Glucohemoglobina HbA1c. Primera parte: conocerla / Glycohemoglobin HbA1c. First part: to know it

La diabetes es una enfermedad crónica con una elevada prevalencia, que va aumentando progresivamente hasta alcanzar rasgos de epidemia. A raíz de la publicación en la década de los noventa de los estudios «Diabetes Control and Complications Trial» (DCCT) y «United Kingdom Prospective Diabetes Study» (UKPDS), la glucohemoglobina (HbA1c) se ha convertido en la imagen del control glucémico. Esto ha hecho que sea utilizada como pieza fundamental en el día a día del cuidado de los pacientes con diabetes. A pesar de su importancia y de sus aplicaciones, la HbA1c no es generalmente muy conocida. En este trabajo pretendemos dar a conocer muchos de los aspectos de la HbA1c desde su definición hasta su aplicación clínica diaria. En esta primera parte, repasaremos los distintos puntos del «complejo Diabetes» donde se usa la HbA1c y conoceremos su definición química (AU)

Diabetes is a chronic disease with a high prevalence, which goes increasing gradually until getting features of epidemic. Since )Diabetes Control and Complications Trial* (DCCT) and )United Kingdon Prospective Diabetes Study* (UKPDS) were released in the 90’s, Glucohemoglobin (HbA1c)has become the glycemic control imagine. This fact is responsible for its use as fundamental piece in the journey of the care of the patients with Diabetes. In spite of its importance and its applications, HbA1c is not generally known. In this work we expect to give the knowledge of many aspects of HbA1c from its definition to its diary clinic application. In this first part, we will revise the different points of the )Diabetes complex* where HbA1c is used and we will know its chemical definition (AU)

Glucohemoglobina HbA1c. Segunda parte: medirla / Glycohemoglobin HbA1c. Second part: to measure it

A pesar de su importancia y de sus aplicaciones, la HbA1c no es generalmente muy conocida. En este trabajo pretendemos dar a conocer muchos de los aspectos de la HbA1c desde su definición hasta su aplicación clínica diaria. En esta segunda parte, repasaremos cuándo debe solicitarse, los distintos métodos para su determinación, los acuerdos alcanzados para la estandarización de estos métodos, las distintas situaciones que pueden interferir en su determinación y, por último, la posibilidad de usar la HbA1c como herramienta de diagnostico de diabetes (AU)

In spite of its importance and its applications, HbA1c is not generally known. In this work we expect to give the knowledge of many aspects of HbA1c from its definition to its diary clinic application. In this second part, we will revise when it is advisable to request it, the different methods for its determination, the agreements which have been got in order to make these methods standard, the different situations which can interfere with its determination and, to conclude, the possibility of using HbA1c as a tool of the diagnostic of Diabetes (AU)

Glucohemoglobina. Tercera parte: interpretarla / Glycohemoglobin. Third part: to interpret it

A pesar de su importancia y de sus aplicaciones, la glucohemoglobina (HbA1c) no es generalmente muy conocida. En este trabajo pretendemos dar a conocer muchos de los aspectos de la HbA1c desde su definición hasta su aplicación clínica diaria. En la tercera parte, repasaremos la relación de la HbA1c con la glucemia en el tiempo, la influencia en ella de las glucemias preprandial y posprandial y los datos más actuales sobre su relación con las glucemias medias (AU)

In spite of its importance and its applications, HbA1c is not generally known. In this work we expect to give the knowledge of many aspects of HbA1c from its definition to its diary clinic application. In this third part, we will revise the relation between HbA1c with the glucose in time, the influence in it caused by fasting and postprandial plasma glucose, and the newest data about its relation with average glucose (AU)

Decreased brain coordinated activity in autism spectrum disorders during executive tasks: reduced long-range synchronization in the fronto-parietal networks.

Current theories of brain function propose that the coordinated integration of transient activity patterns in distinct brain regions is the essence of brain information processing. The behavioural manifestations of individuals with autism spectrum disorders (ASD) suggest that their brains have a different style of information processing. Specifically, a current trend is to invoke functional disconnection in the brains of individuals with ASD as a possible explanation for some atypicalities in the behaviour of these individuals. Our observations indicate that the coordinated activity in brains of children with autism is lower than that found in control participants. Disruption of long-range phase synchronization among frontal, parietal and occipital areas was found, derived from magnetoencephalographic (MEG) recordings, in high-functioning children with ASD during the performance of executive function tasks and was associated with impaired execution, while enhanced long-range brain synchronization was observed in control children. Specifically, a more significant prefrontal synchronization was found in control participants during task performance. In addition, a robust enhancement in synchrony was observed in the parietal cortex of children with ASD relative to controls, which may be related to parietal lobe abnormalities detected in these individuals. These results, using synchronization analysis of brain electrical signals, provide support for the contention that brains of individuals with autism may not be as functionally connected as that of the controls, and may suggest some therapeutic interventions to improve information processing in specific brain areas, particularly prefrontal cortices.

