Falla autonómica asociada a hipoglucemia / Hypoglycemia associated autonomic failure

La hipoglucemia inadvertida (HI) es una complicación del tratamiento de la diabetes mellitus tipo 1 (DM1) y DM2 tratada con insulina o sulfonilureas, que se caracteriza por una capacidad reducida para percibir el inicio de los episodios de hipoglucemia. En general, coexiste con una insuficiente respuesta hormonal contrarreguladora a la hipoglucemia denominada falla autonómica asociada a la hipoglucemia (FAAH). El desarrollo de HI y de falla contrarreguladora a la hipoglucemia aumentan significativamente el riesgo de hipoglucemias severas. Se han desarrollado escalas de puntuación para identificar, en la consulta clínica, a este grupo de personas con elevado riesgo de hipoglucemias severas. La piedra angular del tratamiento consiste en evitar las hipoglucemias mediante una intervención multifactorial de cuidados clínicos y educación estructurada.

Hypoglycemia unawereness is a complication of type 1 diabetes treatment and of type 2 diabetes treatment treated with insulin or sulfonylureas, characterized by a reduced ability to perceive the onset of episodes of hypoglycemia. In general, it coexists with an insufficient counterregulatory hormonal response to hypoglycemia called: hypoglycemia associated autonomic failure (HAAF). The development of hypoglycemia unawereness and counterregulatory failure to hypoglycemia significantly increase the risk of severe hypoglycemia. Scoring scales have been developed to identify this group of people at high risk of severe hypoglycemia in the clinic. The cornerstone of treatment is to avoid hypoglycemia through a multifactorial intervention of clinical care and structured education.

Neuropatía autonómica diabética: manifestaciones clínicas poco conocidas / Diabetic autonomic neuropathy: little known clinical manifestations

La neuropatía crónica es la complicación más prevalente de la diabetes. De las distintas formas de neuropatía diabética, la polineuropatía distal y simétrica y la neuropatía autonómica, particularmente la neuropatía autonómica cardíaca, son las más estudiadas y en ocasiones son asintomáticas. Los pacientes con prediabetes también pueden desarrollar neuropatías similares a la neuropatía diabética. La prevención es un componente clave en la atención de estas complicaciones. La neuropatía autonómica diabética afecta varios órganos y sistemas de la economía. Nuestro objetivo es describir aquellas manifestaciones clínicas poco conocidas, y en consecuencia poco tenidas en cuenta, que afectan el sistema cardiovascular, el gastrointestinal y el compromiso vesical

Chronic neuropathy is the most prevalent of the diabetic complications. Distal and symmetric sensitive polyneuropathy, and autonomic compromise, particularly cardiac autonomic neuropathy,are the most studied; occasionally they are asymptomatic. Like diabetic patients, prediabetics can also develop neuropathy. Prevention is a key component in these complications. Autonomic neuropathy affects several body´s organs and systems. Our goal is to describe those less known clinical manifestations, and because of this, less considered complications that affect cardiovascular, gastrointestinal system and bladder functioning

Actualización del tratamiento de la polineuropatía diabética periférica dolorosa 2015. Comité de Neuropatía Diabética. Sociedad Argentina de Diabetes / Treatment update of painful peripheral diabetic neuropathy. Diabetic Neuropathy Committee 2015. Argentine Society of Diabetes

La diabetes es una enfermedad crónica y progresiva que se asocia a complicaciones potencialmente discapacitantes, entre ellas, la neuropatía diabética es probablemente la afectación sintomática más frecuente con importante impacto social y económico. El tratamiento de la neuropatía somática dolorosa y del sistema nervioso autónomo ha sido un desafío durante años. Nuevas terapéuticas se encuentran disponibles, las cuales mejoran el dolor y brindan esperanza de lograr alivio a personas que padecen esta complicación

Neuropatía en el contexto del Síndrome Metabólico y de la disglucemia no diabética / Neurpathy in metabolic síndrome and non-diabetic disglycemia

La neuropatía diabética (ND) es la complicación microvascular más frecuente y más precoz asociada a la diabetes mellitus (DM), no obstante esta situación, es la más olvidada y la menos diagnosticada. Al mismo tiempo es de amplio conocimiento que el síndrome metabólico (SM) tiene una elevada prevalencia, y que la relación entre este estado y el compromiso macrovascular está documentada. Es de interés para el Comité de Neuropatía Diabética analizar la afectación neuropatía en el marco del SM y en el de uno de sus componentes constitutivos como es la disglucemia no diabética. El subdiagnóstico de esta entidad y el aumento del riesgo de la morbimortalidad de los pacientes que la padecen hacen importante alertar a la comunidad médica de la existencia de esta complicación microvascular que excede el marco de la DM y se presenta también en el SM y en la disglucemia tanto de ayunas como posprandial.

Discourse analysis of the written press reports regarding rheumatoid arthritis, psoriasis, and psoriatic arthritis.

