Glycemic control and maternal and fetal outcomes in pregnant women with type 1 diabetes according to the type of basal insulin.

OBJECTIVE: To examine the potential role of the type of basal insulin on glycemic control and maternal and foetal outcomes in pregnant women with type 1 diabetes (T1DM). STUDY DESIGN: Retrospective cohort study of pregnancies attended at 18 Spanish tertiary hospitals. INCLUSION CRITERIA: T1DM, singleton pregnancies, delivery between 2002-2010, and use of the same basal and prandial insulin from before pregnancy until delivery. RESULTS: A total of 1534 pregnancies were included. The basal insulin most commonly used was Neutral Protamine Hagedorn (NPH) (51.7%), followed by glargine (23.2%) and continuous subcutaneous insulin infusion (CSII) (21.1%). CSII users had longer diabetes duration. Multiple logistic regression analysis showed that CSII was independently associated with lower doses of insulin, higher glycated haemoglobin (HbA1c) in all trimesters, and higher rates of miscarriage, preterm birth and neonatal hypoglycemia. Glargine was related to a higher risk of preterm birth and a small-for-gestational age infant (SGA). The odds ratios (OR) of the associations between insulin type and clinical outcomes (from 0.642 to 4.894) have a relevant magnitude. CONCLUSIONS: In this observational study of pregnant women with T1DM, the type of basal insulin was independently associated with metabolic variables and foetal outcomes.

Abordaje del manejo de la disfunción tiroidea en la gestación. Documento de consenso de la Sociedad Andaluza de Endocrinología y Nutrición (SAEN) / Thyroid dysfunction in pregnancy. Consensus document. Andalusian Society of Endocrinology and Nutrition (SAEN)

En nombre de la Sociedad Andaluza de Endocrinología y Nutrición (SAEN) se ha elaborado un consenso sobre la atención a la mujer gestante que presenta algún tipo de disfunción tiroidea, basándose en la revisión de la bibliografía actualizada y sobre todo de las guías de buena práctica clínica. Se desarrolla bajo distintos epígrafes o apartados en los que se contempla tanto el diagnóstico como el tratamiento del hipotiroidismo clínico y subclínico, el hipertiroidismo franco y subclínico, la hipotiroxinemia y la tiroiditis posparto, así como la justificación de la realización de cribado universal de la disfunción tiroidea durante la gestación, proporcionando a los profesionales que asisten a estas pacientes un arma de toma de decisiones razonada (AU)

A position statement on the diagnosis and treatment of thyroid dysfunction in pregnancy has been agreed on behalf of The Sociedad Andaluza de Endocrinología y Nutrición (SAEN), based on a review of the literature to date and all good clinical practice guidelines. The document is set out in different sections as regards the diagnosis and treatment of, overt and subclinical hypo- and hyperthyroidism, isolated hypothyroxinaemia and postpartum thyroiditis. It also justifies the implementation of universal screening for thyroid dysfunction in pregnancy, and provides practitioners who care for these patients with tool for rational decision making (AU)

[Thyroid dysfunction in pregnancy. Consensus document. Andalusian Society of Endocrinology and Nutrition (SAEN)]. / Abordaje del manejo de la disfunción tiroidea en la gestación. Documento de consenso de la Sociedad Andaluza de Endocrinología y Nutrición (SAEN).

A position statement on the diagnosis and treatment of thyroid dysfunction in pregnancy has been agreed on behalf of The Sociedad Andaluza de Endocrinología y Nutrición (SAEN), based on a review of the literature to date and all good clinical practice guidelines. The document is set out in different sections as regards the diagnosis and treatment of, overt and subclinical hypo- and hyperthyroidism, isolated hypothyroxinaemia and postpartum thyroiditis. It also justifies the implementation of universal screening for thyroid dysfunction in pregnancy, and provides practitioners who care for these patients with tool for rational decision making.

