¿Cuántas víctimas se necesitan para definir un desastre? / How many victims are needed to define a disaster?

Objetivo. Describir una situación de atención de víctimas múltiples. Analizar las características particulares del síndrome de inhalación de humo (SIH). Material y Métodos. Se evaluaron 5 pacientes (pts), ingresados al Servicio de Emergencias del HRRG en Noviembre del 2006, de los cuales tres ingresaron al Servicio de Terapia Intensiva (STI), único en la zona norte de la Provincia de Tierra del Fuego. La capacidad instalada del Hospital es de 5 camas de Terapia Intensiva con 5 respiradores microprocesador y con un ingreso anual de 300 pts con un índice de ocupación de camas de 5.4 pts/día. Los motivos de ingreso al STI fueron: Síndrome de Inhalación de Humo (SIH) e Insuficiencia Respiratoria Aguda. Se dividió a las Lesiones de la Inhalación de Humo (LIH) en: Lesión Térmica de la Vía Aérea (LTVA), Asfixia (A) y Lesiones por Gases Irritantes (LGI)*. Se evaluaron: Índice Trauma Pediátrico (ITP), APACHE II, características demográficas, estadía en TI (ETI), déficit de base en las 48 hs (DB/48) y mortalidad (M). Resultados. De los 5 pts (2 mujeres y 3 hombres), la edad promedio fue 8,6 años (rango 3-16), el APACHE II (promedio): 24.6 puntos (rango 2230), la ETI (promedio): 11,6 días (rango 1-18), ITP (promedio): 0 (-4 a +4) y el DB 48 (promedio) 11.4 mEq (rango -6 a -19). La mortalidad global fue del 40%. Tres pacientes presentaron LTVA, A y LGI, mientras que los dos restantes presentaron LTVA y A. Conclusión. La recepción de los 5 pts superó, en forma inmediata, los recursos en el sistema local hospitalario, cumpliendo con la definición de desastre. La acidosis metabólica durante las primeras 48 hs en el contexto del SIH se acompañó de mayor morbimortalidad.(AU)

How many victims are necessary to define a disaster? Objective. Describe a situation of care of multiple victims. Analyse the particular characteristics of smoke inhalation syndrome (SIH). Material and methods. 5 patients (pt) admitted to the Emergency Service of HRRG in November 2006 were evaluated. Three patients were admitted to the Intensive Care Unit, the only Service in the northern province of Tierra del Fuego. The Intensive Care Unit has 5 beds and 5 critical care ventilators to assit patients with respiratory failure. We admitted roughly 300 patients each year. The reasons for the admision were: Smoke inhalation Syndrome (SIH) and acute respiratory failure Injuries because inhaling smoke (LIH) were classified in: Thermal Injury of the Air (LTVA), Asphyxia (A) and Gas Injures Irritants (LGI). We consigned Pediatric Trauma Index (ITP), Apache II score, demographics, length of stay in STI, the basic deficit within 48 hours (DB/48) and mortality (M). Results. Of the 5 pt (2 women and 3 men), age was 8.6 years (range 3-16), the Apache II: 24.6 (range 22-30), length of stay 11.6 days (range 1-18), ITP: 0 (-4 to +4) and DB 48 (average) - 11.4 mEq (-6 to -19 range). The mortality rate was 40%. Three patients had LTVA, A and LGI, while the remaining two, both presented LTVA and A Conclusion. The admission of the 5 pt exceeded, immediately, resources in the local hospital system, fulfilling with the definition of disaster. The metabolic acidosis during the first 48 hours in the context of SIH was associated with increased morbidity and mortality(AU)

Prevalencia de anticuerpos anti islotes pancreáticos en 1.021 parientes de diabéticos tipo 1 / Prevalence of anti pancreatic islet antibodies among 1.021 relatives of type 1 diabetic patients

