Subtipos no clásicos de diabetes mellitus / Non classical subtypes of diabetes mellitus

Background: Some adult, obese and diabetic patients, initiate their disease with a severe diabetic ketoacidosis without a precipitating factor and do not require insulin thereafter. These patients are classified as having a non classical diabetes mellitus. Aim: To study the clinical, immunological, genetic and metabolic features of patients with non classical diabetes mellitus. Patients and methods: Ten patients (9 men, aged 45ñ12 years old) with non classical diabetes mellitus were studied. Anti islet and anti glutamic acid decarboxylase antibodies (ICA and anti GAD), HLA DQ a arginine 52 and non aspartic ß57 were measured. Insulin secretion was measured by C peptide after glucagon injection and with the minimal model of Bergman. The latter model was also used to determine insulin sensitivity. Results: Three patients were immunologically classified as type 1, since they had positive ICA or antiGAD antibodies and type 1 genetics (neutral or susceptible HLA DQ a and ß). They had insulin secretion after glucagon stimulus (C peptide ranging from 2.2 to 7.5 pmol/ml), but an almost absent response to a glucose load. They were also insulin resistant (a sensitivity index ranging from 0.05 to 1.67 x 10-4 min/µU x ml). These three cases could be categorized as latent type 1. The other seven patients were ICA negative and antiGAD negative. Five had a susceptible HLA genotype for type 1 diabetes and two were neutral. All had insulin secretion after glucagon stimulation and a variable response to glucose. Six were insulin resistant (sensitivity index ranging from 0.32 to 1.29 x 10-4 min/µU x ml). One patient was insulin sensitive (sensitivity index of 3.83 x 10-4 min/µU x ml). Therefore all these patients were classified as type two diabetics with an atypical debut. Conclusions: Not all diabetics presenting with a severe diabetic ketoacidosis are type I. Among these, there are subjects with a latent type 1 diabetes or with an atypical type 2 diabetes

Parenting and physical punishment: primary care interventions in Latin America

Physical punishment is a form of intrafamilial violence associated with short - and long - term adverse mental health outcomes. Despite these possible consequences, it is among the most common forms of violent interpersonal behavior. For many children it begins within the first year of life. The goal of this study was to determine the feasibility of involving public sector primary health care providers to inform parents about alternatives to phuysical punishment. The study used a qualitative design utilizing focus groups and survey questionnaires with parents and providers at six clinic sites chosen to be representative of public sector practice settings in Costa Rica and in metropolitan Santiago, Chile. The data were collected during 1998 and 1999. In the focus groups and surveys the parents voiced a range of opinions about physical punishment. Most acknowledged its common use but listed it among their least preferred means of discipline. Frequency of its use correlated positively with the parents' belief in its effectiveness and inversely with their satisfaction with their children's behavior. Some parents wanted to learn more about discipline; others wanted help with life stresses they felt led them to use physical punishment. Parents reported they chose other family memebers more frequently as a source of parenting information than they did health care providers. Some parents saw providers as too rushed and not knowledgeable enough to give good advice. Providers, in turn, felt ill equipped to handle parents' questions, but many of the health professionals expressed interest in more training. Parents and providers agreed that problems of time, space, and resources were barriers to talking about child discipline in the clinics. Many parents and providers would welcome a primary-care-based program on physical punishment. Such a program would need to be customized to accommodate local differences in parent and provider atitudes and in clinic organization. Health care professionals need more training in child discipline and in the skills required to interact with parents on issues relating to child behavior

Obesidad / Obesity

La obesidad es una enfermedad crónica de prevalencia creciente que acarrea graves consecuencias para la salud ya sea en forma directa o a través de promover la expresión de otros factores de riesgo cardiovascular. Esta revisión entrega las herramientas clínicas para enfocar el estudio del paciente obeso y resume brevemente las armas terapéuticas para enfrentar este importante problema de salud pública

Nueva clasificación y criterios diagnósticos de la diabetes mellitus / The new classification and diagnostic criteria for diabetes mellitus

