Recomendaciones para el monitoreo continuo de la glucosa en pacientes embarazadas con diabetes mellitus tipos 1, 2 y gestacional / Recommendations for continuous glucose monitoring in pregnant patients with type 1, 2 and gestational diabetes mellitus

Resumen OBJETIVO: Emitir recomendaciones para la vigilancia y seguimiento de pacientes embarazadas con diabetes mellitus tipos 1, 2 y gestacional con base en la experiencia de un grupo de especialistas y en lo reportado en la bibliografía, desde la perspectiva del sistema de salud mexicano. MATERIALES Y MÉTODOS: Se utilizó la metodología del panel Delphi modificado, mediante la unanimidad de criterios de un grupo de especialistas en Ginecoobstetricia, Biología de la Reproducción y Medicina Materno Fetal mexicanos, tomando en cuenta un nivel de unanimidad del 80% de los participantes. RESULTADOS: Con base en un ejercicio de consenso se recomienda el monitoreo continuo de la glucosa en todas las pacientes embarazadas con diabetes mellitus tipos 1 y 2 a partir del primer trimestre de la gestación. En pacientes con diabetes gestacional considerar, a partir del segundo o tercer trimestre, el monitoreo continuo de la glucosa en usuarias de insulina o en descontrol glucémico, dependiendo del momento en que se diagnostique la diabetes gestacional, del descontrol glucémico y de la necesidad de insulina. La hemoglobina glucosilada y el tiempo en las concentraciones límite también son métricas de control glucémico. CONCLUSIONES: El monitoreo continuo de la glucosa tiene ventajas en: menos complicaciones perinatales, detección oportuna y reducción de eventos de hiper o hipoglucemia, menor descontrol, ajuste de dosis respecto del tratamiento con insulina y mejora en los hábitos para controlar las concentraciones de glucosa.

Abstract OBJECTIVE: To issue recommendations for the surveillance and follow-up of pregnant patients with types 1, 2 and gestational diabetes mellitus based on the experience of a group of experts and on what is reported in the literature, from the perspective of the Mexican health system. MATERIALS AND METHODS: A modified Delphi Panel methodology was performed, through consensus among gynecology, reproductive biologist, and fetal-maternal specialists, and an 80% consensus of all participants. RESULTS: Based on the consensus exercise, we recommend continuous glucose monitoring in all pregnant patients with type I and II diabetes starting on the first trimester; meanwhile in patients with gestational diabetes, continuous monitoring should be considered in patients treated with insulin or uncontrolled glycemia, starting in the second or third trimester, depending on the moment of diagnosis, glycemic levels and insulin requirements, taking into account HbA1c levels and time in range as well as glycemic control metrics. CONCLUSIONS: Continuous glucose monitoring has advantages including the reduction of perinatal complications, timely detection, reduction in the number of hyper/hypoglycemia events, fewer uncontrolled patients, and the capacity for insulin dosage adjustments and improvement of habits for glucose control.

Correlación de los valores de sFlt-1, PlGF y su cociente en preeclampsia con criterios de severidad en una Unidad de Cuidados Intensivos / Correlation of the values of sFlt-1, PlGF and its precilampsy court with severity criteria in an Intensive Care Unit / Correlação dos valores de sFlt-1, PlGF e seu coeficiente em preeclampsia com critérios de gravidade em uma Unidade de Terapia Intensiva

Resumen: Introducción: La detección del desequilibrio entre los factores proangiogénicos/antiangiogénico (sFlt-1, PlGF, cociente sFlt-1/PlGF) en la sangre materna son herramientas de pronóstico y diagnóstico en preeclampsia. Objetivo: Determinar la correlación entre los valores sanguíneos de sFlt-1, PlGF, cociente sFlt-1/PlGF y las complicaciones en mujeres con preeclampsia severa. Material y métodos: Se estudiaron a mujeres que ingresaron a la UCI con diagnóstico de preeclampsia con criterios de severidad y se determinaron las variables clínicas y de laboratorio. Las concentraciones séricas de sFlt-1 y PlGF se realizaron con un equipo automático KRYPTOR compact Plus. Resultados: Encontramos que 33.3% fue preeclampsia temprana y 66.7% tardía. Los criterios de severidad fueron: 66.7% crisis hipertensiva y 33.3% encefalopatía hipertensiva. Existió una correlación negativa entre los valores de sFlt-1 y urea, creatinina, proteínas de orina en 24 horas, presión sistólica (TAS) y presión diastólica (TAD). La correlación fue pobre y no fue estadísticamente significativa. Existió una correlación positiva y estadísticamente significativa para ácido úrico. Existió una correlación negativa entre los valores de PlGF en TAS, TAD. No existió correlación entre los valores cociente sFlt-1/PlGF y las variables medidas como TAS, TAD. Conclusiones: Este estudio confirma que es posible identificar un desbalance angiogénico en mujeres con preeclampsia severa. Sin embargo, los marcadores angiogénicos no presentaron una correlación estadísticamente significativa con respecto a las variables clínicas y bioquímicas de preeclampsia en la Unidad de Cuidados Intensivos.