Background: An immunological damage of beta cells in the islets of Langerhans, plays a role in the pathogenesis of type 1 diabetes. Recently, the identification of individuals in pre clinical phase and with high risk of developing type 1 diabetes, has become possible by means of the detection of immune markers such as islet cell antibodies (ICA) and the measurement of first phase response of insulin (FPRI). Subjects and methods: We studied 1,021 first degree relatives of type 1 diabetics, aged 4 to 35 years. ICA were measured using poly-IgG peroxidase in sections of human pancreas. In those subjects with positive ICA and normal oral glucose tolerance test, the FPRI was measured. FPRI was defined as the sum of insulinemias at minutes 1 and 3 after a three minutes 0.5 g/kg glucose load. Results: Thirty subjects were ICA (+), defined as having more than 20 juvenile diabetes foundation units (prevalence of 2.9 percent). No differences in age, sex and closeness of familial relationship was found between ICA (+) and ICA (-) individuals. FPRI was measured in 24 subjects with normal oral glucose tolerance test and was normal in five. Seventeen subjects had a decreased response (between percentiles 1 and 5) and two had a response below percentile 1. No relationship between ICA levels and FPRI was found. Conclusions: The early detection of populations at risk of developing type 1 diabetes should be regarded as an important tool to better understand the natural history of the disease and to develop preventive programs in the future

Marcadores inmunológicos y de secreción insulínica en pacientes diabéticos no insulino dependientes con fracaso secundario a drogas hipoglicemiantes orales / Immunologic and insulin secretion markers in diabetic non insulin dependent patients with secondary failure to oral hypoglycemic agents

The pathogenesis of secondary failure to hypoglycemic agents is heterogenous. Some patients are true insulin dependent diabetics with a slow autoimmune disease suggested by their positive islet cell antibodies. Others, have an increased insulin resistance. To assess the frequency of positive islet cell antibodies in diabetic patients with secondary failure to oral hypoglycemic agents. 31 diabetics, 16 with recent (less than six months) secondary failure and 15 with metabolically stable non insulin dependent diabetes were studied. All patients were older than 25 years old and had a body mass index of less than 30 kg/m2. C peptide levels before and at 5,15 and 30 min after IV glucagon, islet cell antibodies using the Poly Human IgG peroxidase method an insulin sensitivity and secretion (estimated by the Homeostasis Model Assessment) were measured. Patients with secondary failure had lower C peptide levels compared to subjects with stable diabetes (basal: 1.5ñ0.2 and 2.8ñ0.2 ng/ml; 5 min: 2.4ñ0.3 and 5.5ñ0.5 ng/ml; 15 min:1.9ñ0.3 and 4.0ñ0.6 ng/ml; 30 min:1.6ñ0.3 and 3.4ñ0.5 ng/ml). Beta cell activity was 20.6ñ4.3 percent in patients with secondary failure and 92.2ñ9 percent in stable diabetics (p<0.01). Insulin sensitivity was similar in both groups (48.6ñ6 and 42.8ñ3.5 percent respectively). Three patients with secondary failure and none with stable diabetes had positive islet cell antibodies. When comparing patients with secondary failure and positive antibodies and subjects with secondary failure and negative antibodies, the former had non significantly lower age, BMI and C peptide levels. Some diabetic patients with secondary failure have positive islet cell antibodies. They should be measured in these patients to start insulin treatment precociously

Drogas anorexígenas en el tratamiento de la obesidad / Anorexigenic drugs in the treatment of obesity

Obesity is highly prevalent and has several adverse effects on health. Its treatment is thus warranted and must aim to modify dietary and physical activity habits. The opinion of this association is that anorexigenic drugs with cathecolaminergic action (diethylpropion, phentermine, mazindol and phenylpropanolamine) or serotoninergic action (fenfluoramine and fluoxetine) may be used in moderate or severe obesity (BMI >30 kg/m2) after a complete clinical assessment and in the context of an integral medical treatment. This association recommends a close surveillance of the use of these drugs, specially when formulated as non-propietary prescriptions