Estudio longitudinal del impacto del tratamiento con infusores de insulina en variables psicológicas, la calidad de vida y el control glucémico de pacientes con diabetes mellitus tipo 1 / Longitudinal study of the impact of the treatment with insulin infusion in psychological, quality of life, and glycemic control of patient with type 1 diabetes mellitus

Introducción: Desde el estudio DCCT, han sido muchas las investigacionesque han intentado evaluar las distintas propuestas de terapia intensiva. Pocosestudios a largo plazo incluyen variables psicosociales. Objetivos: Evaluarvariables psicológicas y metabólicas en pacientes con diabetes tipo 1 tras 2años de tratamiento con infusión subcutánea continua de insulina (ISCI). Materialesy métodos: Veintidós pacientes con diabetes tipo 1 en tratamientocon múltiples dosis de insulina recibieron tratamiento con ISCI. Se realizó unaevaluación a los 6, 12 y 24 meses, utilizando diversos instrumentos como elBDI, el DQOL, la MHLC, el STAI y el cuestionario de miedo a las hipoglucemias.Se admitió un control glucémico adecuado con una HbA1c <7,5%. Elanálisis estadístico se realizó mediante pruebas no paramétricas y el coeficientede correlación de Pearson. Resultados: Los pacientes partían de una puntuaciónmedia en depresión de 9,55 ± 9,12 (media ± DT). En calidad devida, los datos iniciales fueron 92,95 ± 16,15, mientras que el nivel de HbA1cfue de 8,45 ± 1,59%. Al cabo de los 2 años de tratamiento, se aprecian mejorassignificativas en las puntuaciones obtenidas en depresión (p= 0,018),calidad de vida (p= 0,005) y control glucémico (p= 0,003). La ansiedad rasgoy el locus de control externo correlacionaron significativamente, encontrándoseuna fuerte relación entre el miedo a las hipoglucemias y las variablespsicológicas estudiadas. Los pacientes con mal control glucémico basal mejoraronal cabo de los 2 años de tratamiento. Conclusiones: Después de 2años con ISCI, los pacientes con diabetes tipo 1 mejoran significativamente sucalidad de vida, su control glucémico y su sintomatología depresiva(AU)

Introduction: Since the DCCT study, many studies have tried to assess differentintensive therapies. However, few long-term studies have included psychosocialvariables. Objectives: To evaluate psychological and metabolic variablesin patients with type 1 diabetes after 2 years of therapy with continuoussubcutaneous insulin infusion (CSII). Materials and methods: Twenty-twotype 1 diabetic patients treated with multiple daily injections were treated withCSII. An evaluation at 6, 12 and 24 months was performed, using several instrumentsas BDI, DQOL, MHLC and a questionnaire to evaluate fear of hypoglycaemia.Acceptable metabolic control was admitted with HbA1c <7.5%.Statistical analysis was realized using non parametric tests and Pearson’s correlationcoefficient. Results: Initially, patients had a mean score for depressionof 9.55 ± 9.12 (mean ± SD). In quality of life, initial values were 92.95 ±16.15, while the level of HbA1c was 8.45 ± 1.59%. After 2 years of treatmentwe found significant improvement in depression (p= 0.018) and quality of life(p= 0.005) scores and glycemic control (p= 0.003). Trait anxiety and externallocus of control showed a significant correlation, with a strong correlation betweenfear of hypoglycemia and the analyzed psychosocial variables. Patientswith bad basal glycemic control improved after 2 years of treatment. Conclusions:After two years with CSII, type 1 diabetic patients improve significantlytheir quality of life, glycemic control and depressive symptoms(AU)

La educación terapéutica de personas con diabetes. Experiencia del Servicio de Endocrinología y Nutrición del Hospital Universitario «Carlos Haya» de Málaga / Therapeutic education in people with diabetes. Experience from the Endocrinology and Nutrition Department of Carlos Haya University Hospital in Málaga, Spain