Abstract: Introduction: The detection of the imbalance between proangiogenic/antiangiogenic factors (sFlt-1, PlGF, sFlt-1/PlGF ratio), in maternal blood are prognostic and diagnostic tools in preeclampsia. Objective: To determine the correlation between blood values of (sFlt-1, PlGF, sFlt-1/PlGF ratio) and complications in women with severe preeclampsia. Material and methods: Women who were admitted to the ICU with a diagnosis of preeclampsia with severity criteria were studied, clinical and laboratory variables were determined. Serum concentrations of sFlt-1, PLGF were performed with a KRYPTOR compact Plus automatic equipment. Results: 33.3% were early preeclampsia and 66.7% late. The severity criteria occurred with 66.7% with hypertensive crisis and 33.3% with hypertensive encephalopathy. There was a negative correlation between the values of sFlt-1 and urea, creatinine, urine proteins in 24 hours, systolic pressure (ASD), diastolic pressure (ADT). The correlation was poor and not statistically significant. There was a positive and statistically significant correlation for uric acid. There was a negative correlation between PlGF values in TAS, TAD. There was no correlation between the sFlt-1/PlGF quotient values and the variables measured as TAS, TAD. Conclusions: This study confirms that it is possible to identify an angiogenic imbalance in women with severe preeclampsia. However, the angiogenic markers did not show a statistically significant correlation, with respect to the clinical and biochemical variables of preeclampsia in the Intensive Care Unit.

Resumo: Introdução: A detecção de desequilíbrio entre fatores pró-angiogênicos/antiangiogênicos (sFlt-1, PlGF, coeficiente sFlt-1/PlGF) no sangue materno são ferramentas de prognóstico e diagnóstico na pré-eclâmpsia. Objetivo: Determinar a correlação entre os valores sanguíneos de (sFlt-1, PlGF, coeficiente sFlt-1/PlGF) e complicações em mulheres com pré-eclâmpsia grave. Material e métodos: Foram estudadas mulheres admitidas na UTI com diagnóstico de pré-eclâmpsia com critérios de gravidade, determinou-se variáveis clínicas e laboratoriais. As concentrações séricas de sFlt-1, PLGF foram realizadas com um equipamento automático KRYPTOR compact Plus. Resultados: 33.3% eram pré-eclâmpsia precoce e 66.7% tardia. Os critérios de gravidade ocorreram com 66.7% com crise hipertensiva e 33.3% com encefalopatia hipertensiva. Houve correlação negativa entre os valores de sFlt-1 e uréia, creatinina, proteínas da urina em 24 horas, pressão sistólica (PAS) e pressão diastólica (PAD). A correlação foi ruim e estatisticamente não significante. Houve uma correlação positiva e estatisticamente significante para o ácido úrico. Encontrou-se uma correlação negativa entre os valores de PLGF no TAS, TAD. Não houve correlação entre os valores do quociente sFlt-1/PlGF e as variáveis medidas como PAS e PAD. Conclusões: Este estudo confirma que é possível identificar um desequilíbrio angiogênico em mulheres com pré-eclâmpsia grave. No entanto, os marcadores angiogênicos não apresentaram correlação estatisticamente significante com relação às variáveis clínicas e bioquímicas da pré-eclâmpsia na unidade de terapia intensiva.

