Hypoglycemia and glycemic variability of people with type 1 diabetes with lower and higher physical activity loads in free-living conditions using continuous subcutaneous insulin infusion with predictive low-glucose suspend system.

INTRODUCTION: Maintaining glycemic control during and after physical activity (PA) is a major challenge in type 1 diabetes (T1D). This study compared the glycemic variability and exercise-related diabetic management strategies of adults with T1D achieving higher and lower PA loads in nighttime-daytime and active- sedentary behavior hours in free-living conditions. RESEARCH DESIGN AND METHODS: Active adults (n=28) with T1D (ages: 35±10 years; diabetes duration: 21±11 years; body mass index: 24.8±3.4 kg/m2; glycated hemoglobin A1c: 6.9±0.6%) on continuous subcutaneous insulin delivery system with predictive low glucose suspend system and glucose monitoring, performed different types, duration and intensity of PA under free-living conditions, tracked by accelerometer over 14 days. Participants were equally divided into lower load (LL) and higher load (HL) by median of daily counts per minute (61122). Glycemic variability was studied monitoring predefined time in glycemic ranges (time in range (TIR), time above range (TAR) and time below range (TBR)), coefficient of variation (CV) and mean amplitude of glycemic excursions (MAGE). Parameters were studied in defined hours timeframes (nighttime-daytime and active-sedentary behavior). Self-reported diabetes management strategies were analysed during and post-PA. RESULTS: Higher glycemic variability (CV) was observed in sedentary hours compared with active hours in the LL group (p≤0.05). HL group showed an increment in glycemic variability (MAGE) during nighttime versus daytime (p≤0.05). There were no differences in TIR and TAR across all timeframes between HL and LL groups. The HL group had significantly more TBR during night hours than the LL group (p≤0.05). Both groups showed TBR above recommended values. All participants used fewer post-PA management strategies than during PA (p≤0.05). CONCLUSION: Active people with T1D are able to maintain glycemic variability, TIR and TAR within recommended values regardless of PA loads. However, the high prevalence of TBR and the less use of post-PA management strategies highlights the potential need to increase awareness on actions to avoid glycemic excursions and hypoglycemia after exercise completion.

Domesticating the condition: Design lessons gained from a marathon on how to cope with barriers imposed by type 1 diabetes.

Through analytical autoethnographic analysis of marathon preparation, this study examines challenges faced by people with Type 1 Diabetes (T1D) who engage in high-performance sports. Autoethnographer and second-person perspectives (T1D runners, family members, and health providers) were collected through introspective activities (autoethnographic diary and in-depth interviews) to understand the T1D runner's coping experience. Six insights involved in T1D self-management were identified and analyzed with reference to related design tools (prototyping, archetyping and journey mapping). Finally, we conclude with a discussion of how endurance physical activity (PA) such as running helps to "domesticate" T1D, a term coined to reflect the difficulties that T1D presents for PA accomplishment and how T1D runners' experiences give them an opportunity to overcome PA barriers promoting physical culture and enriching further health psychology studies.

Transcatheter aortic valve implantation in very elderly patients: immediate results and medium term follow-up.

OBJECTIVE: To evaluate immediate transcatheter aortic valve implantation (TAVI) results and medium-term follow-up in very elderly patients with severe and symptomatic aortic stenosis (AS). METHODS: This multicenter, observational and prospective study was carried out in three hospitals. We included consecutive very elderly (> 85 years) patients with severe AS treated by TAVI. The primary endpoint was to evaluate death rates from any cause at two years. RESULTS: The study included 160 consecutive patients with a mean age of 87 ± 2.1 years (range from 85 to 94 years) and a mean logistic EuroSCORE of 18.8% ± 11.2% with 57 (35.6%) patients scoring ≥ 20%. Procedural success rate was 97.5%, with 25 (15.6%) patients experiencing acute complications with major bleeding (the most frequent). Global mortality rate during hospitalization was 8.8% (n = 14) and 30-day mortality rate was 10% (n = 16). Median follow up period was 252.24 ± 232.17 days. During the follow-up period, 28 (17.5%) patients died (17 of them due to cardiac causes). The estimated two year overall and cardiac survival rates using the Kaplan-Meier method were 71% and 86.4%, respectively. Cox proportional hazard regression showed that the variable EuroSCORE ≥ 20 was the unique variable associated with overall mortality. CONCLUSIONS: TAVI is safe and effective in a selected population of very elderly patients. Our findings support the adoption of this new procedure in this complex group of patients.