En la segunda mitad del siglo XX, la medicina ha cambiado más que en toda su historia anterior. Este cambio ha sido la consecuencia no sólo de los avances científicos y técnicos, sino también de los cambios del modelo social. Los pacientes han dejado de ser personas pasivas y han pasado a disfrutar de un creciente protagonismo en la toma de decisiones: es la manera de llevar a la práctica el principio de autonomía, que, junto con los principios de beneficencia y de justicia, constituyen los pilares básicos de la ética médica. Pero la autonomía no es real si el paciente no disfruta de los instrumentos para ejercerla realmente. La educación terapéutica es el mejor instrumento para transferir información desde el médico y el sistema sanitario hacia el paciente. La diabetes mellitus es el prototipo de enfermedad crónica susceptible de beneficiarse de la participación activa del paciente. Los programas de educación de pacientes diabéticos han pasado a formar parte de los espacios establecidos de atención clínica de la diabetes. Por lo general, hasta no hace mucho los servicios clínicos carecían de experiencia en la introducción de la educación como parte de la terapéutica clínica. No es sorprendente, pues, que la manera de organizar la educación de los pacientes haya sido muy diversa: dependía de la capacidad de cada servicio para dar respuesta a los nuevos retos, pero también, y sobre todo, de la sensibilidad y la cultura que se tuviera sobre la relación médico-enfermo. Así, aunque se ha hecho un esfuerzo por estandarizar la educación terapéutica, lo cierto es que ha habido tantos programas como espacios donde se ha puesto en marcha. En el presente artículo se reflexiona sobre la educación de pacientes desde la experiencia de más de 20 años en un servicio de endocrinología y nutrición

In the second half of the 20th century, the field of «Medicine» underwent more changes than throughout its entire previous history. This transformation has been the consequence not only of scientific and technical advances, but of changes in the social model as well. Patients have gone from being passive individuals to having an increasingly prominent role in the decision-making process. This is the manner of putting into practice the principle of autonomy, which, together with the principles of beneficence and justice, is a mainstay of medical ethics. However, this autonomy is not real if the patient is not provided with the tools he or she needs to actually exercise it. Therapeutic education is the best tool for transferring information from the physician and health care system to the patient. Diabetes mellitus represents the prototype of the chronic diseases that could benefit from the active participation of the patient. Education programs for diabetic patients have become a part of the conventional ambit of clinical care in diabetes. The staffs of clinical services generally lack experience in the introduction of education as a part of clinical therapeutics. Thus, it is not surprising that the approach to organizing patient education has varied widely. It has depended on the capacity of each service to respond to the new challenges, but, above all, on the existing sensitivity and culture with respect to the physician-patient relationship, as well. Although there has been an effort to standardize therapeutic education, the truth is that there have been as many programs as settings in which they have been introduced. In the present article, the authors reflect on patient education, following more than twenty years of experience in an endocrinology and nutrition department

Yodo y embarazo: resultados de un estudio en una población de mujeres embarazadas sanas del sureste andaluz / Iodine and pregnancy: Results of a population’s study of healthy pregnant women in the south-est of Andalucia (Spain)

En España estudios recientes han demostrado que la ingesta de yodo en las mujeres embarazadas es baja, incluso en zonas donde teóricamente hay programas institucionales para promover el consumo de sal yodada para la prevención de la deficiencia de yodo. Nuestro estudio muestra que en la población de mujeres gestantes de Málaga la ingesta de yodo está por debajo de las recomendaciones nutricionales. La eliminación de yodo por la orina va aumentando a lo largo del embarazo, produciéndose un incremento del tamaño del volumen tiroideo al final del mismo. Aunque no se encontró una correlación individual entre el volumen tiroideo y la eliminación de yodo por la orina, los resultados sugieren claramente que el incremento en el volumen tiroideo es la consecuencia de una disfunción tiroidea a lo largo del embarazo. Esta disfunción del tiroides se corresponde con lo esperado en una situación de yododeficiencia. A pesar de existir en distintas zonas de España unas campañas de salud pública recomendando la utilización de sal yodada, los resultados de distintos estudios nos muestran que este aporte es insuficiente en las mujeres gestantes, con el consecuente riesgo que conlleva para el desarrollo fetal. Los resultados del presente estudio apoyan la conveniencia de instaurar programas sistemáticos de suplementación de yodo durante el embarazo

