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1.
Rev. cienc. cuidad ; 19(1): 42-56, 2022.
Article in Spanish | LILACS, BDENF, COLNAL | ID: biblio-1362458

ABSTRACT

Introducción: La hipoglucemia inadvertida incrementa el riesgo de la hipoglucemia severa en pacientes con diabetes. Una medición objetiva de la misma requiere instrumentos como el HypoA-Q, que, a diferencia de otros, mide conciencia de episodios nocturnos; sin embargo, no se dispone de una versión en español. Objetivo: Traducir y adaptar culturalmente la escala HypoA-Q para la medición de conciencia de la hipoglucemia en pacientes colombianos con Diabetes Mellitus. Metodología: Estudio de Adaptación transcultural del instrumento Hy-poA-Q. Se obtuvo la autorización de la autora para su traducción y adaptación a la población colombiana. Se siguió la metodología de la European Organisation for Research and Treat-ment for Cancer (EORTC). Al respecto, se realizaron dos traducciones directas por hablantes nativos del español, una versión reconciliada, dos traducciones inversas por dos hablantes nativos del inglés y una prueba piloto en 15 pacientes con diagnóstico de diabetes. Resulta-dos: Aunque las traducciones directas al español fueron similares, se hicieron ajustes para obtener una versión reconciliada con palabras más fáciles de comprender cambiando las uni-dades de mmol/L a mg/dl. Las traducciones inversas fueron similares al original en inglés. La prueba piloto, realizada en 15 pacientes, no requirió ajustar ningún ítem, pues la frecuencia de ítems con dificultades de comprensión, confusión o palabras ofensivas fue menor al 15%. Conclusiones: Se dispone de la versión en español para Colombia de la escala HypoA-Q. Se aconseja realizar un estudio de evaluación de sus propiedades psicométricas antes de ser usada en investigaciones o en la práctica clínica


Introdução: a hipoglicemia inadvertida incrementa o risco de hipoglicemia severa em pacientes com diabetes. Uma medição da mesma requer instrumentos como o HypoA-Q, que a diferença de outros, mede consciência de episódios noturnos; entretanto, não se dispõe de uma versão em espanhol. Objetivo: traduzir e adaptar culturalmente a escala HypoA-Q para mensurar a consciência de hipoglicemia em pacientes colombianos com Diabetes Mellitus. Materiais e métodos: estudo de adaptação transcultural do instrumento HypoA-Q. Obteve-se a autorização da autora para a sua tradução e adaptação à população colombiana. Seguiu-se a metodologia da European Organization for Research Treatment for Cancer (EORTC). Realizaram-se duas traduções diretas por falantes nativos de língua espanhola e uma versão conciliada, duas traduções inversas por falantes nativos da língua inglesa e uma prova piloto em 15 pacientes com diagnostico de diabetes. Resultados: Embora as traduções diretas ao espanhol foram semelhantes, foram feitos ajustes para obter uma versão conciliada com palavras mais simples de compreender substituindo as unidades de mmol/L para mg/dl. As traduções inversas foram semelhantes ao instrumento original em inglês. A prova piloto realizada não precisou ajustar nenhum item, devido a que os itens com dificuldade de compreensão, confusão ou palavras ofensivas foi inferior ao 15%. Conclusão: Dispõe-se da versão em espanhol para Colômbia da escala HypoA-Q. Aconselha-se realizar um estudo de avaliação das propriedades psicométricas antes de ser usada em pesquisa ou na prática clinica


Subject(s)
Validation Study , Surveys and Questionnaires , Conscience , Hypoglycemia
2.
Revista Digital de Postgrado ; 10(1): 275, abr. 2021. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1147596

