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1.
Rev. chil. endocrinol. diabetes ; 14(4): 171-177, 2021. tab
Article in Spanish | LILACS | ID: biblio-1348218

ABSTRACT

Los avances en el campo de la fibrosis quística han aumentado la esperanza de vida de estos pacientes, por lo que cada vez es más prevalente la Diabetes Relacionada con la Fibrosis Quística (DRFQ) y sus complicaciones. La DRFQ se asocia a mayor morbimortalidad, deterioro de la función pulmonar y del estado nutricional. Por lo mismo, el manejo óptimo de esta patología depende de un diagnóstico precoz, tratamiento individualizado y vigilancia de las complicaciones diabéticas. El screening de DRFQ debe realizarse anualmente a partir de los 10 años, mediante una Prueba de Tolerancia a la Glucosa Oral (PTGO), lo cual permite el diagnóstico. El manejo de esta patología tiene por objetivo estabilizar y mejorar la función pulmonar y el estado nutricional y metabólico de los pacientes. Actualmente, la insulina es el tratamiento farmacológico de elección para controlar la hiperglicemia y el esquema de uso debe ser individualizado para cada persona. En caso de enfermedades agudas pueden existir mayores requerimientos de insulina. Además, se deben tener consideraciones especiales en cuanto a la dieta y la insuficiencia pancreática exocrina que presentan estos pacientes. Para la vigilancia de complicaciones microvasculares se debe realizar una monitorización anual a partir de los 5 años desde el diagnóstico de DRFQ. Debido a la complejidad de estos pacientes, para alcanzar el mejor cuidado posible se necesita un enfoque multidisciplinario con distintos profesionales de la salud coordinados, incluyendo en la toma de decisiones al paciente y su familia.


Advances made in the field of cystic fibrosis have increased the life expectancy of these patients, which is why Cystic Fibrosis-Related Diabetes (CFRD) and its complications are becoming more and more prevalent. CFRD is associated with increased morbidity and mortality, lower lung function and inadequate weight maintenance. Therefore, the optimal management of this pathology depends on an early diagnosis, individualized treatment and monitoring of diabetic complications. For CFRD, routine screening with an Oral Glucose Tolerance Test (OGTT) should be carried out yearly from the age of 10, which allows to diagnose it. The treatment goals in CFRD are to stabilize and improve lung function and obtain adequate weight gain. Currently, insulin is the pharmacological treatment of choice to control hyperglycemia and the insulin regimen must be personalized for each person. In acute illnesses, there may be higher insulin requirements. In addition, special considerations must be taken regarding diet and exocrine pancreatic insufficiency that these patients present. For the surveillance of microvascular complications, annual monitoring should be carried out 5 years after the diagnosis of CFRD. Due to the complexity of these patients, in order to achieve the best possible care, a multidisciplinary approach is needed with different coordinated health professionals, including the patients and their family in the decision-making process.


Subject(s)
Humans , Cystic Fibrosis/complications , Cystic Fibrosis/diagnosis , Cystic Fibrosis/therapy , Diabetes Mellitus/etiology , Diabetes Mellitus/therapy , Patient Care Team , Mass Screening , Cystic Fibrosis/physiopathology , Nutrition Therapy , Diabetes Mellitus/diagnosis , Diabetes Mellitus/physiopathology , Insulins/therapeutic use , Glucose Tolerance Test , Hypoglycemic Agents/therapeutic use
2.
Rev. chil. endocrinol. diabetes ; 13(1): 20-23, 2020. tab
Article in English | LILACS | ID: biblio-1048916

ABSTRACT

Se presenta el caso de dos mujeres con hipotiroidismo, con TSH persistentemente elevada, lo que hacía aumentar la dosis de levotiroxina y llegar a un hipertiroidismo clínico con TSH anormalmente alto. Se realizó un seguimiento de los niveles de TSH y T4 libre, durante un período de 20 y 10 meses respectivamente. En ambas situaciones no hubo una respuesta esperable a las dosis de levotiroxina ascendentes. Después de descartar causas posibles que explicaran esta situación, se sospechó y confirmó la presencia de Macro TSH, que es un complejo biológicamente inactivo de TSH e Inmunoglobulina G. Se obtiene como resultado la estabilidad de ambas pacientes siendo su seguimiento prioritariamente clínico y con mediciones de T4L, comprendiendo por qué la TSH persiste elevada. Nos pareció interesante la comunicación de estos casos, que permite recordar causas atípicas de refractariedad al tratamiento con levotiroxina, como es la macro TSH, indispensable pesquisar para el manejo adecuado de estos pacientes.


An inadequate response to levothyroxine treatment in a patient with hypothyroidism suggests lack of intake, lack of absorption, nephrotic syndrome, thyroid hormone resistance among other reasons. We present the case of two women with hypothyroidism and a persistently elevated level of TSH, which required increasing the dose of levothyroxine, resulting in a clinical hyperthyroidism with an abnormally high TSH. A TSH and free T4 follow up was performed during a period of 20 and 10 months respectively, in both situations there was not an adequate response to rising levothyroxine treatment. After ruling out other possible causes that could explain this situation, it was suspected and then confirmed the presence of Macro TSH, which is a biologically inactive complex of TSH and Immunoglobulin G. Therefore, both patients achieved disease stability once controlled by clinical state and free T4 measurements, understanding why THS persited high. We present these interesting cases, because this allows us to remember atypical causes of refractory treatment with levothyroxine, such as the Macro TSH, indispensable to search for the proper management of these patients.