In Spain several studies have demonstrated that iodine intake of pregnant women is low. Our study shows that in the south-west (Malaga), the intake of iodine in the population of pregnant women is under the nutritional recommendations. The iodine urine elimination increases during the pregnancy with an increasing of the thyroid volume during pregnancy. There is no individual correlation between thyroid volume and urine iodine elimination, but the results suggest the origin of the thyroid dysfunction thought the pregnancy is the increased thyroid volume. Besides the health public campaign of using iodine salt in several zones of Spain, the results of some studies shown that this supplementation is inadequate, with the risk for the fetal development. The results of this study support the necessity of systematic programmes of iodine supplementation during the pregnancy

Protocolo para el estudio de trastornos debidos a la deficiencia nutricional de yodo / Protocol for the study of iodine deficiency disorders

El protocolo aquí presentado es el desarrollo de la ponencia del mismo título expuesta en la mesa redonda sobre yodo deficiencia del congreso de la Sociedad Española de Endocrinología (SEEN) celebrado en Cáceres. En él se recogen las experiencias de protocolización previas que se han producido en España para el estudio de los trastornos por déficit de yodo, que han sido de gran utilidad para sistematizar los estudios realizados en los últimos años. Con este protocolo se pretende actualizar la sistemática del estudio de los trastornos por déficit de yodo en el contexto de los nuevos conocimientos y de los importantes cambios sociosanitarios que se han producido en los últimos años (AU)

The protocol presented here in is anextension of the communication with the same title delivered during the round table on iodine deficiency at the meeting of the Spanish Society of Endocrinology and Nutrition in Caceres. The protocol collates the experience gained from previous protocols for the study of iodine deficiency disorders (IDD) in Spain, which have proved highly useful for the systematic study of these disorders in recent years. This new protocol aims to update the systematic study of IDD in the context of new knowledge and the considerable social and healthcare changes that have taken place in recent years (AU)

Oleic acid from cooking oils is associated with lower insulin resistance in the general population (Pizarra study).

AIM: To evaluate the relation between type of dietary fatty acid and degree of insulin resistance. DESIGN: A cross-sectional study. METHODS: Anthropometrical data were measured in 538 subjects, aged 18-65 Years, selected randomly from the municipal census of Pizarra (Spain). An oral glucose tolerance test (OGTT) was given to all subjects and measurements were made of glycemia, insulinemia and the proportion of fatty acids in plasma phospholipids. Insulin resistance (IR) was estimated by homeostasis model assessment. Samples of cooking oil being used were obtained from the kitchens. The strength of association between variables was measured by calculating the odds ratio (OR) from logistic models, and the relationships were measured by linear correlation coefficients. RESULTS: Insulin resistance was significantly less in people who used olive oil compared with those who used sunflower oil or a mixture. Statistical significance remained in the group of people with normal OGTT after adjusting for obesity. In the whole sample, IR correlated negatively with the concentration of oleic acid (r=-0.11; P=0.02) and positively with that of linoleic acid (r=0.10; P=0.02) from the cooking oil. In subjects with normal OGTT, IR correlated negatively with oleic acid from cooking oil (r=-0.17; P=0.004) and from plasma phospholipids (r=-0.11; P=0.01) and positively with the concentration of linoleic acid in cooking oil (r=0.18; P=0.004) and plasma phospholipids (r=0.12; P=0.005). The risk (OR) of having raised IR was significantly lower in people who consumed olive oil, either alone (OR=0.50) or mixed (OR=0.52) compared with those who consumed only sunflower oil. CONCLUSION: There is an association between the intake of oleic acid, the composition of oleic acid in plasma phospholipids and peripheral insulin action.

