Excessive daytime somnolence is associated with hypoglycemia in adult Latinos with type 2 diabetes mellitus.

OBJECTIVE: This study aimed to determine the frequency of sleep disorders in hypoglycemic diabetic patients and possible relationships with scores of sleep disorders and restless legs syndrome in mestizo population in Guayaquil, Ecuador. METHODS: A multicenter, cross-sectional study conducted at an outpatient endocrinology clinic in urban and rural Ecuador regions, included 290 participants with type 2 diabetes mellitus with severe hypoglycemic episodes, completed, validated, and culturally adapted sleep questionnaires to assess daytime sleepiness, risk of sleep apnea and restless legs syndrome. Logistic regression analysis was conducted to identify factors associated with severe hypoglycemia. RESULTS: The prevalence of EDS was 56.8%, RLS prevalence of 46.2%, and 38.6% prevalence of high risk Berlin score. Multivariate logistic regression indicated hypoglycemic T2DM in the range of 56-75 years old were more likely to have high ESS (p 0.0001). CONCLUSION: A high prevalence of sleep disorders in diabetic Latinos living in Ecuador was evidenced. The presence of somnolence in patients older than 56 years and high HbA1c levels should alert the clinician for the occurrence of hypoglycemic episodes.

Cribado y caracterización bioquímica del hiperparatiroidismo primario en Guayaquil (Ecuador) / Screening and biochemical characterization of primary hyperparathyroidism in Guayaquil (Ecuador)

Objetivos: Conocer la prevalencia del hiperparatiroidismo primario (HPTP) mediante el cribado con la determinación de PTH y calcio iónico, en una muestra poblacional de Guayaquil (Ecuador). Materiales y métodos: Estudio transversal, prospectivo, realizado entre el 1 enero de 2009 y el 30 noviembre de 2014, en 13.860 personas que acudieron a exámenes de control rutinarios. A todos se les determino en suero la hormona paratiroidea (PTH), el calcio iónico, la creatinina sérica y la 25(OH) vitamina D total (VD total). Se confirmó el diagnóstico de HPTP si el nivel de PTH y/o calcio iónico se mantenía elevado al menos en dos ocasiones diferentes. Se excluyeron los casos con elevación de la creatinina sérica, malabsorción, hepatopatías crónicas, insuficiencia de vitamina D, o los que recibían tratamientos que alteran el metabolismo fosfocálcico. Resultados: Se encontró 61 casos con la PTH elevada al menos en dos ocasiones diferentes. Entre estos, 34 presentaban insuficiencia de vitamina D y fueron excluidos del análisis. En 27 casos (4 hombres y 23 mujeres) se confirmó el diagnóstico de HPTP. La edad media en mujeres fue de 64,5±15,4 años y en hombres de 71,3±12,8 años; los valores de PTH medios fueron 115±24,2 pg/ml; de calcio iónico, 5,15±0,4 mg/dl; de VD total, 47,1±20,2 ng/ml; y de creatinina sérica 0,84±0,2 mg/ml; La prevalencia de HPTP corresponde a 2 casos por mil adultos (IC 95%: 1,71-2,18). El mayor incremento en la prevalencia ocurrió en mujeres ?60 años. Conclusión: En esta muestra, la prevalencia de HPTP es baja comparada con la reportada en series internacionales, siendo mayor en edades avanzadas y en mujeres. Con el cribado propuesto de PTH y calcio iónico encontramos en la mayoría de los casos la forma normocalcémica de HPTP (AU)

Objectives: To determine the prevalence of primary hyperparathyroidism (HPTP) using PTH and Ionic calcium screening in a population sample of Guayaquil (Ecuador). Materials and methods: Prospective, cross-sectional study carried out between January 1, 2009 and November 30, 2014 of 13,860 people who attended routine control tests. All were tested in serum parathyroid hormone (PTH), ionic calcium, serum creatinine and the 25 (OH) total vitamin D (total VD). The diagnosis of HPTP was confirmed if PTH or Ionic calcium levels remained high at least in two different occasions. We excluded patients with raised serum creatinine, vitamin D insufficiency, malabsorption, chronic liver disease, or those receiving treatments that alter phosphocalcic metabolism. Results: 61 cases were found with raised PTH on at least two different occasions. Among these, 34 presented vitamin D insufficiency and were excluded from the analysis. In 27 cases (4 men and 23 women) the diagnosis of HPTP was confirmed. The average age for women was 64.5±15.4 years and men of 71.3±12.8 years; average PTH values were 115±24.2 pg/ml; Ionic calcium, 5.15±0.4 mg/dl; total VD, 47.1±20.2 ng/ml; and serum creatinine 0.84±0.2 mg/ml; prevalence of HPTP corresponds to 2 cases per thousand adults (95% CI: 1.71-2.18). The greatest increase in prevalence occurred in women aged 60 years. Conclusion: PTH prevalence in this sample is low compared to that reported in international series, being higher in advanced ages and in women. With the proposed screening for PTH and ionic calcium, we detected the normocalcemic form of HPTP in most cases (AU)

[Guidelines for the clinical management of neuropathic pain (II)]. / Guías de práctica clínica del dolor neuropático (II).