ABSTRACT

El hígado graso del embarazo es una patología poco frecuente en la especialidad obstétrica, cuyo diagnóstico se realiza basado en los criterios de Swansea, muchas veces es un diagnóstico que se realiza por exclusión; usualmente se presenta entre las semanas 30 y 35 del embarazo, y la cura definitiva se realiza con la interrupción expedita del mismo; con una tasa de recuperación casi del 100% si se realiza la interrupción oportuna y una tasa de mortalidad materno fetal actual del 10%. Es importante estar atentos a la ganancia ponderal de la embarazada durante el control prenatal, la epigastralgia, y los signos clínicos asociados a hipoglicemia(AU)


Fatty liver of pregnancy is a rare pathology in obstetrics, whose diagnosis is made based on the Swansea criteria, many times it is a diagnosis that is made by exclusion; It usually occurs between weeks 30 and 35, and the definitive cure is carried out with the expeditious interruption of pregnancy; with a recovery rate of almost 100% if timely interruption is made and a current maternal-fetal mortality rate of 10%. It is important to be attentive to the weight gain of the pregnant woman during prenatal control, epigastric pain, and clinical signs associated with hypoglycemia


Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications/diagnosis , Fatty Liver/diagnosis , Pregnancy Complications/surgery , Pregnancy Trimester, Third , Cesarean Section , Acute Disease , HELLP Syndrome/diagnosis , Diagnosis, Differential , Fatty Liver/surgery , Fatty Liver/complications , Hypoglycemia/diagnosis , Jaundice/complications , Jaundice/diagnosis
3.
Rev. cuba. endocrinol ; 32(1): e154, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1289389

ABSTRACT

La evidencia clínica que ha permitido relacionar la diabetes mellitus con la infertilidad se basa en la importancia del metabolismo de la glucosa durante el proceso de espermatogénesis, debido a que en los episodios tanto de hipoglucemia como de hiperglucemia pueden ocurrir cambios epigenéticos en algunas proteínas involucradas en la espermatogénesis. En la presente comunicación se describen los aspectos teóricos de los efectos de la diabetes sobre el líquido seminal con énfasis en la espermatogénesis(AU)


The clinical evidence that has made it possible to link diabetes mellitus with infertility is based on the importance of glucose metabolism during the spermatogenesis process, because in episodes of both hypoglycemia and hyperglycemia, epigenetic changes can occur in some proteins involved in spermatogenesis. This communication describes the theoretical aspects of the effects of diabetes on seminal fluid with emphasis on spermatogenesis(AU)


Subject(s)
Humans , Spermatogenesis , Diabetes Mellitus/epidemiology , Hyperglycemia/etiology , Hypoglycemia/etiology , Infertility/therapy
4.
Repert.Med.Cir ; 30(3): 199-213, 2021. ilus., tab.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1362899

ABSTRACT

Introducción:La hipoglucemia es la complicación más frecuente del tratamiento con insulina en adultos. Los eventos de hipoglucemia severa se asocian con complicaciones a corto, mediano y largo plazo en pacientes con diabetes mellitus. Una de las estrategias para reducir la frecuencia de hipoglucemia son las intervenciones de enfermería y aunque hay pocos estudios que las enuncian de manera explícita, se ha publicado respecto a las necesidades de dichos pacientes, que permiten determinar diagnósticos de enfermería y a partir de ellos establecer metas e intervenciones para el cuidado de dichos pacientes. Objetivo: identificar los cuidados de enfermería para prevenir y controlar los eventos de hipoglucemia en pacientes adultos diagnosticados con diabetes mellitus. Metodología: revisión integrativa, se realizó en seis fases: planteamiento de la pregunta PICO; búsqueda en bases de datos y metabuscadores; lectura crítica; análisis, clasificación, validación por nivel de evidencia y grado de recomendación, y presentación de la información. Resultados: la revisión reportó cinco categorías: factores de riesgo y protectores, miedo a la hipoglucemia, atención brindada al paciente, disminución de la hipoglucemia y descripcióndel impacto de la hipoglucemia en los pacientes. Conclusiones: a partir de las necesidades reportadas en las 5 categorías de los resultados se determinaron características definitorias y factores relacionados que permitieron formular diagnósticos de enfermería y determinar como principales intervenciones: enseñanza del proceso de enfermedad, medicamentos prescritos, entrenamiento de asertividad, manejo de la hipoglicemia, nutricional y de la medicación, mejorar el afrontamiento, enseñanza individual, facilitar el aprendizaje y potenciación de la disposición de aprendizaje.