Subject(s)
Humans , Female , Adult , Middle Aged , Thyroid Hormones/blood , Hypothyroidism/diagnosis , Hypothyroidism/blood , Thyroxine/administration & dosage , Immunoglobulin G , Hypothyroidism/drug therapy
3.
Rev. chil. endocrinol. diabetes ; 12(4): 208-215, 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1088029

ABSTRACT

INTRODUCCIÓN: Si bien, los edulcorantes no nutritivos (ENN) estevia y D-tagatosa han sido reportados como seguros, han demostrado tener algunos efectos metabólicos tras su ingesta. OBJETIVO: Describir los efectos de la ingesta de estevia y D-tagatosa sobre el metabolismo de la glucosa y ácido úrico, y del apetito-saciedad, a partir de la evidencia disponible. MÉTODOS: Revisión descriptiva. Se realizó búsqueda en PubMed utilizando los siguientes términos y palabras clave: "stevia rebaudiana", "tagatose", "D-tagatose", "blood glucose", "insulin", "metabolic processes", "uric acid", "hyperuricemia", "appetite" o "satiety". El análisis de los estudios seleccionados fue discrecional. RESULTADOS: Existen estudios que demuestran efectos beneficiosos tras el consumo de estevia o D-tagatosa sobre el control glicémico, apetito y saciedad tanto en sujetos sanos como con alteraciones en el metabolismo de la glucosa. Por otra parte, un número importante de estudios que evalúan la ingesta de estevia reportan efectos nulos sobre dichos parámetros. En relación al ácido úrico, solo un estudio en sujetos con enfermedad renal crónica reporta aumento en la concentración de ácido úrico plasmático tras la ingesta de 500 mg/día de estevia. Pocos estudios han evaluado el efecto de la ingesta de D-tagatosa sobre uricemia, en sujetos sanos y diabéticos, reportando un aumento transitorio y significativo en los niveles de ácido úrico sérico, sin embargo, no se ha logrado demostrar un efecto hiperuricémico asociado. Es importante destacar que la metodología de los estudios revisados es heterogénea, especialmente en relación al tamaño muestral, tiempo, dosis y vía de adminitración del edulcorante. CONCLUSIÓN: La ingesta de estevia y D-tagatosa ha demostrado efectos beneficiosos sobre el metabolismo de la glucosa, el apetito y la saciedad. El efecto del consumo de D-tagatosa sobre ácido úrico sérico requiere mayor evidencia para demostrar su significancia clínica.


INTRODUCTION: No-nutritive sweeteners stevia and D-tagatose have been reported as safe according to their acceptable daily intake, however, they have been shown to have metabolic effects after their ingestion. OBJECTIVE: To describe the effects of stevia and D-tagatose intake on parameters associated to glucose, uric acid metabolism and on appetite-satiety, considering the available evidence. METHODS: Descriptive review. PubMed search was carried out to identify the totality of the published articles. The following terms and key words were used: "stevia rebaudiana", "tagatose", "D-tagatose", "blood glucose", "insulin", "metabolic processes", "uric acid", "hyperuricemia", "appetite" o "satiety". The analysis of the selected studies was discretionary. RESULTS: studies have shown beneficial effects of stevia and D-tagatose consumption on glycemic control, appetite and satiety in healthy subjects as well as subjects with impairment glucose metabolism. On the other hand, a significant number of studies evaluating estevia intake report null effects on these parameters. In relation to uric acid, only one study in subjects with chronic kidney disease reported an increase in plasmatic uric acid concentration after the intake of 500 mg/day of stevia. Several studies have evaluated the effect of D-tagatose intake on plasmatic uric acid, in healthy and diabetic subjects, reporting a transient and significant increase in serum uric acid levels, however, has not been able to demonstrate an associated hyperuricemic effect. It is important to highlight that the methodology of the studies reviewed is heterogeneous, especially in relation to sample size, dose administered, time and route of exposure to the sweetener. CONCLUSION: Stevia and D-tagatose intake has shown beneficial effects on glucose metabolism, appetite and satiety. The effects of the consumption of both sweeteners on uric acid require further study to demonstrate their clinic significance.