INTRODUCTION: Up to 5% of the population suffers from neuropathic pain (NP). A bibliographical search in several databases revealed that, to date, there are no protocols to guide physicians who are not specialists in pain that enable them to treat NP and thus improve patients' quality of life. AIMS: The aim of this study is to provide Spanish-speaking physicians who are not specialists in pain with a set of guidelines for the treatment of NP. A bibliographical search was performed in order to base the results and conclusions on the evidence-based medicine methodology. DEVELOPMENT: First, we review the most effective clinical and paraclinical methods for diagnosing NP, and the LANSS pain scale is reported as the most appropriate method of clinically evaluating NP. The anatomical paths and the physiology of pain are then described and we review the molecular variables involved. Finally, we point out the current therapeutic options and propose an algorithm for the treatment of NP. CONCLUSIONS: There is no specific set of guidelines for the treatment of NP. At the present time, the keystone of NP treatment consists in the use of antidepressant and anticonvulsive drugs. There is a need for further clinical trials to prove the effectiveness of using combined medication.

[Guidelines for the clinical management of neuropathic pain (I). Protocol]. / Guías de práctica clínica del dolor neuropático (I). Protocolo.

AIMS: The aim of this study is to develop a set of guidelines for the clinical management of neuropathic pain (NP), a disorder suffered by up to 5% of the population, specifically for use by the Spanish-speaking community, in order to improve the quality of medical care and to standardise the treatments offered in medical centres. DEVELOPMENT: The paper describes the methodology used to search for guidelines concerning the clinical management of NP in databases, written communications and other resources, and the results of this search are presented. The research group is split into three groups: anatomical-physiological, diagnosis and therapeutic approach, each of which defines the nature of the papers that used to design the protocol.

Guías de práctica clínica del dolor neuropático (II) / Guidelines for the clinical management of neuropathic pain (II)

Introducción. El dolor neuropático (DN) se presenta hasta en el 5% de la población. Después de una búsqueda bibliográfica en varias bases de datos, se determinó que hasta la fecha no existen protocolos que orienten al médico que no es especialista en dolor para tratar el DN y mejorar la calidad de vida de los pacientes. Objetivo. Presentar unas guías de tratamiento del DN dirigidas a médicos no especialista en dolor de habla hispana. Se realizó una búsqueda bibliográfica para fundamentar los resultados y las conclusiones con la metodología de la medicina basada en la evidencia. Desarrollo. En primera instancia se revisan los métodos clínicos y paraclínicos más eficaces para el diagnóstico del DN y se describe la escala de LANSS como la opción más adecuada para la evaluación clínica del DN. Posteriormente, se describen las vías anatómicas y la fisiología del dolor y se revisan las variables moleculares involucradas. Finalmente, se señalan las opciones terapéuticas actuales y se propone un algoritmo de tratamiento del DN. Conclusiones. No existe un esquema específico para el tratamiento del DN. Actualmente, los antidepresivos y los anticonvulsionantes son la piedra angular del tratamiento. Se requieren ensayos clínicos que evidencien la eficacia del uso de medicamentos combinados

Introduction. Up to 5% of the population suffers from neuropathic pain (NP). A bibliographical search in several databases revealed that, to date, there are no protocols to guide physicians who are not specialists in pain that enable them to treat NP and thus improve patients’ quality of life. Aims. The aim of this study is to provide Spanish-speaking physicians who are not specialists in pain with a set of guidelines for the treatment of NP. A bibliographical search was performed in order to base the results and conclusions on the evidence-based medicine methodology. Development. First, we review the most effective clinical and paraclinical methods for diagnosing NP, and the LANSS pain scale is reported as the most appropriate method of clinically evaluating NP. The anatomical paths and the physiology of pain are then described and we review the molecular variables involved. Finally, we point out the current therapeutic options and propose an algorithm for the treatment of NP. Conclusions. There is no specific set of guidelines for the treatment of NP. At the present time, the keystone of NP treatment consists in the use of antidepressant and anticonvulsive drugs. There is a need for further clinical trials to prove the effectiveness of using combined medication

Guías de práctica clínica del dolor neuropático (I). Protocolo / Guidelines for the clinical management of neuropathic pain (I). Protocol

Objetivo. Desarrollar unas guías de práctica clínica para el dolor neuropático (DN), un trastorno que se manifiesta hasta en el 5% de la población, específicamente para la comunidad de habla hispana, con el fin de mejorar la calidad del cuidado médico y estandarizar los tratamientos en los centros clínicos. Desarrollo. Se describe la metodología de búsqueda de guías de práctica clínica de DN en bases de datos, comunicaciones escritas y otros recursos, y se muestran los hallazgos. El grupo investigador se distribuye en tres grupos: aproximación anatomofisiológica, aproximación diagnóstica y aproximación terapéutica, cada uno de los cuales define la pertinencia de los artículos que se utilizarán para diseñar el protocolo

Aims. The aim of this study is to develop a set of guidelines for the clinical management of neuropathic pain (NP), a disorder suffered by up to 5% of the population, specifically for use by the Spanish-speaking community, in order to improve the quality of medical care and to standardise the treatments offered in medical centres. Development. The paper describes the methodology used to search for guidelines concerning the clinical management of NP in databases, written communications and other resources, and the results of this search are presented. The research group is split into three groups: anatomical-physiological, diagnosis and therapeutic approach, each of which defines the nature of the papers that used to design the protocol