ntroduction: hypoglycemia is the most common complication of insulin therapy in adults. Events of severe hypoglycemia are associated with short, medium and long term complications in patients with diabetes mellitus (DM). One of the strategies to reduce the frequency of hypoglycemia are nursing interventions and although there are few studies that explicitly describe them, there are publications on the needs of such patients, allowing the determination of nursing diagnoses and based on them, setting goals and interventions to deliver care for these patients. Objective: to identify nursing care interventions to prevent and control hypoglycemic events in adult patients diagnosed with DM. Methodology: an integrative review was conducted in six phases: posing the PICOT question; search in databases and metasearch engines; critical reading; analysis, classification, validation by level of evidence and degree of recommendation, and data presentation. Results: the review reported five categories: risk and protective factors, fear of hypoglycemia, care provided to the patient, decrease in hypoglycemia and description of the impact of hypoglycemia on patients. Conclusions: Based on the needs reported in the resulting five categories, defining characteristics and related factors were determined allowing the formulation of nursing diagnoses and identifying the following as the main nursing interventions for hypoglycemia management: teaching of the disease process, prescribed medication, assertiveness training, hypoglycemia management, nutritional and medication therapy, improving coping, individual teaching, facilitating learning and empowering the willingness to learn.


Subject(s)
Diabetes Mellitus , Hypoglycemia , Therapeutics , Adult , Nursing Care
5.
Repert. med. cir ; 30(1): 59-63, 2021. ilus., tab.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1292229

ABSTRACT

La hipoglucemia es una urgencia médica frecuente que en la mayoría de los casos es secundaria al uso de fármacos hipoglucemiantes, orales o inyectados, indicados en pacientes con diabetes mellitus. No obstante, puede presentarse en forma espontánea y severa relacionándose con múltiples condiciones clínicas, incluyendo las neoplasias. Ante una hipoglucemia de origen paraneoplásico se deben reconocer los mecanismos fisiopatológicos que la generan y establecer el diagnóstico oportuno y preciso para disminuir las complicaciones propias de este síndrome clínico. Presentamos dos pacientes con cuadro de hipoglucemia refractaria al manejo médico inicial, de aparición similar con patologías diferentes. El primer caso corresponde a un paciente con insulinoma y el segundo con un hemangiopericitoma.


Hypoglycemia is a common medical emergency which is mostly secondary to the use of oral or injected hypoglycemic drugs indicated in patients with diabetes mellitus. However, it can present spontaneously and severely in relation to multiple clinical conditions, including neoplasms. When faced with hypoglycemia associated with paraneoplastic disorders, the pathophysiological mechanisms of hypoglycemia must be recognized and a timely and accurate diagnosis must be established in order to diminish complications inherent to this clinical syndrome. We herein present two patients with hypoglycemia refractory to initial medical management, sharing similar appearance with other pathologies. The first case corresponds to a patient with an insulinoma and the second to a patient with a hemangiopericytoma.


Subject(s)
Humans , Male , Adult , Middle Aged , Pancreatic Neoplasms/complications , Hemangiopericytoma/complications , Hypoglycemia/etiology , Insulinoma/complications , Pancreatic Neoplasms/diagnostic imaging , Hemangiopericytoma/diagnostic imaging , Insulinoma/diagnostic imaging
6.
J. Health Biol. Sci. (Online) ; 9(1): 1-7, 2021. tab
Article in English | LILACS | ID: biblio-1352413