Subject(s)
Humans , Sweetening Agents/pharmacology , Uric Acid/metabolism , Blood Glucose/drug effects , Appetite/drug effects , Satiation/drug effects , Stevia/metabolism , Glucose/metabolism , Hexoses/pharmacology , Insulin/metabolism
4.
Rev. chil. endocrinol. diabetes ; 12(4): 220-223, 2019. tab
Article in Spanish | LILACS | ID: biblio-1088032

ABSTRACT

Introducción: El hipotiroidismo constituye una patología frecuente, y su tratamiento habitual es el suplemento de levotiroxina (LT4) oral (VO). Sin embargo, existen casos inhabituales donde no es posible corregir esta condición a pesar de la utilización de LT4 en dosis alta. El hipotiroidismo refractario se define como la persistencia del hipotiroidismo a pesar del uso de LT4 > 1,9 ug/kg/día. La prevalencia del hipotiroidismo refractario no ha sido suficientemente documentada hasta ahora. Descripción del caso: Mujer de 53 años con antecedentes de hipotiroidismo, obesidad, dislipidemia, hipertensión arterial e insulinorresistencia. Fue derivada desde APS a nivel terciario por hipotiroidismo persistente a pesar del uso de LT4 800 ug/día y liotironina 80 ug/día. En forma ambulatoria se descartaron distintas causas, como mala adhesión al tratamiento, pseudo-malabsorción, síndromes de malabsorción; interacciones farmacológicas o interacciones alimentarias. Ante esto, y manteniéndose en su condición, se decide hospitalizar. Durante la hospitalización se prueban distintas fórmulas de administración. Finalmente, se logra respuesta adecuada con LT4 por vía rectal 100 ug/día asociado a 100 ug c/12 horas VO. Discusión: A pesar de no contar con herramientas óptimas para enfrentar este caso, se logró aplicar una estrategia sistemática especializada, que permitió un buen manejo de la paciente. Luego de probar distintas formulaciones de hormonas tiroideas, se logró respuesta mediante la administración por vía rectal, lo cual sugiere que esta paciente presentaba algún trastorno celular/bioquímico intestinal alto, que impedía la absorción óptima de LT4 VO. Conclusiones: La principal fortaleza de este trabajo consiste en la demostración de la utilidad práctica, en un contexto de recursos limitados, de una estrategia de estudio y tratamiento sistemático del hipotiroidismo refractario, lo cual ha sido escasamente publicado en la literatura internacional. Además, se recalca la importancia de una intervención especializada oportuna para evitar los riesgos sistémicos asociados a dosis altas de hormonas tiroideas.


Introduction: Hypothyroidism is a common condition, and its usual treatment is the supplement of oral levothyroxine (po). However, there are unusual cases where it is not possible to correct this condition despite the use of high-dose levothyroxine. Refractory hypothyroidism is defined as the persistence of hypothyroidism despite the use of levothyroxine > 1.9 ug/kg/ day. The prevalence of refractory hypothyroidism has not been sufficiently documented so far. Case description: 53 year old woman with a history of hypothyroidism, obesity, dyslipidemia, hypertension and insulin resistance. She was sent from primary care to tertiary level due to persistent hypothyroidism despite the use of 800 ug/day levothyroxine and liothyronine 80 ug/ day. On an outpatient basis, different causes were excluded as poor adherence to treatment, pseudo-malabsorption, malabsorption syndromes; drug interactions or food interactions. Given this, and staying on her condition, it was decided to hospitalize. Different forms of administration were tested during hospitalization. Finally, got adequate response with levothyroxine rectally 100 ug/day associated with 100 ug po bid. Discussion: Despite not having optimum tools to deal with this case, it was succeeded thanks to the implementation of a specialized systematic strategy. After testing different formulations of thyroid hormones, a positive response by rectal administration was achieved, which suggests that this patient presented any high intestinal cell/biochemist disorder that prevented the optimal absorption of levothyroxine po. Conclusions: The main strength of this work consists in demonstrating the practical utility, in a context of limited resources, of a study and systematic treatment strategy of refractory hypothyroidism, which has barely been published in the international literature. It is also highlighted the importance of an early specialized intervention to prevent the systemic risks associated with high doses of thyroid hormones.


Subject(s)
Humans , Female , Middle Aged , Thyroxine/administration & dosage , Hypothyroidism/complications , Hypothyroidism/drug therapy , Malabsorption Syndromes/complications , Administration, Rectal
5.
Bol. Hosp. Viña del Mar ; 73(3): 88-91, sept. 2017.
Article in Spanish | LILACS | ID: biblio-948056

ABSTRACT

INTRODUCCIÓN: existe asociación entre diabetes mellitus(DM) e insuficiencia cardiaca (IC), planteándose una miocardiopatía inducida por DM, sin embargo, se desconoce la fisiopatología exacta. OBJETIVO: describir la población de pacientes hospitalizados por insuficiencia cardiaca descompensada (ICD). MÉTODOS: estudio descriptivo de cohorte transversal en pacientes hospitalizados con diagnóstico de ICD.Se obtuvieron datos delingreso de la Unidad de Emergencias, anamnesis y epicrisis. Las variables estudiadas fueron: edad, sexo, duración de la hospitalización, comorbilidades, causa de la IC y de su descompensación, evolución clínica y complicaciones adyacentes, realización de ecocardiograma y hospitalizaciones previas por ICD. Se comparó descriptivamente entre subgrupo de pacientes diabéticos y no diabéticos. RESULTADOS: se obtuvo 31 pacientes,todos con diagnóstico previo de IC, 10 de ellos diabéticos.La etiología isquémica fuemásfrecuente en los diabéticos y éstos presentaban mayores hospitalizaciones previas por ICD y mayores complicaciones durante la hospitalización. Los no diabéticos tuvieron más días de hospitalización y fracción de eyección (FE) más baja. Fallecieron 2 pacientes, ninguno diabético. Los pacientes diabéticos tenían un inadecuado control metabólico según valor de hemoglobina glicada. CONCLUSIONES: la población diabética presentó mayor proporción de insuficiencia cardiaca de etiología isquémica y mayores complicaciones durante la hospitalización. Se encontró diferencias a lo descrito en la literatura, en cuanto a días de hospitalización y mortalidad,lo que probablemente se explica por la muestra pequeña y laFE menor en no diabéticos. La DM mal controladaparecióser unfactorinfluyente enla rehospitalización porICD.


