Detección de pacientes con diabetes mellitus tipo 2 oculta desde las farmacias comunitarias de Valladolid. Valoración del impacto ambiental. Prueba piloto / Pilot trial on the detection of patients with undiagnosed diabetes mellitus type 2 carried out in pharmacies in Valladolid. Environmental impact assessment

Introducción: las complicaciones que puede desarrollar la DM2 y las cifras de población no diagnosticadas (6 %) ponen de manifiesto la importancia de realizar cribados a nivel poblacional. El objetivo de este trabajo es evaluar un programa de detección precoz de DM2 oculta desde la farmacia comunitaria y posterior derivación al médico para determinar el posible diagnóstico, así como evaluar el impacto ambiental de las actuaciones. Material y métodos: cuestionario Findrisc a los pacientes que, cumpliendo con los criterios de inclusión, aceptan participar en el estudio. Se realiza glucemia basal capilar si el resultado es ≥15 puntos y derivación al médico si la glucemia basal es ≥110 mg/dL. Resultados: participaron 44 farmacias. La muestra incluyó 434 usuarios. Se realizó la glucemia a 125 de los 135 pacientes con Findrisc ≥15 puntos, obteniéndose una media de 124,5 mg/dL (DE=33,6). Se de­rivaron al médico 89 pacientes de los que en 13 casos se confirmó el diagnóstico de diabetes, lo que supone un 3 % de la muestra total analizada y un 14,6 % de los derivados. Discusión: los nuevos diagnósticos (3 %) reflejan que la farmacia comunitaria es un buen punto de detección de diabetes oculta. Además, tras analizar la intervención del farmacéutico, se podría indicar su utilidad como educador sanitario, indicando hábitos de vida saludables a aquellos pacientes no susceptibles de derivación al médico. Por otra parte, sería precisa una mayor colaboración médico-farmacéutico en los cribados de diabetes (AU)

Small ruminant lentivirus infections and diseases.

Small ruminant lentiviruses include viruses with diverse genotypes that frequently cross the species barrier between sheep and goats and that display a great genetic variability. These characteristics stress the need to consider the whole host range and to perform local surveillance of the viruses to opt for optimum diagnostic tests, in order to establish control programmes. In the absence of effective vaccines, a comprehensive knowledge of the epidemiology of these infections is of major importance to limit their spread. This article intends to cover these aspects and to summarise information related to characteristics of the viruses, pathogenesis of the infection and description of the various syndromes produced, as well as the diagnostic tools available, the mechanisms involved in transmission of the pathogens and, finally, the control strategies that have been designed until now, with remarks on the drawbacks and the advantages of each one. We conclude that there are many variables influencing the expected cost and benefits of control programs that must be evaluated, in order to put into practice measures that might lead to control of these infections.

MR imaging and CT of central nervous system tuberculosis in the patient with AIDS.

CNS TB represents a disease that complicates AIDS with an increasing incidence in endemic areas as well as in developed countries in those patients who have some risk factors such as intravenous drug abuse. Although TB infection of the CNS in AIDS patients may follow a rapidly progressive course, the imaging findings otherwise are similar to those of the nonimmunosuppressed population. Meningeal enhancement, hydrocephalus, parenchymal granulomata, and infarcts are seen frequently and are often observed in combination with one another. Nevertheless, the differential diagnosis in AIDS patients must include other opportunistic infections and primary or metastatic lymphoma of the CNS. Spinal TB usually is seen in the form of epidural abscess secondary to tuberculous spondylitis, although it may be seen in isolation of spinal column involvement. The differential diagnosis includes spinal lymphoma or pyogenic abscess formation. Radiculomyelitis or isolated spinal cord tuberculomata are much less frequently observed and can be suspected on imaging only if there is concomitant evidence of the classic findings of intracranial TB.

Intracranial tuberculosis in AIDS: CT and MRI findings.

CT and MRI findings in 35 patients with the acquired immune deficiency syndrome (AIDS) and proven intracranial tuberculosis (TB) are presented. Over 90% of the patients were intravenous drug abusers and in two-thirds TB was the first manifestation of AIDS. CT was normal in one quarter, the most frequent findings being hydrocephalus (51%) and meningeal enhancement (41%), commonly seen together (31.5%). Meningeal enhancement was seen in 48% of the CT studies with intravenous contrast medium and in 3 cases studied with MRI and i.v. gadolinium DTPA, in 2 of which CT was negative. Parenchymal involvement was found in 37% of cases; MRI was more sensitive than CT for its detection. One quarter of the patients had ischaemic lesions, mainly in the basal ganglia. We confirm the usefulness of CT and the superiority of MRI in the diagnosis of intracranial TB and in differential diagnosis from other conditions likely to be found in these patients.