Fiebre Q aguda: riesgo de desarrollo de endocarditis / Acute Q fever and the risk of developing endocarditis

Objetivo: Valorar los datos clínicos y serológicos como parámetros indicativos de posible evolución a endocarditis tras un episodio de fiebre Q aguda. Pacientes y métodos: Estudio de cohortes retrospectivo de la evolución a endocarditis tras un episodio de fiebre Q aguda, analizando evolución clínica, serológica y tratamiento antibiótico recibido. Resultados: Se reclutó a 80 pacientes, presentando el 20% niveles de anticuerpos IgG de fase I ≥ 1:1.024 en los primeros 3 meses. Solo el 44% recibió antibioterapia en la fase aguda; únicamente 2 enfermos recibieron antibioterapia prolongada. Se realizó ecocardiograma al 15%. Ningún paciente presentó síntomas indicativos de infección crónica ni evolucionó a endocarditis tras una mediana de seguimiento de 100 meses, independientemente de la elevación precoz de anticuerpos IgG de fase I. Conclusiones: La elevación precoz de anticuerpos IgG fase I no se asoció a evolución a endocarditis a pesar de no haberse realizado tratamiento antibiótico prolongado en pacientes asintomáticos (AU)

Objectives: Assess clinical and serological data as parameters indicative of a possible evolution to endocarditis after an episode of acute Q fever. Patients and methods: Retrospective cohort study of evolution to endocarditis after an acute Q fever episode, analyzing the clinical and serological evolution and the antibiotic treatment administered. Results: Eighty patients were recruited, 20% of whom had phase I IgG antibody levels ≥ 1:1024 in the first 3 months. Only 44% of the patients underwent antibiotherapy in the acute phase; only 2 patients underwent extended antibiotherapy. Fifteen percent of the patients underwent an echocardiogram. None of the patients had symptoms suggestive of chronic infection or progressed to endocarditis after a median follow-up of 100 months, regardless of the early increase in phase I IgG antibodies. Conclusions: The early increase in phase I IgG antibodies in asymptomatic patients is not associated with progression to endocarditis despite not undergoing prolonged antibiotic treatment (AU)

Acute Q fever and the risk of developing endocarditis. / Fiebre Q aguda: riesgo de desarrollo de endocarditis.

OBJECTIVES: Assess clinical and serological data as parameters indicative of a possible evolution to endocarditis after an episode of acute Q fever. PATIENTS AND METHODS: Retrospective cohort study of evolution to endocarditis after an acute Q fever episode, analyzing the clinical and serological evolution and the antibiotic treatment administered. RESULTS: Eighty patients were recruited, 20% of whom had phase i IgG antibody levels ≥ 1:1024 in the first 3 months. Only 44% of the patients underwent antibiotherapy in the acute phase; only 2 patients underwent extended antibiotherapy. Fifteen percent of the patients underwent an echocardiogram. None of the patients had symptoms suggestive of chronic infection or progressed to endocarditis after a median follow-up of 100 months, regardless of the early increase in phase i IgG antibodies. CONCLUSIONS: The early increase in phase i IgG antibodies in asymptomatic patients is not associated with progression to endocarditis despite not undergoing prolonged antibiotic treatment.

Estudio de la variabilidad glucémica en niños y adolescentes con diabetes tipo 1 en tratamiento con insulina glargina / A study of variability in glycaemia in children and adolescents with diabetes mellitus type 1 on treatment with insulin glargine