INTRODUCTION: diabetes mellitus and heart failure are associated, possibly through a diabetes-induced myocardiopathy, however the precise pathophysiology remains unknown. OBJECTIVE: to describe a population of patients hospitalized for heart failure. METHODS: a descriptive study of a transversal cohort of inpatients diagnosed with heart failure. Data were taken from Aand E admissions, patient histories and discharge papers. The variables studied were: age, sex, length of stay, co-morbidities, cause of heart failure and its exacerbation, clinical course and complications, heart ultrasound findings, and prior hospitalizations for heart failure. The sub-groups diabetic and non-diabetic were compared descriptively. RESULTS: We describe 31 patients already diagnosed with heart failure, 10 being diabetic. Ischemic etiology was more frequent in the diabetic patients and these had had more hospitalizations and presented more complications. The non-diabetics had longer hospital stays and a lower ejection fraction. Two patients died. Neither was diabetic. Glycated hemoglobin levels showed that the diabetics had poor metabolic control. CONCLUSIONS: the diabetic group had a higher incidence of ischemic heart failure and more complications during their stay. Our values for length of stay and mortality differ from those found in the literature, probably because of the small sample size and the low ejection fraction found in non-diabetics. Poorly controlled diabetes seems to be a factor in re-admission for heart failure


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Cardiovascular Diseases/complications , Cardiovascular Diseases/epidemiology , Diabetes Complications , Diabetes Mellitus/epidemiology , Cross-Sectional Studies
6.
Rev. chil. endocrinol. diabetes ; 10(3): 95-99, jul. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-998978

ABSTRACT

Introduction: Patients with hypothyroidism may have worse quality of life, specially in Hashimoto's Thyroiditis (HT). Objective: Describe differences in the quality of life in patients with HT, compared to other causes of hypothyroidism in ambulatory patients. Method: Cross sectional, observational and descriptive study. The survey SF36 was applied, with prior authorization, to hypothyroid outpatients over 18 years without psychiatric, physical or mental disorder, dividing the sample into two groups: patients with TH and other causes of hypothyroidism. We used QualityMetric Health OutcomesTM Scoring Software 5.0, that gives a descriptive analysis of each area included in the instrument. Results: 53 patients, of whom 30 where diagnosed with TH, and 23 with other causes of hypothyroidism were surveyed. The characteristics were similar in both groups. The total group of hypothyroid patients had mental component under the average. In the specific analysis of the groups, the physical component was within the average general population. The mental component, was decreased in patients with other causes of hypothyroidism, but not in patients with TH. Conclusion: Comparing both groups, there were no differences in the physical component of patients with hypothyroidism. The mental component of the total group of hypothyroid patients compared to the general population was below average, especially in patients with other causes of hypothyroidism. The reason is unclear, but could be related to the absence of endogenous thyroid hormones


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Quality of Life , Hashimoto Disease/psychology , Hypothyroidism/psychology , Cross-Sectional Studies , Surveys and Questionnaires
7.
Rev. chil. endocrinol. diabetes ; 10(2): 49-52, abr. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-998951

ABSTRACT

INTRODUCTION: Subclinical hypothyroidism (SH) is characterized by elevation of thyroid stimulating hormone (TSH) with normal free thyroxine (FT4). SH has been associated with cardiovascular risk factors (CVRF) such as increased blood pressure, lipid level and atherosclerosis; however, its association with coronary heart disease is controversial. OBJECTIVES: The primary objective was to know the prevalence of SH in patients with acute coronary syndrome (ACS) in 3 hospitals of the Viña del Mar-Quillota Health Service. The secondary objective was to know the prevalence of CVRF in patients with SH and euthyroidism. MATERIAL AND METHOD: A cross-sectional study that included patients admitted for ACS. CVRF and thyroid hormone levels were recorded. RESULTS: Of the 81 patients recruited, 11 (13.6 percent) had SH. AHT was present in 68.3 percent of euthyroid and 90.9 percent of SH (p = 0.16). 55 percent of euthyroid and 63.6 percent of SH had dyslipidemia (p = 0.74). Overweight or obesity was found in 76.6 percent of euthyroid and 54.5 percent of SH (p = 0.15). The median CVRF was 3 (IQR 2-4) in euthyroid and 3 (IQR 3-4) in SH (p = 0.78). CONCLUSIONS: The prevalence of SH in patients with ACS was not higher than that reported in the general population and there were no differences in CVRF between SH and euthyroid. We require prospective cohort studies with a larger sample size to establish incidence and risk of adverse cardiovascular outcomes in SH.