Los determinantes de la yoduria en una población escolar del sur de España / Determinant factors of ioduria in a scholar population in the south of Spain

Antecedentes. La yoduria es un buen marcador de la ingesta de yodo.En los países desarrollados existe una yodoprofilaxis silente, como consecuencia de un creciente contacto con sustancias y alimentos yodados. Objetivos. Conocer los determinantes ambientales de la yoduria en el curso de un estudio poblacional sobre deficiencia de yodo y bocio endémico. Material y métodos. A 756 niños de la población escolar de la Axarquía aleatoriamente seleccionados se les realiza una exploración clínica y medición de yodo en orina y hormonas tiroideas en sangre. A 548 niños se les realizó una encuesta alimentaria y de otros factores ambientales que pudieran condicionar el aporte de yodo. Resultados. La prevalencia de bocio ha sido del 37 por ciento y la mediana de yoduria, de 120 µg/l. Las siguientes variables han condicionado la yoduria de los niños: función tiroidea, procedencia geográfica, procedencia del agua de bebida, desinfección local de heridas recientes y muy especialmente la cantidad de leche ingerida. Conclusiones. La ingestión de leche ha sido la fuente más estable y consistente de yodo. El estudio demuestra que en ausencia de una yodoprofilaxis sistemática una mediana de yoduria de 120 µg/l es conseguida predominantemente a partir de fuentes (alimentarias y no alimentarias) que están sometidas a una gran variabilidad y discrecionalidad tanto en su composición de yodo como en su consumo, sobre todo si tenemos en cuenta el bajo consumo de sal yodada de la población. Ante la dificultad para conseguir una política institucional de yodoprofilaxis parece necesario aumentar la ingestión de lácteos en la población escolar, una recomendación, por otro lado, necesaria también para conseguir otros objetivos de salud (AU)

Comparación de diferentes criterios de diagnóstico poblacional de la deficiencia de yodo (DDY). Prevalencia de bocio endémico en la axarquía (málaga) / Comparison of different criteria for the diagnosis of iodine deficiency (ID) in the population. Prevalence of endemic goitre in the Axarquía (Málaga), Spain

Objetivos. a) Evaluar la prevalencia de bocio y de deficiencia de yodo (DDY) en la comarca de la Axarquía (Málaga) (el último estudio data de 1980), y b) comparar los diferentes criterios (bocio, yoduria, concentraciones de TSH neonatal, tiroglobulina y volumen tiroideo) propuestos para identificar los DDY. Material y método. Población de referencia: población escolar de la comarca de la Axarquía (sureste de la provincia de Málaga). Muestra: 756 niños. Error muestral del 3,4 por ciento (intervalo de confianza del 95 por ciento; 3,3-3,5 por ciento). Procedimientos: se calcula la prevalencia de bocio y DDY a partir de: a) palpación de tiroides y yoduria (criterios de las agencias internacionales); b) concentraciones de tiroglobulina > 10 ng/ml; c) valores de TSH de cribado de hipotiroidismo congénito (TSH > 5 µU/ml), y d) volumen tiroideo (ecografía) > percentil 97 (Delange, OMS). Resultados. La prevalencia de bocio por palpación ha sido del 37 por ciento. El 20,8 por ciento presentó un bocio grado Ia y el 16,3 por ciento, grado Ib. El bocio ha sido más frecuente en los pueblos del interior especialmente en la zona de la sierra de Almijara (59,7 por ciento). La yoduria media fue de 121,5 µg/l y la mediana de 120 µg/l. El 48,5 por ciento de los niños excretaron menos de 100 µg/l. La variable que más ha contribuido al riesgo de tener bocio ha sido la zona en la que se vive dentro de la comarca (odds ratio [OR] = 2,06). La tiroglobulina fue más alta en el grupo de niños con yodurias menores de 50 µg/dl. El 34,1 por ciento de los niños tuvieron la tiroglobulina entre 10 y 19,9 ng/ml y el 7 por ciento por encima de 20 ng/ml. La mediana de la tiroglobulina para toda la muestra ha sido de 8,9 ng/ml. La prevalencia de niños con TSH > 5 µU/ml en el programa de detección precoz de hipotiroidismos congénitos ha sido del 9,3 por ciento, en la Axarquía y 9,8 por ciento, en la comarca limítrofe de Antequera, frente al 6,6 y al 7,4 por ciento de dos distritos de Málaga capital. La prevalencia de bocio a partir del P-97 del volumen tiroideo por ecografía siguiendo los criterios propuestos por Delange fue del 3,2-3,8 por ciento. Discusión. En la comarca de la Axarquía (Málaga) persiste, en 1999, una endemia bociosa de grado I, a pesar de presentar una mediana de yoduria de 120 µg/l. De haber utilizado la tiroglobulina y los puntos de corte de volumen tiroideo grande propuestos por Delange como indicadores de DDY, se habría desestimado la existencia de esta endemia (AU)