Objetivo: Determinar la utilidad de la insulina glargina (IG) en la disminución de hipoglucemias e hiperglucemias en niños y adolescentes con diabetes tipo 1. Pacientes y métodos: Se trata de un estudio retrospectivo/prospectivo, en el que 29 pacientes con hipoglucemias leves/moderadas frecuentes, con edades comprendidas entre 3 y 18 años, y HbA1c de 8 ± 0,7, recibieron tratamiento con IG una vez al día e insulina regular o un análogo de la insulina rápida antes de cada comida. Los criterios de inclusión fueron los siguientes: a) tratamiento previo con insulina de acción intermedia (NPH); b) más de 1 año de evolución de la diabetes, y c) más de tres controles de glucemia/día. Se recogió la incidencia de episodios de hipoglucemias (leves, moderadas y graves), hiperglucemias, los valores de HbA1c, el índice de masa corporal y la dosis diaria de insulina antes y después de iniciar el tratamiento con IG. Además, se realiza una encuesta de opinión directa a la familia sobre la calidad de vida. Resultados: Los resultados se obtuvieron a partir de 1.294 ± 411 glucemias/paciente. La incidencia global de hipoglucemias no se reduce (el 5,9 frente al 6,2 % de valores glucémicos/mes) y las hiperglucemias globales permanecen sin cambios. Sin embargo, se reduce de forma significativa la hiperglucemia en ayunas (el 4,3 frente al 2,6 %) con tendencia a la disminución de las hipoglucemias nocturnas. La HbA1c continúa también sin cambios al igual que los requerimientos totales de insulina diaria (0,8 ± 0,2 U/kg/día). Conclusiones: La IG consigue un control glucémico similar al que se logra con la NPH, con tendencia a la disminución de las hipoglucemias nocturnas y a la mejoría de los valores de glucemia en ayunas (AU)

Objective: To determine the usefulness of insulin glargine (IG) to reduce hipoglycaemias and hyperglycaemic events in children and adolescents with type 1 diabetes. Patients and methods: In a retrospective/prospective study, 29 patients with a high number of non-severe hypoglycaemias, aged 3-18, and an average HbA1c of 8 ± 0.7, received IG once daily plus regular insulin or rapid analogue before meals. Inclusion criteria were: a) previous treatment with NPH insulin; b) diagnosis of type 1 diabetes for at least 1 year before starting IG, and c) > 3 blood glucose controls within a day. Incidence of severe and non-severe hypoglycaemic events, hyperglycaemic events, HbA1c values, body mass index, daily insulin dose before and after the institution of glargine therapy, were collected. Additionally, family were asked to complete a diabetes quality of life survey. Results: 1,294 ± 411 glycaemias/subject were obtained. Hypoglycaemic episodes were not reduced (5.9 % vs 6.2 %) and hyperglycaemic events remained unchanged. Fasting blood glucose levels decreased from 195.3 ± 36.6 to 162.8 ± 25.8 in all patients (p < 0.05) and a tendency a decrease in nocturnal hypoglycaemias was observed. The average HbA1c and total daily insulin dosis also remained unchanged (0.8 ± 0.2 UI/Kg/day). Conclusions: Using IG achieves a glycaemic control similar to NPH, with a tendency to decrease the frecuency of nocturnal hypoglycaemias and an improvement in fasting glycaemia values(AU)

[A study of variability in glycaemia in children and adolescents with diabetes mellitus type 1 on treatment with insulin glargine]. / Estudio de la variabilidad glucémica en niños y adolescentes con diabetes tipo 1 en tratamiento con insulina glargina.

OBJECTIVE: To determine the usefulness of insulin glargine (IG) to reduce hipoglycaemias and hyperglycaemic events in children and adolescents with type 1 diabetes. PATIENTS AND METHODS: In a retrospective/prospective study, 29 patients with a high number of non-severe hypoglycaemias, aged 3-18, and an average HbA1c of 8+/-0.7, received IG once daily plus regular insulin or rapid analogue before meals. Inclusion criteria were: a) previous treatment with NPH insulin; b) diagnosis of type 1 diabetes for at least 1 year before starting IG, and c) >3 blood glucose controls within a day. Incidence of severe and non-severe hypoglycaemic events, hyperglycaemic events, HbA1c values, body mass index, daily insulin dose before and after the institution of glargine therapy, were collected. Additionally, family were asked to complete a diabetes quality of life survey. RESULTS: 1,294+/-411 glycaemias/subject were obtained. Hypoglycaemic episodes were not reduced (5.9% vs 6.2%) and hyperglycaemic events remained unchanged. Fasting blood glucose levels decreased from 195.3+/-36.6 to 162.8+/-25.8 in all patients (p<0.05) and a tendency a decrease in nocturnal hypoglycaemias was observed. The average HbA1c and total daily insulin doses also remained unchanged (0.8+/-0.2 UI/Kg/day). CONCLUSIONS: Using IG achieves a glycaemic control similar to NPH, with a tendency to decrease the frequency of nocturnal hypoglycaemias and an improvement in fasting glycaemia values.