Subject(s)
Humans , Male , Adolescent , Adult , Acute Coronary Syndrome/epidemiology , Hypothyroidism/epidemiology , Chile/epidemiology , Prevalence , Cross-Sectional Studies , Risk Factors
8.
Rev. méd. Chile ; 145(3): 393-396, Mar. 2017.
Article in Spanish | LILACS | ID: biblio-845553

ABSTRACT

Diabetic ketoacidosis with mild hyperglycemia is a major complication of sodium-glucose cotransporter 2 inhibitors. Although its use is not approved for patients with type 1 diabetes mellitus, the drug is often prescribed with the hope of optimizing metabolic control. We report a 20 years old female with hypothyroidism and type 1 diabetes consulting for vomiting and abdominal pain. The patient had used canagliflozin during the two previous months. Laboratory showed a blood glucose of 200 mg/dl, a severe metabolic acidosis (pH 7.1) and ketonemia. The patient was successfully treated in the intensive care unit.


Subject(s)
Humans , Female , Adult , Diabetic Ketoacidosis/chemically induced , Canagliflozin/adverse effects , Hyperglycemia/chemically induced , Hypoglycemic Agents/adverse effects , Diabetic Ketoacidosis/diagnosis , Diabetes Mellitus, Type 1/drug therapy , Canagliflozin/therapeutic use , Sodium-Glucose Transporter 2 Inhibitors , Hyperglycemia/diagnosis , Hypoglycemic Agents/therapeutic use
9.
Rev. chil. endocrinol. diabetes ; 9(4): 121-124, 2016. tab
Article in Spanish | LILACS | ID: biblio-1291569

ABSTRACT

Diabetes Mellitus (DM) is a prevalent pathology. It has been noticed that patients tend to have longer stays in the hospital and one of the factors that causes it corresponds to bad metabolic control. AIM:To assess prevalence and different variables related to an erroneous metabolic control and a longer hospital stay. PATIENTS AND METHODS:It is a cross-sectional study on diabetics patients hospitalized at the Internal Medicine service in the Hospital of city of Quilpué, for a period of two months, quantifying epidemiologic data, days of hospital stay and metabolic control. A statistical multivariate correlative study was carried. RESULTS: Patient prevalence with DM was 13.15% (n = 35/266), all of them were type 2 (DM), being the 91.4% (n = 32) hypertensive, 97.1% (n = 34) older than 40 years old, 62.9% (n = 22) with HbA1c ≥ 7%, 17,1% (n = 6) had a bad metabolic control and an average of 22,8 (rank = 6-136) days of hospital stay versus 12,1 days without DM. An association was observed between inadequate previous metabolic control and "bad metabolic hospital control" (p < 0.05). DISCUSSION: Prevalence of DM patients in the hospital was lower than other centers of the region. A statistical association between bad metabolic chronic control with bad metabolic hospital control was found. No associations between bad hospital control and long stays were observed, a possible reason might be the biased values of glycemia's records and different handling of these patients.


Subject(s)
Humans , Male , Female , Middle Aged , Diabetes Mellitus, Type 2/therapy , Diabetes Mellitus, Type 2/epidemiology , Chile/epidemiology , Cross-Sectional Studies , Multivariate Analysis , Glycemic Control , Hospitalization/statistics & numerical data , Length of Stay
10.
Rev. chil. endocrinol. diabetes ; 9(3): 89-91, 2016. tab, ilus
Article in Spanish | LILACS | ID: biblio-836025

ABSTRACT

Subacute thyroiditis is a transient inflammatory process of the thyroid gland and the most common cause of painful thyroiditis. It usually involves the whole thyroid. We present a clinical case of a 45 years old woman developing tachycardia, fever and painful sensation in the left anterior cervical region after an upper respiratory tract infection. In addition the patient presented an enlarged and painful left thyroid lobe. Laboratory analysis demonstrated elevated acute phase reactants, high T4 levels and suppressed thyrotropin with absence of antithyroid antibodies. Thyroid scintigram showed an absent left radioactive iodine uptake. One month later the patient started with malaise, fatigue with an enlarged painful right thyroid lobe. A new scintigram showed complete absence of radioactive iodine uptake. A course of prednisone was initiated with excellent clinical response. Four months later the patient was asymptomatic with normal thyroid function.


Subject(s)
Humans , Female , Middle Aged , Thyroiditis, Subacute , Thyroiditis, Subacute/complications , Thyrotoxicosis/etiology , Thyrotoxicosis/drug therapy , Prednisone/therapeutic use
11.
Rev. chil. endocrinol. diabetes ; 8(4): 146-150, oct. 2015. tab
Article in Spanish | LILACS | ID: biblio-831327

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Middle Aged , /epidemiology , Hypoglycemia/epidemiology , Hospitalization/statistics & numerical data , Comorbidity , Prospective Studies
12.
Bol. Hosp. Viña del Mar ; 70(3): 100-103, sept.2014. tab
Article in Spanish | LILACS | ID: lil-779199

