Hipoglicemia en el paciente diabético hospitalizado / Hypoglycemia in hospitalized diabetic patiens

Introduction: Hypoglycaemia occurs frequently in hospitalized diabetic patients and increases inpatient morbidity and mortality. In 60 percent of cases, it isn’t managed properly. The goal of this study was to determine prevalence, treatment, complications and length of hospital stay related to hypoglycaemia with local patients. Patients and Methods: This study was designed as a prospective series of cases with diabetic patients, hospitalized in internal medicine and surgical services. Results: 105 cases of hypoglycaemia presented in 47 patients, with a mean of 2,21 +/- 1,68 episodes per patient. 53,32 percent of hypoglycaemic episodes presented in surgical patients. The cause was not determined in 49,52 percent (n = 52) of the episodes, and 41,9 percent (n = 44) of them were asymptomatic. 59,57 percent (n = 28) of patients presented complications during their hospital stay, mainly infectious, with no difference between surgical and medical services. Median inpatient stay in the surgical service was of 28 days (RIQ 19-45), and of 16 days (RIQ 11-28) in the internal medicine service. Treatments were modified in 57,45 percent (n = 27)of patients after their first hypoglycaemic episode occurred, 17 in internal medicine service, and 10 in surgical service (p = 0,003). Conclusions: the majority of patients presented at least two hypoglycaemic events, and only in half of were treatments modified in order to prevent another episode, which is more that reported in literature, particularly in internal medicine service, where diabetologists work. Highlighting the large number of undetermined causes of hypoglycaemia, caused mainly by lack of registry, can lead to the creation of a registry form for these kinds of occurrences in order to successfully prevent more episodes and decrease inpatient stay and complications.

Sobrevida de pacientes con cáncer de mama y metástasis ósea / Survival of patients with breast cancer and bone metastasis

Introduction: Breast cancer is an important cause of death among female cancer in Chile. It metastasizes to any part of the body, being bone the first area of dissemination in 26-50 percent of cases and being found in 75 percent of patients dead from this cause. A median survival of 18 to 24 months is reported, and a probability of surviving 5 years of 20 percent. Therefore the objective of this study is to determine the difference of median survival depending on the presence of bone metastasis. Methods: A retrospective cohort study was conducted with 822 patients diagnosed with breast cancer between 2003 and 2010. The exposed cohort had scintigraphicly diagnosed bone metastasis, and the control group had no bone metastasis. Results: 8.88 percent of 822 patients, had bone metastasis. Those with bone metastasis had a mortality of 74 percent, and in the group with no bone metastasis, 16.69 percent died (p < 0.01). The median survival of patients with no metastasis was 44.3 months (IQR 35-83), and with metastasis was of 35 (IQR 18.6-46.1) (p < 0.01). With bone metastasis, over 48 months survival was 30.6 percent; and over 84 months 14.8 percent. Without bone metastasis, above 84 months, 78.51 percent survived (p < 0.01). Discussion and Conclusions: The difference between the two groups, considering global survival, is significant and implies an important decrease in survival and quality of life; the result obtained also differs from those reported in literature and it makes us reflect on the importance to consider bone metastasis not as a terminal event...

Introducción: El cáncer de mama es una importante causa de muerte por cáncer en las mujeres chilenas. Metastatiza a cualquier parte del cuerpo, siendo hueso la primera zona de diseminación en 26-50 por ciento de los casos, encontrándose un 75 por ciento de los pacientes que fallecen por esta causa. Se reporta una sobrevida de 18-24 meses, y una supervivencia a los 5 años del 20 por ciento. El objetivo del siguiente trabajo es determinar la sobrevida ante presencia de metástasis óseas. Pacientes y Método: Se realizó un estudio de cohortes retrospectivas con 822 pacientes diagnosticadas con cáncer de mama entre los años 2003 y 2010. La cohorte expuesta tiene diagnóstico cintigráfico de metástasis ósea, y la de control no tiene metástasis óseas. Resultados: 8,88 por ciento del total de 822 pacientes, presentó metástasis ósea. Con metástasis ósea existió una mortalidad del 74 por ciento, mientras que sin metástasis fue 16,69 por ciento (p < 0,01). La mediana de sobrevida sin metástasis ósea fue 44,3 meses (RIQ 35-83), en cambio, ante metástasis ósea fue 35 meses (RIQ 18,6-46,1) (p < 0,01). A los 48 meses, la supervivencia fue del 30,6 por ciento, para los pacientes con metástasis ósea y a los 84 meses, 14,8 por ciento, mientras que en los pacientes sin metástasis, la sobrevida a los 84 meses fue de 78,51 por ciento (p < 0,01). Discusión y Conclusiones: La diferencia de sobrevida entre pacientes con y sin metástasis ósea es significativa, implica una disminución en la supervivencia y la calidad de vida; difiere poco de lo reportado en la literatura, pero no debe hacernos considerar la metástasis ósea como un evento terminal de la enfermedad...