ABSTRACT

Objective: Inpatient glycemic control is considered an important component of hospital care and patient safety. Nevertheless, its importance in the hospital setting is often underestimated. We aimed to evaluate glycemic control in non-critically hospitalized patients in the state of Ceará, in Northeast Brazil. Methods: A cross-sectional study was conducted in three tertiary hospitals in the state of Ceará. We evaluated non-critically ill inpatients, aged 18 years or older, who had hyperglycemia during hospitalization (random plasma glucose > 140 mg/dL or self-reported diabetes mellitus [DM]). Results: We evaluated 136 patients (66.2% male, mean age 57.9 ± 16.6 years), 64% of whom had a prior DM diagnosis. Specific nutritional support for DM or hyperglycemia was prescribed for 59.6% of patients. In total, 69.9% of the patients were using insulin. Among them, 47.4% used sliding-scale regular insulin, 18.9% basal-bolus (neutral protamine Hagedorn [NPH] insulin), 28.4% basal-plus (NPH) and 3.1% basal insulin (NPH). The prescriptions given were considered adequate for 26.4% of patients. Of the patients, 69.9% presented blood glucose levels > 180 mg/dL and 29.4% presented levels > 300 mg/dL. Hypoglycemia was observed in 25.7% of patients; protocols for hypoglycemia management were prescribed for 76.5% of them. Education on diabetes during hospitalization was reported by 30.1%. Conclusion: The glycemic control regime followed neither national nor international guidelines. These data suggest a need for teams of diabetes specialists in public hospitals in Ceará, working to improve care and following protocols to guide the safety of hospitalized patients.


Objetivo: O controle glicêmico é considerado um componente importante do cuidado hospitalar e da segurança do paciente. Entretanto, sua relevância no contexto hospitalar muitas vezes é subestimada. Nesse estudo, buscamos avaliar o controle glicêmico em pacientes não-críticos internados no estado do Ceará, no Nordeste do Brasil. Métodos: Trata-se de um estudo transversal realizado em três hospitais terciários do estado do Ceará. Foram avaliados os pacientes internados nas unidades de enfermaria, com idade acima de 18 anos, que apresentaram hiperglicemia (definida por medida de glicemia plasmática aleatória acima de 140 mg/dL) ou diagnóstico prévio (autorrelato) de diabetes mellitus (DM). Resultados: Foram avaliados 136 pacientes (66.2% do sexo masculino, idade média 57.9 ± 16.6 anos), dos quais 64% tinham um diagnóstico prévio de DM. O acompanhamento nutricional específico para DM ou hiperglicemia foi prescrito em 59.6% dos pacientes. No total, 69.9% dos pacientes estavam em uso de insulina. Dentre eles, 47.4% utilizavam insulina regular sob demanda (sliding-scale), 18.9% basal-bolus (insulina NPH), 28.4% basal-plus e 3.1% insulina basal (NPH). As prescrições foram consideradas adequadas para 26.4% dos pacientes. Entre os pacientes analisados, 69.9% apresentaram glicemia capilar > 180 mg/dL e 29.4% apresentaram níveis > 300 mg/dL. Hipoglicemia foi observada em 25.7% dos pacientes e protocolo para hipoglicemia foi prescrito em 76.5% deles. Educação sobre diabetes durante a internação foi realizada em 30.1%. Conclusão: O manejo do controle glicêmico não seguiu diretrizes nacionais ou internacionais. Esses dados sugerem a necessidade de uma equipe de especialistas em diabetes em hospitais públicos do Ceará, visando melhorar o cuidado e seguir os protocolos que proporcionam segurança ao paciente internado.


