the diagnosis of lymphoproliferative disorders, most lymph node specimens required special histochemical or immunohistochemical stains. The mean turnaround time for results reporting/results transmittal to the ordering physician varied between 1.14 and 1.66 days. The 1992 annual mean turnaround time for a total of 14,862 surgical pathology specimens was 5.7 days as compared with 4.2 days for a total of 17,931 surgical pathology specimens in 1994.

Middle-ear adenoma (MEA): a report of two cases, one with predominant "plasmacytoid' features.

Middle-ear adenomas (MEAs) are rare neoplasms which can display several histological patterns and represent a diagnostic challenge. We present two cases of MEA which share some histopathological features such as medium to small cells forming solid infiltrating tumour nests as well as scattered glandular structures with Alcian blue and PAS positive material within. The second case also displayed a distinct and predominant "plasmacytoid' appearance which, in a small biopsy, might have been misleading. Both cases expressed an admixture of epithelial and neuroendocrine immunohistochemical markers, whereas ultrastructural study demonstrated electron dense granules. Taken together, these observations support a mixed epithelial and neuroendocrine nature for these neoplasms, the differential diagnosis of which includes paragangliomas and other tumours or tumour-like lesions involving less frequently the middle ear, such as meningiomas, plasmacytomas and inflammatory polyps. The existence of MEAs with plasmacytoid features should be remembered to avoid confusion with plasmacytomas, plasmacytoid myoepithelioma and plasma cell inflammatory infiltrates.

[Hepatic mesenchymatous hamartoma presenting in an adult patient]. / Hamartoma mesenquimatoso hepático de presentación en la edad adulta.

Mesenchymatous hamartoma is a benign liver tumor characteristically found in childhood, particularly during the first two years of life. A case of mesenchymatous hamartoma detected in a 23-year-old female during a study for non specific abdominal disturbances is presented. Imaging techniques showed a large mass in the right hepatic lobe with hypodense areas of cystic appearance. Pathologic study demonstrated the characteristic mixoid mesenchymatous component with areas of cyst formation and rests of liver tissue inside the tumor. Despite its rarity in adults this case demonstrates the need to consider mesenchymatous hamartoma in the differential diagnosis of hepatic masses in adults, particularly when radiologic examination demonstrates cystic components.