Drug use prevention projects in schools in Vitória, Brazil: quality analysis and improvement proposals

Abstract Adolescents living in vulnerable regions are more exposed to risk factors for drug use. The prevention of such use in school is a public policy that needs evaluation. Based on technical criteria and derived from a mixed research, this article analyses the quality of school-based prevention of drug use in Vitória, state of Espírito Santo, Brazil, and proposes improvements. A checklist of quality elements was completed with data from 16 projects proposed by 99 teachers from public schools. In 10 projects (62.5%), the approximate quality index was above 0.50. The majority of projects fulfilled the requirement of theoretical foundation (81.25%) and some of the methodological (93.75%), design (75%) and implementation (62%) requirements. Other requirements were absent: the majority were not designed by the whole school community (87.5%), and the participation of the family (62.5%) or the students as mediators (62.5%) was not considered. In general, contents of life skills (87.5%), positive relationships and alternative activities to drug use (56.25%) were not included. Activities for reinforcing the content were not described in any of the projects, and evaluation activities were described in only a few (31.25%). Many projects did not describe the inclusion of the project in the school curriculum (62.5%). Although, considering all items of effectiveness, regardless of their weight, more than half of the projects had an above average quality. The present items provide quality to the projects, whereas absent items indicate shortcomings to be improved using some of the measures described in this study.

Análisis de los componentes en la adquisición de la lectura en castellano: una aplicación del modelo logístico lineal / Component analysis of Spanish reading process: an application of the linear logistic test model

Se analizan los componentes básicos para la adquisición de la lectura en castellano mediante la aplicación del modelo logístico lineal de Fisher (Linear Logistic Test Model [LLTM]). Participaron en el estudio 245 niños y niñas de edades comprendidas entre los 4 y los 9 años a los que se administró una extensa batería diseñada para evaluar distintos procesos básicos para la lectura (PROBALES). Se aplicaron técnicas de análisis factorial para seleccionar un subconjunto de ítems que mostrasen ajuste al modelo de Rasch. El LLTM permitió confirmar la validez del modelo teórico según el cual el aprendizaje de la lectura descansa en el desarrollo de tres habilidades básicas: reconocimiento de palabras, conciencia fonológica y comprensión de la lectura. Se muestra la capacidad predictiva del modelo mediante análisis discriminante, y se constata que se clasificó correctamente en su curso escolar al 68% de los participantes.

The basic components for the acquisition of reading in Spanish are analyzed by using the Fisher Linear Logistic Test Model (LLTM). An extensive battery designed to assess different Basic Processes for Reading (PROBALES, acronym in Spanish) was applied to 245 children aged 4 to 9. Factor analysis techniques were used to select a subset of items that would adjust to the Rasch model. The LLTM confirmed the validity of the theoretical model which states that reading acquisition relies on the development of three basic skills: word recognition, phonological awareness, and reading comprehension. The theoretical model's predictive ability is shown by discriminant analysis, thereby confirming that 68% of participants were correctly classified in their school grade.

Anormalidades cerebrales en sujetos disléxicos / Brain abnormalities in dyslexic subjects

Desde hace varias décadas se han intentado precisar los fundamentos biológicos de la dislexia. Dicho proceso de investigación y análisis ha permitido confirmar una serie de diferencias funcionales y morfológicas en el cerebro de los sujetos disléxicos. En esta línea de investigación, el artículo que presentamos examina la evidencia sobre las posibles anormalidades cerebrales en diferentes niveles: plano temporal, lóbulo parietal, cuerpo calloso, cerebelo, ínsula y hemisferio derecho. En el mismo, se analizan los hipotéticos factores genéticos que participan en la dislexia, poniendo elénfasis en el hecho de que, probablemente, un defecto en el procesamiento fonológico del lenguaje sea el factor determinante de la dislexia. Asi mismo, se plantea si la variedad de su sintomatología y de los defectos asociados podría relacionarse con la presencia de diferentes variables. Se concluye que, posiblemente, la dislexia no es una entidad discreta sino que se presenta como una gradación continua. Igualmente, se aporta la idea de que las características específicas de los distintos sistemas de lecto escritura podrían incidir en la frecuencia aparente y las manifestaciones particulares de la dislexia de desarrollo, así como en la probabilidadde hallar anormalidades cerebrales.

Since decades ago, significant research had been directed to pinpoint the biological foundations of dyslexia. Throughout history, several functional and morphological differences in dyslexics’ brains have been reported. In this paper, the evidence about brain abnormalities in different structures associated with dyslexia is examined: planumtemporale, parietal lobe, corpus callosum, cerebellum, insula and right hemisphere. Potential genetic factors involved in dyslexia are analyzed. It is emphasized that a defect in the phonological language processing may represent the core defect in dyslexia. It is concluded that dyslexia probably is not a discrete entity; most likely, it presents a continued gradation. Diversity in symptomatology and associated defects could be related with the involvement of different variables. Furthermore, the specific characteristics of the different writing systems could affect the apparent dyslexia frequency and its specific manifestations, as well as the likelihood to find brain abnormalities.