Implante percutáneo de la válvula autoexpandible CoreValve ® en pacientes con estenosis aórtica grave y aorta de porcelana: seguimiento a medio plazo / Percutaneous implantation of the CoreValve ® self-expanding valve prosthesis in patients with severe aortic stenosis and porcelain aorta: medium-term follow-up

Introducción y objetivos. Hay escasa información sobre la utilización del implante valvular aórtico transcatéter en pacientes con estenosis aórtica grave y aorta de porcelana. El objetivo primario del estudio es analizar la mortalidad total tras el implante de una válvula percutánea CoreValve® en pacientes con estenosis aórtica grave, con y sin aorta de porcelana. Métodos. Estudio multicéntrico, observacional y prospectivo. Se implantó una válvula aortica percutánea a 449 pacientes con estenosis aórtica grave calcificada en tres hospitales. De ellos, 36 (8%) reunían criterios de aorta de porcelana. El objetivo primario fue la mortalidad total a 2 años. Resultados. El grupo con aorta de porcelana presentó con mayor frecuencia arteriopatía extracardiaca (11 [30,6%] frente a 49 [11,9%]; p = 0,002), revascularización coronaria previa (15 [41,7%] frente a 98 [23,7%]; p = 0,017) y dislipemia (26 [72,2%] frente a 186 [45%]; p = 0,02). En este grupo se utilizó con mayor frecuencia anestesia general (15 [41,7%] frente a 111 [16,9%]; p = 0,058) y acceso axilar (9 [25%] frente a 34 [8,2%]; p = 0,004). El porcentaje de éxito del procedimiento (el 94,4 frente al 97,3%; p = 0,28) y la incidencia de complicaciones (7 [19,4%] frente a 48 [11,6%]; p = 0,20) fueron similares en ambos grupos. No hubo diferencias estadísticamente significativas en el objetivo primario a los 24 meses de seguimiento (8 [22,2%] frente a 66 [16%]; p = 0,33). La presencia de complicaciones durante el implante (hazard ratio = 2,6; intervalo de confianza del 95%, 1,5-4,5; p = 0,001) fue la única variable predictora del objetivo primario. Conclusiones. El implante percutáneo con la prótesis autoexpandible CoreValve® en pacientes con estenosis aórtica y aorta de porcelana rechazados para cirugía de recambio valvular, es factible y seguro (AU)

Introduction and objectives. There is little information on the use of transcatheter aortic valve implantation in patients with severe aortic stenosis and porcelain aorta. The primary aim of this study was to analyze death from any cause after CoreValve® implantation in patients with severe aortic stenosis, with and without porcelain aorta. Methods. In this multicenter, observational prospective study, carried out in 3 hospitals, percutaneous aortic valves were implanted in 449 patients with severely calcified aortic stenosis. Of these, 36 (8%) met the criteria for porcelain aorta. The primary end-point was death from any cause at 2 years. Results. Patients with porcelain aorta more frequently had extracardiac vascular disease (11 [30.6%] vs 49 [11.9%]; P=.002), prior coronary revascularization (15 [41.7%] vs 98 [23.7%]; P=.017), and dyslipidemia (26 [72.2%] vs 186 [45%]; P=.02). In these patients, there was greater use of general anesthesia (15 [41.7%] vs 111 [16.9%]; P=.058) and axillary access (9 [25%] vs 34 [8.2%]; P=.004). The success rate of the procedure (94.4 vs 97.3%; P=.28) and the incidence of complications (7 [19.4%] vs 48 [11.6%]; P=.20) were similar in both groups. There were no statistically significant differences in the primary end point at 24 months of follow-up (8 [22.2%] vs 66 [16%]; P=.33). The only predictive variable for the primary end point was the presence of complications during implantation (hazard ratio=2.6; 95% confidence interval, 1.5-4.5; P=.001). Conclusions. In patients with aortic stenosis and porcelain aorta unsuitable for surgery, percutaneous implantation of the CoreValve® self-expanding valve prosthesis is safe and feasible (AU)

Bifid nose - a mild degree of frontonasal dysplasia. A case report.