[The quality of the care in parenteral nutrition: the benefits after the incorporation of a nutritional support team]. / Calidad asistencial en nutrición parenteral: beneficios tras la incorporación de un equipo de soporte nutricional.

GOALS: The purpose of the study was to analyze the quality of the prescription and follow-up of the total parenteral nutrition (PNT) before and after the incorporation of a nutritional support team (NST). MATERIAL AND METHODS: A random sample of 96 patients was selected retrospectively, with 48 prior to the incorporation of the NST (the Non-NST group) and 48 after its incorporation (the NST group), to whom TPN was prescribed. The following points were assessed: 1. The existence of a minimum analytical and nutritional assessment, prior to the incorporation of TPN; 2. The follow-up of the same. RESULTS: The average duration of TPN per patient was 13.8 days without differences between the two groups. There is a written record of the weight and height in 15% and 10% of cases, respectively, in the Non-NST group as opposed to 100% and 99% in the NST group (p < 0.0001). Prior to the incorporation of the NST, the nutritional requirement was not verified in any patients (0%) as opposed to 97% afterwards. Statistically significant differences were detected in the measurement of albumin prior to the start of TPN (p < 0.01). During the analytical follow-up, statistically significant differences were detected in the measurement of: blood tests (p < 0.05); basic biochemistry (p < 0.01); general biochemistry, magnesium, zinc, pre-albumin, transferrin and nitrogen balance (p < 0.0001). In the TPN follow-up, the Non-NST group did not change any of the components contained in it (in terms of volume, macro or micronutrients) in 81% of patients, while 17% had one change and 2% had 2 or more changes, as opposed to 27%, 42% and 31%, respectively in the NST group (p < 0.0001). There were no significant differences in metabolic complications between the two groups. CONCLUSIONS: The implementation of a nutritional support team in charge of the prescription and follow-up of TPN has notably improved the quality of these follow-up studies.

Calidad asistencial en nutrición parenteral: beneficios tras la incorporación de un equipo de soporte nutricional / Quality of assistance in parenteral nutrition: benefits following the incorporation of a nutritional support team