ABSTRACT

Most of patients that present hyperglycemia during hospitalization still have the condition when they are discharged. A good level of metabolic control for hospitalized patients was set at a glycemic value between 70 and 180 mg/dl, taking into account that no statistics exist for the studied population. Aim: To describe reasons for hospitalization and glycemic control of patients with Diabetes Mellitus (DM) hospitalized in the Internal Medicine UNIT (SMI) of Hospital San Martin of Quillota (HSMQ). Patients and methods: Descriptive study of serial cases that included all patients of the SMI of HSMQ during July and August 2014. The information was obtained by daily census, analysis of nursing data, and interviews with patients. The information included general characteristics of the population and in patient management. Results: Of a total of 353 patients, 55 (15.6 percent) corresponded to diabetic patients, of them 92.7 percent had DM type 2. The average duration of hospitalization for not DM was 7 days where as for the DM it was 13.4 days. The principal reason for hospitalization for DM patients was infection: 23.6 percent (13/55). During hospitalization, most of patients’ care was controlled by means of "sliding scale" (28/55), but the schemes were quite variable, predominantly resulting in normal glycemia (63.8 percent) followed by hyperglycemia (33.7 percent). Conclusion: We found a significant percentage of patients with hyperglycemia and a great variability in the managing of DM in this sample, which indicates the importance of implementing a protocol for managing these cases...


Subject(s)
Humans , Male , Adult , Female , Middle Aged , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Hospitalization , Comorbidity , Diabetes Complications/epidemiology , Diabetes Complications/therapy , Epidemiology, Descriptive , Internal Medicine , Interviews as Topic , Prospective Studies
13.
Rev. chil. endocrinol. diabetes ; 7(1): 10-13, ene.2014. tab
Article in Spanish | LILACS | ID: lil-779327

ABSTRACT

Thyroid dysfunction, whether it be from an increase or decrease in the levels of thyroid hormones, has multiple repercussions in the cardiovascular system which have been associated with an increase in mortality and heightened risk of cardiovascular events. This risk must be taken into consideration when evaluating patients with thyroid dysfunction in order to include strategies that assure a timely diagnosis and treatment of the above-mentioned complications. Similarly, it is necessary to evaluate the thyroid function in patients who present cardiovascular events such as heart failure, arrhythmias, coronary acute syndrome or acute stroke. Some of these alterations will cease with the recovery of euthyroidism. Randomized controlled trials are needed to define the best way to treat these patients, especially in cases of subclinical hypothyroidism, where it is still unknown if treatment with L-thyroxin helps reducing cardiovascular risk...


Subject(s)
Humans , Thyroid Diseases/physiopathology , Cardiovascular System/physiopathology
14.
Rev. chil. enferm. respir ; 29(1): 9-13, mar. 2013. ilus
Article in Spanish | LILACS | ID: lil-678047

ABSTRACT

Introducción: la neumonía grave del adulto adquirida en la comunidad (NAC grave) se caracteriza por requerir manejo en la unidad de cuidados intensivos (UCI), dado su mayor mortalidad y riesgo de complicaciones, por lo cual se han diseñado distintas escalas de predicción de gravedad. Objetivo: identificar apacientes adultos con NAC grave manejados en la sala de cuidados generales. Pacientes y Métodos: estudio clínico descriptivo retrospectivo, se revisaron las fichas clínicas de 131 pacientes adultos egresados del servicio de medicina del hospital de Quilpué con el diagnóstico de NAC entre el 1 de enero y 31 de diciembre del 2010. Se examinaron los criterios de NAC grave de la Sociedad de Tórax Americana (ATS) y se midió el CURB-65 de 89 pacientes que consignaban esta información. Resultados: en 16 pacientes (18 por ciento) se obtuvo una puntuación del CURB-65 > 3 y en 8 pacientes (9 por ciento) se identificaron > 3 criterios menores de la ATSy en 2 de ellos un criterio mayor. Conclusión: se identificaron pacientes con NAC grave manejados en la sala de cuidados generales de un hospital publico.


Introduction: severe community-acquired pneumonia (severe CAP) is characterized by intensive care unit (ICU) requirement, given its higher mortality and complications rate. Different prediction scales have been designed to assess severity. Objective: identify adult patients with severe CAP managed in the general ward of a public hospital. Patients and Methods: retrospective descriptive study, including all adult patients dischargedfrom hospital with CAP diagnosis, from january 1st to december 31st, 2010, with a total of 131 medical records reviewed. The American Thoracic Society criteria (ATS) of severe CAP and CURB-65 scores from 89 medical records were calculated. Results: 16 patients (18 percent) had CURB-65 score > 3, 8 patients (9 percent) had > 3 minor ATS criteria, and 2 of those patients had a major criterion. Conclusion: a significant number of patients with severe CAP were managed on the general ward of a public hospital.