Subject(s)
Blood Glucose , Diabetes Mellitus , Glycemic Control , Insulin , Patients , Tertiary Care Centers , Hypoglycemia , Inpatients
7.
Ciênc. cuid. saúde ; 20: e55696, 2021. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1356126

ABSTRACT

RESUMO Objetivo: avaliar os fatores de risco para quedas em pessoas idosas residentes na comunidade. Métodos: estudo descritivo, transversal e quantitativo, desenvolvido na região Nordeste do Brasil com 221 pessoas idosas residentes na comunidade. A coleta de dados ocorreu de junho a setembro de 2016 com a utilização de instrumentos estruturados. Realizou-se uma análise exploratória dos dados com medidas de tendência central, dispersão e associação entre as variáveis. Resultados: em relação ao perfil, observaram-se faixa etária entre 60 e 79 anos (75,6%); sexo feminino (70,6%); casados (43,9%); até quatro anos de escolaridade (33,9%); renda pessoal mensal de até um salário mínimo (45,7%) proveniente da aposentadoria (60,2%); três a cinco comorbidades (51,6%). Quanto ao risco para quedas, destacou-se como preditores a Fall Risk Score classificada como "alto risco", seguida por medicamentos antiparkinsonianos, antidepressivos e diuréticos, hipoglicemia, deficiência auditiva, dor, incontinência urinária e sintomas neurológicos. Conclusão: faz-se necessário estabelecer ações individuais e coletivas para a prevenção e promoção da saúde diante dos riscos para quedas. A rede de saúde deve trabalhar para possibilitar a conscientização de que as quedas constituem um problema de saúde pública e, por isso, ressalta-se a necessidade de cuidados direcionados, evitando consequências na qualidade de vida da pessoa idosa.


RESUMEN Objetivo: evaluar los factores de riesgo para caídas en personas mayores residentes en la comunidad. Métodos: estudio descriptivo, transversal y cuantitativo, desarrollado en la región Nordeste de Brasil con 221 personas mayores residentes en la comunidad. La recolección de datos tuvo lugar de junio a septiembre de 2016 con la utilización de instrumentos estructurados. Se realizó un análisis exploratorio de los datos con medidas de tendencia central, dispersión y asociación entre las variables. Resultados: en relación al perfil, se observaron franja etaria entre 60 y 79 años (75,6%); sexo femenino (70,6%); casados (43,9%); hasta cuatro años de escolaridad (33,9%); renta personal mensual de hasta un salario mínimo (45,7%) proveniente de la jubilación (60,2%); tres a cinco comorbilidades (51,6%). En cuanto al riesgo de caídas, se destacó como predictores la FallRisk Score clasificada como "alto riesgo", seguida por fármacosAntiparkinsonianos, antidepresivos y diuréticos, hipoglucemia, deficiencia auditiva, dolor, incontinencia urinaria y síntomas neurológicos. Conclusión: se hace necesario establecer acciones individuales y colectivas para la prevención y promoción de la salud frente a los riesgos para caídas. La red de salud debe trabajar para posibilitar la concienciación de que las caídas constituyen un problema de salud pública y, por eso, se resalta la necesidad de cuidados dirigidos, evitando consecuencias en la calidad de vida de la persona anciana.


ABSTRACT Objective: to assess risk factors for falls in elderly people living in the community. Methods: descriptive, cross-sectional, and quantitative study, developed in the Northeast region of Brazil with 221 elderly people living in the community. Data collection took place from June to September 2016 using structured instruments. An exploratory data analysis was performed with measures of central tendency, dispersion, and association between variables. Results: regarding the profile, there was an age group between 60 and 79 years old (75.6%); females (70.6%); married (43.9%); up to four years of education (33.9%); monthly personal income of up to one minimum wage (45.7%) from retirement (60.2%); three to five comorbidities (51.6%). As for the risk of falls, the Fall Risk Score classified as "high risk" stood out as predictors, followed by antiparkinsonian drugs, antidepressants and diuretics, hypoglycemia, hearing loss, pain, urinary incontinence, and neurological symptoms. Conclusion: it is necessary to establish individual and collective actions for the prevention and promotion of health because of the risks of falls. The health network must work to raise awareness that falls are a public health problem and, therefore, the need for targeted care is emphasized, avoiding consequences on the quality of life of elderly people.