Frontonasal dysplasia is an unusual congenital condition with a wide phenotypic range. Because of this, only a small number of cases and their management have been reported in the literature. The ideal surgical procedures to correct mild cases of frontonasal dysplasia, and the time to perform them, are still controversial. The case of a 9-month-old girl with a mild form of this condition (a congenital bifid nose and a duplicated frenulum), and its surgical management, is presented. The surgery achieved an early improvement of the patient's appearance and she had no complications. In the future, it is probable that she will need secondary rhinoplasty to aid in the projection of the tip and refine the shape of the nose.

Pro B-type natriuretic peptide plasma value: a new criterion for the prediction of short- and long-term outcomes after transcatheter aortic valve implantation.

BACKGROUND: To determine the prognostic value of pro B-type natriuretic peptide (pro-BNP) to predict mortality after transcatheter aortic valve implantation (TAVI). Logistic EuroSCORE (LES) overestimates observed mortality after TAVI. A new risk score specific to TAVI is needed to accurately assess mortality and outcome. METHODS: Eighty-five patients were included. Indications for TAVI were nonoperable or surgically high-risk patients (LES>20%). Pro-BNP was measured 24h before the procedure. Cox proportional hazards model was used to evaluate clinical factors. The predictive accuracy of these Cox models was determined by using time-dependent receiver operating characteristic (ROC) curves. RESULTS: Pro-BNP levels (log-transformed) were significantly higher in non-survivors than in survivors at 30 days (3.36 ± 0.43 vs. 3.81 ± 0.43, p<0.004) and at the end of follow-up (3.34 ± 0.42 vs. 3.63 ± 0.48, p<0.011). Multivariate analysis revealed that only increased log pro-BNP levels were associated with higher mortality rate at short [hazard ratio (HR) (95% confidence intervals (CI)]=5.35 (1.74-16.5), p=0.003] and long-term follow-ups [HR=11 (CI: 1.51-81.3), p=0.018]. LES was not associated with increased mortality at either time point [HR=1.03 (CI: 0.95-1.10), p=0.483 and HR=1.03 (CI: 0.98-1.07), p=0.230, respectively]. At 30, 90, 180, and 365 days, the c-index was 0.72 for log pro-BNP and 0.63 for LES (p=0.044). CONCLUSION: Pre-procedure log transform of plasma pro-BNP levels are an independent and strong predictor of short- and long-term outcomes after TAVI and are more discriminatory than LES.

Percutaneous implantation of the CoreValve® self-expanding valve prosthesis in patients with severe aortic stenosis and porcelain aorta: medium-term follow-up.

INTRODUCTION AND OBJECTIVES: There is little information on the use of transcatheter aortic valve implantation in patients with severe aortic stenosis and porcelain aorta. The primary aim of this study was to analyze death from any cause after CoreValve(®) implantation in patients with severe aortic stenosis, with and without porcelain aorta. METHODS: In this multicenter, observational prospective study, carried out in 3 hospitals, percutaneous aortic valves were implanted in 449 patients with severely calcified aortic stenosis. Of these, 36 (8%) met the criteria for porcelain aorta. The primary end-point was death from any cause at 2 years. RESULTS: Patients with porcelain aorta more frequently had extracardiac vascular disease (11 [30.6%] vs 49 [11.9%]; P=.002), prior coronary revascularization (15 [41.7%] vs 98 [23.7%]; P=.017), and dyslipidemia (26 [72.2%] vs 186 [45%]; P=.02). In these patients, there was greater use of general anesthesia (15 [41.7%] vs 111 [16.9%]; P=.058) and axillary access (9 [25%] vs 34 [8.2%]; P=.004). The success rate of the procedure (94.4 vs 97.3%; P=.28) and the incidence of complications (7 [19.4%] vs 48 [11.6%]; P=.20) were similar in both groups. There were no statistically significant differences in the primary end point at 24 months of follow-up (8 [22.2%] vs 66 [16%]; P=.33). The only predictive variable for the primary end point was the presence of complications during implantation (hazard ratio=2.6; 95% confidence interval, 1.5-4.5; P=.001). CONCLUSIONS: In patients with aortic stenosis and porcelain aorta unsuitable for surgery, percutaneous implantation of the CoreValve(®) self-expanding valve prosthesis is safe and feasible.