Subject(s)
Humans , Male , Adult , Female , Middle Aged , Aged, 80 and over , Community-Acquired Infections/epidemiology , Pneumonia/epidemiology , Comorbidity , Hospitalization , Prognosis , Retrospective Studies , Risk Assessment , Severity of Illness Index
15.
Rev. chil. endocrinol. diabetes ; 5(2): 62-67, abr. 2012. tab, graf
Article in Spanish | LILACS | ID: lil-640615

ABSTRACT

Background: Radioiodine treatment fails in 17 percent of patients with Basedow Graves disease (BGD). Aim: To assess the frequency and possible associated factors of treatment failure of the first radioiodine dose in patients with BGD. Material and Methods: Review of medical records of patients with BGD treated with radioiodine at a general hospital between 2004 and 2008. Normal thyroid function or hypothyroidism ensuing after treatment were considered as treatment success criteria. Results: According to the databases of the hospital, 298 patients received radioiodine in the study period. Of these, 254 medical records were recovered and 86 were analyzed. Treatment success and failure was recorded in 67 (78 percent) and 19 (22 percent) patients, respectively. The mean dose used was 12 +/- 2 mCi. Clinically determined goiter size and a high free thyroxin level were significantly associated to treatment failure. The area under the receiver operating characteristic curve (ROC) for a thyroid weight over 60 g, estimated clinically was 0.73, rendering a sensitivity and specificity of 63 and 89 percent respectively, for this parameter as predictor or treatment failure. Conclusions: Thyroid gland size may be a predictor of radioiodine treatment failure. However the variability of the clinical estimation of this parameter casts doubts about its usefulness.


Subject(s)
Humans , Male , Adult , Female , Middle Aged , Graves Disease/radiotherapy , Iodine Radioisotopes/therapeutic use , Medical Futility , Probability , Prognosis , Retrospective Studies , ROC Curve , Sensitivity and Specificity , Treatment Outcome
16.
Rev. chil. endocrinol. diabetes ; 5(1): 17-21, ene. 2012. tab
Article in Spanish | LILACS | ID: lil-640648

ABSTRACT

Background: Endothelial dysfunction is associated to erectile dysfunction. This last condition can even be considered as a cardiovascular risk factor. Aim: To determine the frequency of erectile dysfunction among hospitalized patients with and without acute coronary syndromes. Material and Methods: Prospective cross sectional study in which all male patients, aged 40 to 70 years admitted to the emergency room or medicine service of a general hospital in a period of two months, were included. Those with acute coronary syndromes were considered as cases and those without, as controls. The international erectile dysfunction index questionnaire (IIEF-5) was applied to all. Results: Forty four patients with acute coronary syndrome aged 57 +/- 8 years and 46 controls aged 56 +/- 9 years were included. Erectile dysfunction was present in 34 (77 percent) cases and 20 (44 percent) controls (p < 0.01). The odds ratio of having erectile dysfunction among coronary patients was 4.4 (95 percent confidence intervals 1.6-12.3). Conclusions: There was a higher frequency of erectile dysfunction among patients with acute coronary syndromes.


Subject(s)
Humans , Male , Adult , Middle Aged , Erectile Dysfunction/epidemiology , Endothelium/physiopathology , Acute Coronary Syndrome/etiology , Body Mass Index , Case-Control Studies , Cross-Sectional Studies , Erectile Dysfunction/physiopathology , Life Style , Biomarkers , Probability , Risk Assessment , Risk Factors , Severity of Illness Index , Waist-Hip Ratio
17.
Rev. chil. cardiol ; 31(3): 232-237, 2012.
Article in Spanish | LILACS | ID: lil-670194

ABSTRACT

Se ha descrito relación entre el uso de estatinas y aparición de nueva diabetes. Se revisa advertencia de la FDA, así como análisis de estudios y meta análisis, que permiten deducir una acción de las estatinas que favorece el desarrollo de nueva diabetes. Las precauciones del uso de estatinas se deben orientar a pacientes con factores de riesgo de diabetes en prevención primaria cardiovascular. Se expresa la necesidad de estudios prospectivos con objetivos primarios específicos, para mayor precisión de información y adopción de recomendaciones basadas en alto nivel de evidencias.


Relationship between statin use and appearance of new diabetes has been described. We review the FDA warning and analysis of studies and meta-analysis, which point to an action of statins which favors the development of new diabetes. Precautions of statin use should guide patients with risk factors for diabetes in primary cardiovascular prevention. It expresses the need for prospective studies with specific primary objectives, for accuracy of information and making recommendations based on high-level evidence.


Subject(s)
Humans , Diabetes Mellitus/etiology , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Disease Prevention
18.
Rev. méd. Chile ; 139(11): 1444-1450, nov. 2011. ilus
Article in Spanish | LILACS | ID: lil-627574

ABSTRACT

Background: Metabolic control of diabetic pregnant women is assessed using glycated hemoglobin (HbAlc) levels and fasting blood sugar. Another glycated protein, namely fructosamine, can be an indicator of average glucose levels during the last three weeks. Aim: To evaluate plasma fructosamine as an indicator of glycemic control in women with gestational diabetes. Patients and Methods: Prospective cohort study of 41 pregnant women aged 30 to 37 years, with gestational and pre-gestational diabetes. Blood glucose, HbAlc, fructosamine were measured. Newborn weight, and other prenatal and postnatal variables, were used to evaluate the correlation between metabolic control and the presence or absence of macrosomia. Results: The correlation observed between fructosamine and fasting blood glucose (r = 0.627, p < 0.001) was superior to that of HbA1c and blood glucose (r = 0.516, p < 0.001). No association was observed between macrosomia and levels of fructosamine, nor between the other studied variables. Conclusions: Fructosamine levels were not associated with macrosomia, but it could be better for the evaluation of glycemic control in patients with gestational diabetes since it allows short-term monitoring.