Subject(s)
Humans , Female , Middle Aged , Aged , Accidental Falls , Aged , Risk Factors , Pain , Primary Health Care , Urinary Incontinence , Pharmaceutical Preparations , Nursing , Diuretics , Disease Prevention , Accident Prevention , Health Promotion , Hypoglycemia , Antidepressive Agents , Antiparkinson Agents
8.
Rev. saúde pública (Online) ; 55: 30, 2021. tab, graf
Article in English | LILACS, BBO | ID: biblio-1252107

ABSTRACT

ABSTRACT OBJECTIVE: Determine the value of the combination of fasting glucose less than the 10th percentile (FG < p10) during 75 gram oral glucose tolerance test (75g OGTT) with maternal characteristics to predict low birth weight (LBW) established by Intergrowth-21st tables. METHODS: Prospective cohort study of pregnant women who was underwent 75g OGTT between 24 and 28.6 weeks. The 10th percentile fasting glucose of the population was determined at 65 mg/dL and women with risk factors that could modify fetal weight, including those related to intrauterine growth restriction, were excluded. Two groups were formed: group FG < p10 and group with normal fasting glucose. The main finding was the diagnosis of LBW. The association between FG < p10, maternal characteristics and LBW was established by multivariate logistic regression. The predictive performance of the models constructed was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC) analysis. RESULTS: 349 women were eligible for study, of whom 66 (18.91%) had FG < p10; neonates in this group had lower birth weights (2947.28 g and 3138.26 g, p = 0.001), higher frequencies of LBW (25% and 6.81%, p < 0.001) and of weights < 2500 g in term births (8.6% and 2.3%, p = 0.034). The basal prediction model consisted of nulliparity by achieving an AUC of 60%, while the addition of FG < p10 resulted in the significant improvement of the previous model (AUC 72%, DeLong: p = 0.005). CONCLUSIONS: In pregnant women without factors that could modify fetal weight, the predictive model created by combining FG < p10 during 75g OGTT with nulliparity was significantly associated with increased risk of LBW. REGISTRATION: ClinicalTrials.gov: NCT04144595.


RESUMEN OBJETIVO: Determinar el valor de la combinación de la glucosa en ayunas menor que el percentil 10 (GA < p10) durante la prueba de tolerancia oral a la glucosa con 75 gramos (PTG-75g) con características maternas para predecir bajo peso al nacer (BPN) establecido mediante tablas de Intergrowth-21st. MÉTODOS: Estudio de cohorte prospectivo de mujeres embarazadas que se realizaron PTG-75g entre las 24 y 28.6 semanas. Se determinó el percentil 10 de glucosa en ayunas de la población en 65 mg/dL y fueron excluidas aquellas mujeres con factores de riesgo que pudieran modificar el peso fetal incluyendo los relacionados con la restricción del crecimiento intrauterino. Se formaron dos grupos: grupo GA < p10 y grupo con glucosa en ayunas normal. El hallazgo principal fue el diagnóstico de BPN. La asociación entre GA < p10, características maternas y BPN se estableció mediante regresión logística multivariante. El desempeño predictivo de los modelos construidos fue evaluado por el análisis de la curva característica operativa del receptor (ROC) y del área bajo la curva (ABC). RESULTADOS: Fueron elegibles para estudio 349 mujeres, de las cuales 66 (18,91%) tuvieron GA < p10; los neonatos de este grupo tuvieron pesos al nacer más bajos (2947.28 g y 3138.26 g, p = 0,001), frecuencias más altas de BPN (25% y 6,81%, p < 0,001) y de pesos < 2500 g en nacimientos de término (8,6% y 2,3%, p = 0,034). El modelo basal de predicción consistió en nuliparidad al lograr un ABC del 60%, mientras que al añadir la GA < p10 se obtuvo la mejora significativa del modelo previo (ABC 72%, DeLong: p = 0,005). CONCLUSIONES: En mujeres embarazadas sin factores que pudieran modificar el peso fetal, el modelo predictivo creado combinando GA < p10 durante la PTG-75g con nuliparidad estuvo asociado significativamente con riesgo incrementado de BPN. REGISTRO: ClinicalTrials.gov: NCT04144595.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Infant, Low Birth Weight , Hypoglycemia , Birth Weight , Blood Glucose , Brazil , Prospective Studies , Glucose Tolerance Test
9.
Rev. chil. endocrinol. diabetes ; 14(1): 17-20, 2021. tab, ilus
Article in Spanish | LILACS | ID: biblio-1146467