Se presenta y comenta la nueva clasificación y criterios diagnósticos de diabetes mellitus (DM), preparado por un grupo de expertos de la Asociación Americana de Diabetes. La nueva clasificación tiene un fundamento etiopatogénico, la antigua clasificación OMS 1985 era de índole terapéutico. Las llamadas diabetes insulinodependientes y diabetes no insulinodependiente, pasan a denominarse tipo 1 y tipo 2, respectivamente. Se mantienen las clases diabetes gestacional e intolerancia a la glucosa, agregándose a esta última el estado de intolerancia a la glucosa de ayuno. Para la pesquisa y diagnóstico de diabetes mellitus se recomienda la glicemia de ayuno y se fija la cifra >126 mg/dl (7,0 mmol/1) como nivel de anormalidad, antiguamente >140 mg/dl. Este cambio se realizó, debido a que los individuos con glicemias de ayunas entre los valores anotados desarrollan complicaciones crónicas. También se consideran diabéticos a los sujetos con una glicemia aleatoria en cualquier momento del día >200 mg/dl y la tercera alternativa diagnóstico corresponde a esta misma cifra, pero obtenida a las dos horas de una carga de 75 g de glucosa. En ausencia de síntomas debe repetirse el examen para confinnar el diagnóstico. Se establece como glicemias normales en ayunas a las menores de 110 mg/dl, los valores intermedios, entre 100 y 126 mg/dl, constituyen el estado de intolerancia a la glucosa de ayuno. No se modifican las cifras de intolerancia a la glucosa, las que corresponden a glicemias >140 y menor de 200 mg/dl a las dos horas post carga. Se mantuvieron los criterios diagnósticos del National Diabetes Data Group para diabetes gestacional, recomendándose realizar pesquisa en todas las mujeres con riesgo entre las semanas 24 y 28 de embarazo, con una glicemia una hora después de ingerir 50 g de glucosa, a cualquier hora del día. Las embarazadas con valores de glicemia >140 mg/dl deben ser sometidas a una prueba de tolerancia con 100g de glucosa y cuatro muestras horarias. El Comité considera la existencia de un grupo de gestantes de bajo riesgo en quienes no es necesario realizar pesquisa. El Grupo de Expertos, al igual que el informe de la OMS 1985, concluye que para la prueba de tolerancia a la glucosa oral sólo se requiere la glicemia de ayunas y la de las dos horas después de 75g de glucosa. Las glicemias intermedias no son necesarias para la práctica clínica. Se resalta además...

Incidencia de diabetes mellitus insulino dependiente en Santiago, Chile, 1990-1993 / Incidence of insuline dependent diabetes mellitus in Santiago, Chile, 1990-1993

The aim of this study was to determine IDDM incidence in the Metropolitan Region of Chile, during the period 1990-1993 as part of the Multinational Project for Childhood Diabetes (WHO DIAMOND project group). The studied population was 1.499.784 inhabitants. All children in whom the diagnosis was made between january 1, 1990 and dec. 31, 1993 were included. We used a retrospective and prospective search and confirmation method, using as data sources public and private hospitals and medical records of pediatricians. The juvenile Diabetes Foundation was used as a secondary data source. All cases had at least two confirmation sources. A total of 176 new cases (90 males) were diagnosed in the study period, with an annual incidence of 2.92/100,000 for females and 2.95 for males. The group of children from 10 to 14 years old had the highest incidence rate (4.9/100.000), specially in women (5.25/100.000). The yearly incidence was 1.31 in 1990, 2.71 in 1991, 2.93 in 1992 and 3.7/1000,000 in 1993). It is concluded that the Metropolitan Region has one of the lowest incidences of IDDM in Latin America, although it increased along the study years

Exámenes de adicción: una aproximación al problema del consumo de drogas / Addiction tests: an approach to the problem of drug consumption

Se presenta la experiencia obtenida a través de 122 exámenes de adicción realizados por médico psiquiatra del Departamento de Programas de las Personas del Servicio de Salud Metropolitano Occidente en el período de 6 meses comprendido entre el 1- de octubre de 1990 y el 31 de marzo de 1991. Se describen las características de la población atendida en función de posibles actividades de prevención secundaria y de rehabilitación para ella y de prevención primaria en grupos de riesgo. Se presenta la ficha de registro de informaciones confeccionada y utilizada la que podría servir para homologar criterios y realizar trabajos en conjunto con otros Servicios de Salud