Objetivos: El objetivo del trabajo fue analizar la calidad de la prescripción y seguimiento de la nutrición parenteral total (NPT) antes y después de la incorporación de un equipo de soporte nutricional (ESN).Material y métodos: Se seleccionó retrospectivamente una muestra aleatoria de 96 pacientes, 48 previos a la incorporación del ESN (grupo NOESN) y 48 posteriores (grupo ESN), a los que se les prescribió NPT. Se evaluó: l) la existencia de una valoración nutricional y analítica mínima, previa a la instauración de la NPT y 2) el seguimiento de la misma.Resultados: La duración media de la NPT por paciente fue de 13,8 días sin diferencias en ambos grupos. Existía constancia escrita del peso y la talla (respectivamente) en el 15 por ciento y 10 por ciento de los casos, en el grupo NOESN, frente al 100 por ciento y 99 por ciento en el ESN (p 2 modificaciones en el 2 por ciento, frente al 27 por ciento, 42 por ciento y 31 por ciento, respectivamente, en el grupo ESN (p < 0,0001). No existieron diferencias significativas en cuanto a complicaciones metabólicas entre los dos grupos.Conclusiones: La implantación de un equipo de soporte nutricional, encargado de la prescripción y seguimiento de la NPT, ha mejorado notablemente la calidad en el seguimiento de las mismas (AU)

Goals: The purpose of the study was to analyze the quality of the prescription and follow-up of the total parenteral nutrition (PNT) before and after the incorporation of a nutritional support team (NST). Material and methods: A random sample of 96 patients was selected retrospectively, with 48 prior to the incorporation of the NST (the Non-NST group) and 48 after its in-corporation (the NST group), to whom TPN was prescribed. The following points were assessed: 1. The existence of a minimum analytical and nutritional assessment, prior to the incorporation of TPN; 2. The follow-up of the same. Results: The average duration of TPN per patient was 13.8 days without differences between the two groups. There is a written record of the weight and height in 15% and 10% of cases, respectively, in the Non-NST group as opposed to 100% and 99% in the NST group (p < 0.0001). Prior to the incorporation of the NST, the nutritional requirement was not verified in any patients (0%) as opposed to 97% afterwards. Statistically significant differences were detected in the measurement of albumin prior to the start of TPN (p < 0.01). During the analytical follow-up, statistically significant differences were detected in the measurement of: blood tests (p < 0.05); basic biochemistry (p < 0.01); general biochemistry, magnesium, zinc, pre-albumin, transferrin and nitrogen balance (p < 0.0001). In the TPN follow-up, the Non-NST group did not change any of the components contained in it (in terms of volume, macro or micronutrients) in 81% of patients, while 17% had one change and 2% had 2 or more changes, as opposed to 27%, 42% and 31 %, respectively in the NST group (p < 0.0001). There were no significant differences in metabolic complications between the two groups. Conclusions: The implementation of a nutritional support team in charge of the prescription and follow-up of TPN has notably improved the quality of these follow-up studies (AU)

Serum leptin and habitual fatty acid dietary intake in patients with type 1 diabetes mellitus.

OBJECTIVE: To study the contribution of a normal intake of nutrients to the variability of serum leptin concentrations in persons with type 1 diabetes mellitus. DESIGN: We studied the relation between serum leptin and nutrient intake in a cross-sectional study. METHODS: Serum leptin measured by radioimmunoassay, nutritional data determined by a self-administered 7-day nutritional questionnaire, and the fatty acid composition of the serum phospholipids (measured by thin layer chromatography and gas chromatography) were determined in 60 patients with type 1 diabetes mellitus. Correlation and regression analyses were performed between serum leptin and dietary fatty acids and serum phospholipid fatty acids. RESULTS: In the prediction models for the concentrations of serum leptin in men with type 1 diabetes mellitus, the dietary fatty acids displaced the anthropometric variables, and were independent of the serum testosterone concentrations. This fact remained when the prediction was made on the basis of indirect markers of the intake, such as the serum phospholipid fatty acids. In the women, the fatty acids from the diet or from the serum phospholipids also partly explained the variation in serum leptin, although not displacing the anthropometric variables. CONCLUSIONS: Our data suggest that, in non-experimental conditions, the concentrations of serum leptin in men with type 1 diabetes mellitus and, to a lesser extent, those in women with diabetes, may be influenced by the composition of the habitual diet, especially the type of dietary fat.

[Trends of antidiabetic drug prescriptions in Andalucia (1986-1994)]. / Tendencias de prescripción de medicamentos antidiabéticos en Andalucía (1986-1994).