The management of rheumatoid arthritis (RA) and psoriasis/psoriatic arthritis (PS/PsA) has radically changed during the last decade modifying physicians' perception about those diseases. However, if communication and transfer of information, from doctors to patients, is not efficient, patients' perception could be influenced by other sources of information. The aim of this study is to analyze newspaper articles about RA or Ps/PsA published in the Argentinean written press between 1995 and 2010. Quantitative and qualitative analyses of all press articles that mentioned RA or Ps/PsA either on the headlines or in the text of the digital versions of the three main Argentinean newspapers from 1995 to 2010 were analyzed. A total of 166 press articles were analyzed; of these, 65.7 % of the articles were informative and the remaining were testimonials. Ninety-five articles were considered positives (57.2 %). Informative articles were positive with more frequency than the testimonials (64.2 vs. 43.9 %, p 0.02). Press articles that mentioned a new treatment were positive more frequently than those that did not mention it (78.3 vs. 49.2 %, p 0.001). Balanced articles included the opinion of, at least, one specialist in 84.2 versus the 48.1 % of the not balanced (p 0.02). Articles about RA and Ps/APs in Argentina tended to be positive all along the study period. A positive result was more frequent in those articles, which informed about a new treatment. The inclusion of the opinion of a professional is not associated with a positive result, although it is to a balanced article.

Brotes por Salmonella spp., Staphylococcus aureus y Listeria monocytogenes asociados al consumo de pollo / Outbreaks of Salmonella spp., Staphylococcus aureus and Listeria monocytogenes associated with poultry consumption. Systematic review.

Introducción. Las enfermedades transmitidas por alimentos son un serio problema de salud pública y, el pollo, uno de los alimentos asociados con ellas. Objetivo. Determinar la distribución y frecuencia de brotes alimentarios asociados al consumo de pollo contaminado por Salmonella spp., Listeria monocytogenes y Staphylococus aureus, mediante una revisión sistemática de la literatura científica. Materiales y métodos. Se buscaron los estudios de brotes asociados a Salmonella spp., S. aureus y L. monocytogenes, en las bases de datos Medline, Pubmed, Science Direct,SciELO,Librería Cochrane (CCRT),Biblioteca Virtual en Salud (BVS), Highwire,HINARI y MedicLatina. Se obtuvieron los datos para el cálculo de odds ratios (OR) mediante la elaboración de tablas de contingencia en el programa RevMan5™. Resultados. Siete artículos cumplieron con los criterios de inclusión y no se encontraron reportes de L. monocytogenes. El OR global fue de 3,01 (IC95% 2,37-3,81), lo que se interpreta como una asociación significativa entre el consumo de pollo contaminado y la infección alimentaria. Se presentó heterogeneidad en los estudios incluidos (p=0,03), por lo que fue necesario un análisis por subgrupos de microorganismos; para el caso de Salmonella spp., el OR fue de 2,67 (IC95% 2,09-3,41). No se hizo análisis para S. aureus por reportarse un solo artículo. Conclusiones. Se encontró un OR de 2,61, lo que indica que hay una fuerte asociación entre el consumo de pollo y la adquisición de salmonelosis. El principal factor de riesgo para adquirir salmonelosis es el consumo de pollo de asadero en los restaurantes.

Introduction. Food borne diseases are a serious public health problem. Poultry are often associated with these outbreaks. Objective. A systematic review of the literature is provided concerning the distribution and frequency of food borne outbreaks associated with consumption of chicken contaminated with Salmonella spp., Listeria monocytogenes and Staphylococcus aureus. Materials and methods. The search for studies of outbreaks associated with Salmonella, S. aureus and L. monocytogenes was conducted in Medline, Pubmed, Science Direct, Scielo, Cochrane Library (CCRT), Virtual Health Library (VHL), Highwire, HINARI and MedicLatina. Data were obtained for the calculation of odds ratio (OR) by preparing contingency tables using the RevMan5 program. Results. Seven articles met the inclusion criteria; however, no reports of L. monocytogenes were obtained. The overall OR was 3.01 (95% CI: 2.37, 3.81); this was interpreted as a significant association between the consumption of contaminated chicken and food poisoning. In the included studies heterogeneity (p= 0.03) was presented, so it took a subgroup analysis of microorganisms, in the case of Salmonella OR was 2.67 (95% CI: 2.09 -3.41). No analysis was made for S. aureus reported a single article. Conclusions. The OR indicated a strong association between chicken consumption and acquisition of salmonellosis. The main risk factor for acquiring salmonellosis is the consumption of chicken from grill restaurants.

[Outbreaks of Salmonella spp., Staphylococcus aureus and Listeria monocytogenes associated with poultry consumption. Systematic review]. / Brotes por Salmonella spp., Staphylococcus aureus y Listeria monocytogenes asociados al consumo de pollo.

INTRODUCTION: Food borne diseases are a serious public health problem. Poultry are often associated with these outbreaks. OBJECTIVE: A systematic review of the literature is provided concerning the distribution and frequency of food borne outbreaks associated with consumption of chicken contaminated with Salmonella spp., Listeria monocytogenes and Staphylococcus aureus. MATERIALS AND METHODS: The search for studies of outbreaks associated with Salmonella, S. aureus and L. monocytogenes was conducted in Medline, PubMed, Science Direct, Scielo, Cochrane Library (CCRT), Virtual Health Library (VHL), Highwire, HINARI and MedicLatina. Data were obtained for the calculation of odds ratio (OR) by preparing contingency tables using the RevMan5 program. RESULTS: Seven articles met the inclusion criteria; however, no reports of L. monocytogenes were obtained. The overall OR was 3.01 (95% CI: 2.37, 3.81); this was interpreted as a significant association between the consumption of contaminated chicken and food poisoning. In the included studies heterogeneity (p= 0.03) was presented, so it took a subgroup analysis of microorganisms, in the case of Salmonella OR was 2.67 (95% CI: 2.09 -3.41). No analysis was made for S. aureus reported a single article. CONCLUSIONS: The OR indicated a strong association between chicken consumption and acquisition of salmonellosis. The main risk factor for acquiring salmonellosis is the consumption of chicken from grill restaurants.