Crying patients in General/Family Practice: incidence, reasons for encounter and health problems / Pacientes que choram em Medicina Geral/de Família: incidência, razões de consulta e problemas de saúde / Pacientes que lloran en Medicina General/de Familia: incidencia, razones de consulta y problemas de salud

Context: Despite evidence demonstrating the benefits of understanding patients, there is a paucity of information about how physicians address psychological and social concerns of patients. No one study has been published about the incidence of crying in General/Family Practice. Objective: To know the incidence of crying in primary care/general practice, and the patients' characteristics, their reasons for encounter and their health problems. Design: A descriptive, prospective study, of one year, of three general practitioners/family physicians in Madrid, Spain. Setting: primary care (doctors' office and patients' home). Subjects: Face to face encounters with crying patients. Main outcome measure: At least one rolling tear. Results: Patients cried in 157 encounters out of a total of 18,627 giving an incidence rate of 8.4 per thousand. More frequent reasons for encounters were: feeling depressed (12.7%), social handicap (mainly social isolation/living alone) (6.4%), relationship problem with partner (5.1%) and feeling anxious (3.2%). More frequent health problems were: depressive disorder (23.6%), anxiety disorder (8.3%), cerebrovascular disease (5.1%) and loss/death of partner (3.8%). Conclusions: Crying in primary care is not uncommon. Reasons for crying cover the whole range of human problems, mainly social and psychological problems.

Contexto: Apesar de estudos que demonstram os benefícios de se compreender o paciente, há escassa informação sobre como os médicos respondem aos problemas psicológicos e sociais. Não encontramos nenhum trabalho publicado sobre a incidência de pacientes que choram. Objetivo: Conhecer a incidência do choro em Medicina Geral/de Família e as características dos pacientes, suas razões de consulta e seus problemas de saúde. Desenho: Estudo descritivo, prospectivo, com um ano de duração, por três clínicos gerais/médicos de família em Madri, Espanha. Local: Atenção Primária (consultórios médicos e casas dos pacientes). Pacientes: Encontros face a face com pacientes que choram. Parâmetro principal: Pelo menos uma lágrima derramada. Resultados: Pacientes choraram em 157 encontros de um total de 18.627, uma incidência de 8,4 por mil. Os motivos mais frequentes de consulta foram: sentir-se deprimido (12,7%), limitações sociais (principalmente, o isolamento/estar sozinho) (6,4%), problemas de relacionamento (5,1%) e sensação de ansiedade (3,2%). Os problemas de saúde mais comuns: depressão (23,6%), ansiedade (8,3%), doença cerebrovascular (5,1%) e perda/morte de um parceiro (3,8%). Conclusões: Chorar não é incomum na Atenção Primária. As razões para chorar cobrem um amplo espectro de problemas humanos, principalmente problemas sociais e psicológicos.

Contexto: A pesar de los estudios que demuestran los beneficios de comprender al paciente, hay escasa información sobre cómo los médicos responden a los problemas psicológicos y sociales. No hemos encontrado ningún trabajo publicado sobre la incidencia de pacientes que lloran. Objetivo: Conocer la incidencia del llanto en Medicina General/de Familia y las características de los pacientes, las razones de sus consultas y sus problemas de salud. Diseño: Estudio descriptivo, prospectivo, de un año de duración, realizado por tres especialistas de Medicina General/de Familia, en Madrid, España. Lugar: Atención Primaria (consultas médicas realizadas en consultorios y consultas domiciliarias). Pacientes: Encuentros "cara a cara" con pacientes que lloran. Parámetro principal: Al menos una lágrima derramada. Resultado: Lloraron pacientes en 157 encuentros de un total de 18.627, lo que resulta en una incidencia de 8,4 por mil. Las razones de consulta más frecuentes fueron: sentimiento depresivo (12,7%), limitaciones sociales (fundamentalmente, aislamiento/vivir solo) (6,4%), problemas de pareja (5,1%) y sentimiento de ansiedad (3,2%). Los problemas de salud más frecuentes fueron: depresión (23,6%), ansiedad (8,3%), enfermedad cerebrovascular (5,1%) y pérdida/muerte de la pareja (3,8%). Conclusiones: Llorar no es raro en la atención primaria. Las razones para llorar cubren el amplio campo de los problemas humanos, principalmente problemas sociales y psicológicos.

