Síndrome de hipoglicemia autoinmune: Primeros casos en Chile / Insulin autoimmune syndrome: Report of two cases

Insulin autoimmune syndrome (IAS) is characterized by spontaneous hypoglycemia with extremely high insulin levels and the presence of circulating autoantibodies against insulin, in patients who have never been exposed to exogenous insulin. We report two patients with the syndrome. A 36 years old male presenting with hypoglycemia in the emergency room had an oral glucose tolerance test showed basal and 120 min glucose levels of 88 and 185 mg/dl. The basal and 120 min insulin levels were 2,759 and 5,942 μUI/ml. The presence of an insulin secreting tumor was discarded. Anti-insulin antibodies were positive. He was successfully treated with a diet restricted in carbohydrates and frequent meals in small quantities. A 65 years old female presenting with hypoglycemia in the emergency room had the fasting insulin levels of 1,910 µUI/ml. No insulin secreting tumor was detected by images and anti-insulin antibodies were positive. The polyethylene glycol precipitation test showed a basal and after exposition insulin level 1,483 and 114 µUI/ml, respectively. She responded partially to diet and acarbose and required the use of prednisone with a good clinical response.

The use of capitation payment by the social security institute and previsional medical enterprises in Nicaragua

Presenta estudio los efectos de capitalización sobre condiciones de trabajo médico y sobre la estructura de mercado de las empresas medicas previsionales (EMP) en Nicaragua. Muestra estadísticas de los beneficiados por el seguro social desde 1978 al 1998. La información esta organizada en 6 secciones: sección 2 presenta el estudio de los objetivos; sección 3 contiene información de antecedentes sobre el sector salud de Nicaragua; sección 4 ofrece un marco teórico sobre los efectos de capitalización sobre la hipótesis que se formula por los resultados esperados de la reforma del seguro social; la sección 5 describe los métodos del estudio; sección 6 estudia los resultados y las sección final ofrece conclusiones sobre el estudio