¿Está justificado el cribado de aneurisma de aorta abdominal en pacientes con hernia inguinal? Estudio de prevalencia en la Comunidad Asturiana / Is abdominal aortic aneurysm screening justified in patients suffering from inguinal hernia? A prevalence study in the Asturian Community

Introducción. La importancia de la detección precoz de los aneurismas de aorta abdominal (AAA) como mediode reducir la elevada morbimortalidad asociada a su rotura, se encuentra ampliamente reconocida, especialmente engrupos de riesgo. Objetivo. Determinar si la hernia inguinal (HI) debe considerarse un factor de riesgo para el desarrollode un AAA. Sujetos y métodos. Se diseñó un estudio de casos y controles, prospectivo y muticéntrico en la comunidadasturiana. Se comparó 291 pacientes que iban a ser intervenidos por HI con 459 controles, obtenidos de la misma población(varones de 50 o más años de edad). La definición de AAA fue la de un diámetro máximo mayor o igual a 30 mm medidoscon ecografía. Se evaluó la asociación entre HI y AAA. Resultados. Se realizó un total de 750 ecografías abdominales,obteniéndose una prevalencia similar de AAA en ambos grupos: 3,8% en el grupo de pacientes con HI y 3,5% enel grupo control. Conclusiones. De acuerdo con los resultados, no podemos confirmar una asociación positiva entre AAAy HI; por lo tanto, con los datos presentes, no se puede justificar el cribado selectivo de pacientes con HI para la detecciónprecoz de AAA

Introduction. Early detection of abdominal aortic aneurysms is broadly accepted as a prominent issue toreduce the high morbimortality rates results from ruptured AAAs, especially in high-risk population. Aim. To estimatewhether inguinal hernia (IH) must be considered as a risk factor for the development of an abdominal aortic aneurysm(AAA). Subjects and methods. A multi centric, prospective case-control study was designed. 291 patients suffering fromIH expecting surgical repair were compared with 459 controls. We seek to evaluate the association between AAA and IH.AAA is defined by a maximum aortic diameter of 30 mm or more measured by ultrasonography. All male aged 50-yearsoldor older subjects were recruited from a single population. Results. An overall 750 abdominal duplex-scans wereperformed. We found a similar prevalence of AAA in both groups: 3.8 % for the hernia group and 3.5 % for the controls.Conclusion. According to the results, we can not confirm a positive association between AAA and IH. Thus, present datado not support selective screening in patients with IH for an early AAA detection

Complex phase synchronization in epileptic seizures: evidence for a devil's staircase.

We describe multifrequency phase synchronization in epileptic seizures. Using magnetoencephalographic recordings from three patients suffering generalized seizures, the evidence is presented that, in addition to the commonly studied 1:1 frequency locking, there exists complex multifrequency coordination that, in some cases, follows a classical "devil's staircase." Within the limitations of observing this phenomenon in a clinical experimental setting, these observations reveal that in pathological brain activity, complex frequency locking can be found similar to that identified in certain pathological cardiac re-entrant arrhythmias. This may suggest the existence of similar re-entrant mechanisms active in cerebral neocortex during epileptic seizures.

Phase response curves in the characterization of epileptiform activity.

Coordinated cellular activity is a major characteristic of nervous system function. Coupled oscillator theory offers unique avenues to address cellular coordination phenomena. In this study, we focus on the characterization of the dynamics of epileptiform activity, based on some seizures that manifest themselves with very periodic rhythmic activity, termed absence seizures. Our approach consists in obtaining experimentally the phase response curves (PRCs) in the neocortex and thalamus, and incorporating these PRCs into a model of coupled oscillators. Phase preferences of the stationary states and their stability are determined, and these results from the model are compared with the experimental recordings, and interpreted in physiological terms.

[Evaluation of primary care treatment of oncology patients with opiates]. / Evaluación del tratamiento con opiáceos en pacientes oncológicos en atención primaria.

OBJECTIVES: To evaluate how adequately pain in terminal cancer patients is managed by morphine taken orally. DESIGN: A descriptive, retrospective study, from January 1993 to March 1994. SETTING: Primary care. Four primary care teams of the 10th Health Area of Madrid. PATIENTS: 37 patients with terminal cancer who took morphine under the supervision of primary care doctors. MEASUREMENTS AND MAIN RESULTS: Average age was 64.6 +/- 14. The most common site of the primary tumour was lungs (n = 6), colon (n = 4) and stomach (n = 4). All the patients received conventional analgesics at first and 82% went on to weak opiates before progressing to morphine. Half the patients began with an oral solution of morphine and the other half with long-acting tablets. Increases in the doses of morphine were correct in 62% of cases. 41% of the patients took antiemetics and 55% laxatives. 82% of the bone and 100% of the brain metastases were correctly treated. CONCLUSIONS: In general, primary care doctors in our area correctly handle pain caused by terminal cancer. The most significant errors are to do with increases in doses of morphine and with the associated use of laxatives. These can easily be rectified so that our patients' quality of life can be improved.

[Horizontal supraglottic laryngectomy. A study of 83 cases]. / Laringectomía horizontal supraglótica. Un estudio de 83 casos.

We present the results obtained in 83 patients with supraglottic laryngeal carcinoma treated by supraglottic laryngectomy. We studied the results, complications and the survival of these patients treated with this conservative surgery. We concluded that this surgical technique improved the survival rates in supraglottic carcinomas.