Terapias no farmacológicas en atención primaria

Libro que incluye la mayoría de ponencias presentadas durante las VII Jornadas Científicas de la Red Española de Atención Primaria (REAP), celebradas en Cáceres en 2002.Dichas jornadas se organizaron a fin de conocer el fundamento científico de algunas de las intervenciones no farmacológicas que se utilizan en el ámbito de la asistencia médica. Se convocó a un nutrido grupo de profesionales para que presentaran sus datos, lo que permitió finalmente incluir en el libro tres bloques de temas: las intervenciones no farmacológicas frente a las adicciones más comunes (alcohol, drogas por vía parenteral y tabaquismo), las intervenciones para el alivio sintomático de los procesos dolorosos osteomusculares y otras como las empleadas para bajar la fiebre, la ingesta de agua en las enfermedades pulmonares crónicas, para finalizar con un capítulo sobre la terapéutica genética.Desde esta página se permite la descarga gratuita de la obra completa en pdf, así como solicitar un ejemplar on-line.

Documento de consenso sobre la utilización de antibióticos en atención primaria / Consensus document on the use of antibiotics in primary care

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[Ecological niche altering: bacterial resistance to antibiotics]. / Alteraciones del nicho ecológico: resistencias bacterianas a los antibióticos.

The antimicrobial resistances to antibiotics are a worldwide public health issue. Today's successful treatments of infections are threatened. If the antimicrobial resistances to antibiotics are not controlled, morbidity, mortality and health care costs would increase. The main reason for the increasing number of these resistances is the wrong use of antibiotics by: health professional prescriptors (physicians, dentists, veterinary surgeons), dispensers (pharmacists), patients (self-prescription, non-fulfillment of treatments) and health care authorities (lack of policy and ineffective management of the rational use of antibiotics). There are multiple ways to solve this problem, but none is definitive by itself. It is required to assume the coexistence with microorganisms instead of trying to exterminate them.

Alteraciones del nicho ecológico: resistencias bacterianas a los antibióticos / Ecological niche altering: bacteria resistance to antibiotics

Las resistencias bacterianas a los antibióticos es un problema de salud pública mundial. Porque está en juego la posibilidad de seguir tratando, con éxito, infecciones que en la actualidad se curan fácilmente con medicamentos. Si no se controlan las resistencias bacterianas se incrementarán la morbilidad, la mortalidad y el coste de la sanidad. La principal causa del incremento de las resistencias se debe al incorrecto uso de los antibióticos: por los profesionales sanitarios prescriptores (médicos, odontólogos, veterinarios) y dispensadores (farmacéuticos), por los pacientes (automedicación, incumplimiento terapéutico), por la administración sanitaria (falta de política y gestión efectiva orientada al uso racional de los antibióticos),y por las industrias farmacéuticas, químicas y agroalimentarias (promoción y utilización inadecuada de los antibióticos). Las soluciones para resolver este problema son múltiples y ninguna definitiva; pero pasan necesariamente por asumir la convivencia con los microorganismos, y no por intentar su exterminación (AU)

The antimicrobial resistances to antibiotics are a worldwide public health issue. Today's successful treatments of infections are threatened. If the antimicrobial resistances to antibiotics are not controled, morbidity, mortality and health care costs would increase. The main reason for the increasing number of these resistances is the wrong use of antibiotics by: health professional prescriptors (physicians, dentists, veterinary surgeons), dispensers (pharmacists), patients (self-prescription, non-fulfilment of treatments) and health care authorities (lack of policy and ineffective management of the rational use of antibiotics).There are multiple ways to solve this problem, but none is definitive by itself. It is required to assume the coexistence with microorganisms instead of trying to exterminate them (AU)

Actualización en asma bronquial para farmacéuticos comunitarios / No disponible

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