Subject(s)
Adult , Female , Humans , Pregnancy , Blood Glucose/analysis , Diabetes, Gestational/blood , Fasting/blood , Fetal Macrosomia/diagnosis , Fructosamine/blood , Glycated Hemoglobin A/analysis , Biomarkers/blood , Epidemiologic Methods
19.
Bol. Hosp. Viña del Mar ; 67(1/2): 1-7, mar. 2011. tab, graf
Article in Spanish | LILACS | ID: lil-658310

ABSTRACT

Introducción: la punción aspirativa con aguja fina (PAAF) ha ido introduciéndose paulatinamente en la práctica clínica y constituye actualmente el método de elección en la aproximación diagnóstica del cáncer tiroideo. La PAAF ha contribuido a reducir el porcentaje de pacientes tiroidectomizados, 67 aumentando la cirugía por cáncer tiroideo del l5 porciento al 39 porciento. Objetivo: determinar el Valor diagnóstico de la PAAF en pacientes sometidos a tiroidectomía en el Hospital Doctor Gustavo Fricke (HGF), entre los71 años 2006-2007. Material y Método: estudio observacional descriptivo retrospectivo. Se utilizó el registro de pacientes sometidos a procedimiento quirúrgico por nódulo tiroideo, que hayan sido previamente estudiados con PAAF en policlínico de Endocrinología del HGF. Resultados: el valor diagnóstico de la PAAF, en el estudio pre-operatorio del nódulo tiroideo y su relación con la biopsia definitiva postoperatoria, alcanzó una sensibilidad de 7l porciento y una especificidad del 54,S porciento. Discusión: el rendimiento que alcanzó la PAAF de los nódulos tiroideos para excluir o confirmar carcinoma tiroideo fueron bajos en relación a estudios internacionales que poseen una sensibilidad del 83 porciento y una especificidad del 92 porciento.


Introduction: the flne-needle aspiration (FNA) has been gradually incorporated into the clinical practice and nowadays represents the method of choice in the diagnosis of the thyroid cancer. The FNA has helped to reduce the percentage of patients that undergo thyroidectomy, and it has increased the operation for thyroid cancer from 15 percent to 39 percent. Objetive: establish the diagnostic value ofthe FNA in patients submitted to thyroidectomy in Hospital Doctor Gustavo Fricke (HGF), between 2006 and 2007. Materials and Methods: this is a descriptive observational retrospective study. We used a register of patients submitted to surgical procedure for thyroid nodule that also have been studied with FNA in the clinic of Endocrinology of the HGF. Results: the diagnostic value of FNA in the preoperative study of the thyroid nodule and its relationship with the definitive surgical biopsy reaches a sensibility of 71 percent and a specificity of S4,8 percent. Discussion: the thyroid nodules FNA had a low performance for exclude or confirm thyroid carcinoma in thyroid nodules compared to international studies (sensibility 83 percent and specificity 92 percent).


Subject(s)
Humans , Adult , Female , Middle Aged , Biopsy, Fine-Needle/methods , Thyroid Neoplasms/diagnosis , Thyroid Nodule/pathology , Chile
20.
Rev. chil. endocrinol. diabetes ; 4(1): 13-17, ene. 2011. tab
Article in Spanish | LILACS | ID: lil-640623

ABSTRACT

Background: Type 2 diabetes mellitus may be associated with cognitive decline (CD) in older subjects. Aim: To determine if CD is more common among diabetic subjects that their non-diabetic counterparts. Material and Methods: Using a case-control design, 17 diabetic patients with a median age of 73 years (nine females) and 21 non diabetic subjects with a median age of 72 years (17 females), with a similar educational background, were studied. Cognitive status was assessed using the Mini mental State Examination (MMSE), using a cutoff point of 23, and the Frontal Assessment Battery (FAB), that evaluated conceptualization, mental flexibility, motor initiative, sensibility to interference, inhibitory control, and environmental autonomy. The presence of any mental or organic cerebral disease, sensorial impairment or illiteracy were considered exclusion criteria. Results: Fifty nine percent of diabetic subjects and 24 percent of their non-diabetic counterparts, had a MMSE below the cutoff point (p = 0.03). An abnormal FAB was found in 29 and 14 percent of diabetic and non-diabetic subjects, respectively (p = NS). Both tests were abnormal in 29 and 5 percent of diabetic and non-diabetic subjects, respectively (p = 0.05). Conclusions: In this group of subjects, CD was more common among diabetics than their non-diabetic counterparts.


Subject(s)
Humans , Male , Female , Aged , /complications , Cognition Disorders/epidemiology , Cognition Disorders/etiology , Case-Control Studies , Hypertension/epidemiology , Interviews as Topic , Frontal Lobe/pathology , Mental Status Schedule , Neuropsychological Tests , Risk Factors , Tobacco Use Disorder/epidemiology , Cognition Disorders/diagnosis
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