Disfunción endotelial en pacientes diabéticos con o sin úlceras del pie / Endothelial Dysfunction In Diabetic Patients With Or Without Foot Ulcers

Introducción. La disfunción endotelial juega un papel preponderante en la génesis de las complicaciones vasculares de la diabetes y precede a las evidencias anatómicas más tempranas de ateroesclerosis El Eco-Doppler vascular, mediante la determinación de laDilatación arterial flujo-dependiente en la arteria braquial ha demostrado una buena correlación con las pruebas invasivas parael diagnóstico de la Disfunción Endotelial. Objetivo: Determinar la presencia de Disfunción endotelial en pacientes diabéticos con o sin úlceras del pie. Método. Se diseñó un estudio observacional, prospectivo de corte transversal, tipo caso-control en pacientes diabéticos con y sin úlceras del pie, con un muestreo simple no probabilístico, con una población de estudio constituida por 100 pacientes diabéticos subdivididos en Grupo A (de estudio) 50 y Grupo B (control) 50. Resultados. La vasoactividad mediada por el flujo (VMF), en el grupo de estudio fue de 3,1% y en el grupo de control 4,3%, resultados ambos que traducen la presencia de disfunción endotelial, pero más intensa en los pacientes con úlceras del pie diabético. Conclusiones. La disminución de la vasoactividad mediada por el flujo constituye una manifestación temprana de la enfermedad arteriosclerótica, detectable inclusive antes de la aparición de eventos clínicos vasculares periféricos en pacientes diabéticos con o sin úlceras del pie. (AU)

Introduction. Endothelial dysfunction plays a preponderant role in the genesis of vascular complications of diabetes and precedes the earliest anatomical evidence of atherosclerosis. Vascular Echo-Doppler, by determining the flow-dependent arterial dilation inthe brachial artery, has demonstrated a good correlation with invasive tests for the diagnosis of Endothelial Dysfunction. Objective: To determine the presence of endothelial dysfunction in diabetic patients with or without foot ulcers. Method. An observational,prospective, cross-sectional, case-control study was designed in diabetic patients with and without foot ulcers, with a simple non-probabilistic sampling, with a study population consisting of 100 diabetic patients subdivided into Group A (of study) 50 and Group B (control) 50. Results. The flow-mediated vasoactivity (VMF) in the study group was 3.1% and 4.3% in the control group, both results that reflect the presence of endothelial dysfunction, but more intense in patients with diabetic foot ulcers. Conclusions: The decrease in flow-mediated vasoactivity constitutes an early manifestation of arteriosclerotic disease, detectable even before the appearance of peripheral vascular clinical events in diabetic patients with or without foot ulcers. (AU)

Recovering activity and illusion: the nephrology day care unit.

Day Care Units are an alternative to hospital care that improves more efficiency. The Nephrology, by its technical characteristics, would be benefit greatly from further development of this care modality. The objectives of this study are to present the process we have developed the Nephrology Day Care Unit in the Puerto Real University Hospital (Cádiz, Spain). For this project we followed the Deming Management Method of Quality improvement, selecting opportunities, analyzing causes, select interventions, implement and monitor results. The intervention plan includes the following points: 1) Define the place of the Day Care Unit in the organization of our Clinical Department of Nephrology, 2) Define the Manual of organization, 3) Define the structural and equipment resources, 4) Define the Catalogue of services and procedures, 5) Standards of Care Processes. Protocols and Clinical Pathways; and 6) Information and Registration System. In the first 8 months we have been performed nearly 2000 procedures, which corresponds to an average of about 10 procedures per day, and essentially related to Hemodialysis in critical or acute patients, the Interventional Nephrology, the Clinical Nephrology and Peritoneal Dialysis. The development of the Nephrology Day Care Units can help to increase our autonomy, our presence in Hospitals, recover the progressive loss of clinical activity (diagnostic and therapeutic skills) in the past to the benefit of other Specialties. It also contributes to: Promote and develop the Diagnostic and Interventional Nephrology; improve the clinical management of patients with Primary Health Level, promote the Health Education and Investigation, collaborate in the Resources Management, and finally, to make more attractive and exciting our Specialty, both for nephrologists to training specialists.