OBJECTIVE: Tendencies in the consumption of antidiabetic agents in Andalusia between 1986-1994 were analysed, with special emphasis on the impact of the introduction of acarbose and mechanized systems for the injection of insulin. METHODS: The information concerning consumption was obtained from the data bases of the Andalusian Health Service and the Ministry of Health which contain details of the items sold in community chemists and charged to the National Health System. Data are expressed as defined daily doses per 1000 inhabitants per day (DID). RESULTS: Insulin consumption rose from 4.67 DID in 1986 to 9.33 DID en 1994, an increase (delta) of 99.8%. All types of insulins contributed to the increase, with the mixtures rising most (delta 275%). Intermediate insulins were the most used. Prefilled syringes accounted for 25% of all insulin dispensed in 1994. Consumption of oral antidiabetic agents (OAA) rose from 12.75 DID in 1986 to 20.92 DID in 1994 (delta 64%). The most prescribed OAAs during these years were second generation sulphonylureas, representing 83% of those dispensed in 1994, followed by acarbose (11%), biguanides (3.8%), and first generation sulphonylureas (2.1%). CONCLUSIONS: There was a notable increase in the consumption of insulins and OAAs. Although the tendency in the consumption differs from that expected according to consensus agreements, qualitative changes were seen, suggesting an improvement in prescription habits. The appearance of mechanized injection systems for insulin and of acarbose have clearly modified prescription habits.

[Comparative analysis of reperfusion time in primary angioplasty vs thrombolysis. Success vs time]. / Análisis del tiempo de reperfusión entre angioplastía primaria y trombolisis: éxito vs tiempo.

UNLABELLED: We studied 398 patients with diagnosis of acute myocardial infarction who arrived within the first six hours of symptom onset that were treated with thrombolysis or primary angioplasty, they were divided in two groups: Group 1 (n = 198), those treated with 1.5 million U of streptokinase over 60 min and Group 2 (n = 200), those treated with primary angioplasty. In Group 1 the "pain-door" time was 3.7 +/- 1.7 hs vs 3.8 +/- 2.4 hs in group 2 (p = NS). The "door-needle" time was 48 +/- 12 min. compared with the "door-balloon" time of 84 +/- 30 min (p < 0.001). In Group 1, 154 (77.6%) of the patients had clinical of reperfusion after thrombolysis, 58 of them underwent coronary angiography and had an infarct related artery (IRA) patency rate of 45.3%. In Group 2 the IRA patency rate was 85.5% (p < 0.005). CONCLUSION: Thrombolysis was achieved in a lesser period of time but our findings showed that primary angioplasty was more effective obtaining a TIMI 3 flow.

[Ebstein's anomaly related with significant pericardial effusion. Report and analysis of a case]. / Anomalía de Ebstein relacionada con derrame pericárdico importante. Informe y análisis de un caso.

Ebstein's anomaly is a malformation of the tricuspid valve characterized from the clinical view point by dysnea, evolutive cyanosis and fatigue. Is it characterized anatomically by a downward displacement of the tricuspid valve into the right ventricle due to anomalous attachment of the tricuspid leaflets. Because of the abnormally situated tricuspid orifice, a portion of the right ventricle lies between the atrioventricular ring and the origin of the valve, that is, an "atrialized" segment of the ventricle, and they have a functionally small ventricular chamber. Roentgenographic studies, usually demonstrate a characteristic enlarged heart. The globular-shaped heart on a chest X-ray may closely resemble the picture usually associated with a large pericardial effusion. The ecocardiographic study is more specific for the differential diagnosis, and usually eliminates one pathology but confirms the other. The patient that we are presenting is unusual, and, as far as we know, it is the only in the literature case in which there is a coexistence of the important pericardial effusion and the Ebstein's anomaly. We review the functional abnormalities of the right ventricle with Doppler and two-dimensional echocardiography in this patient.