ABSTRACT

Insulinoma es un tumor neuroendocrino que surge de las células ß del páncreas y produce hiperinsulinemia endógena. Son neoplasias raras con una incidencia reportada de 4 casos por millón de habitantes por año. La presentación clínica típicamente cursa con síntomas adrenérgicos y neuroglucopénicos secundarios a hipoglicemia. Requiere estudios de niveles séricos de insulina, pro-insulina y péptido C, además de imágenes diagnosticas que confirmen los hallazgos. La mayoría de los insulinomas son benignos, su sitio primario más común es el páncreas y pueden extirparse quirúrgicamente. Se presenta el caso de un hombre de 36 años con déficit cognitivo leve y episodios de diaforesis con deterioro neurológico hasta convulsiones tónico clónicas generalizadas que curiosamente resolvían con uso doméstico de "panela molida". Se ingresó a urgencias por ataques recurrentes de hipoglicemia severa con requerimiento de altas dosis de dextrosa al 50% por acceso central, hasta confirmación diagnóstica, intervención y resección de tumor neuroendocrino pancreático bien diferenciado (G1 según clasificación OMS) tipo insulinoma en la cola del páncreas.


Insulinoma is a neuroendocrine tumor that arises from the ß cells of the pancreas and produces endogenous hyperinsulinemia. They are rare neoplasms with a reported incidence to 4 cases per million inhabitants per year. The clinical presentation typically presents with adrenergic and neuroglycopenic symptoms secondary to hypoglycemia. It requires studies of serum levels of insulin, pro-insulin and C-peptide, in addition to diagnostic images that confirm the findings. Most insulinomas are benign, their most common primary site is the pancreas, and they can be removed surgically. We present the case of a 36-year-old man with mild cognitive deficits and episodes of diaphoresis with neurological deterioration to generalized clonic tonic seizures that curiously resolved with domestic use of "ground brown sugar". He was admitted to the emergency department due to recurrent attacks of severe hypoglycemia with a high-dose requirement for 50% dextrose through central access, until diagnostic confirmation, intervention, and resection of a welldifferentiated pancreatic neuroendocrine tumor (G1 according to WHO classification) insulinoma in the tail of pancreas.


Subject(s)
Humans , Male , Adult , Pancreatic Neoplasms/diagnosis , Insulinoma/diagnosis , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/complications , Magnetic Resonance Imaging , Neuroendocrine Tumors , Diagnosis, Differential , Epilepsy/diagnosis , Glucose/therapeutic use , Hyperinsulinism/etiology , Hypoglycemia/etiology , Hypoglycemia/drug therapy , Insulinoma/surgery , Insulinoma/complications
10.
Acta Medica Philippina ; : 89-100, 2021.
Article in English | WPRIM | ID: wpr-877169

ABSTRACT

@#Objectives. To determine the knowledge, attitudes and practices (KAP) of health care providers at the Philippine General Hospital towards hypoglycemia among non-critically ill patients using a validated, self-administered survey tool. Methods. This study covered two phases out of a three-phased project: (1) development and validation of a 43- item KAP survey tool and (2) assessment of KAP among nurses and residents using the tool. Phases 1 and 2 are analytic cross-sectional studies. Data for the KAP survey was collected using the developed tool and focused group discussions (FGDs). Results of this study will be the framework for Phase 3, which is the development of an in-patient hypoglycemia protocol. Results. The validated KAP survey tool yielded a low overall mean score of 12.56 ± 2.11 in the knowledge domain although high scores (4.88 ± 1) were noted for knowledge on management of hypoglycemia. In terms of attitude, majority (99.31%) of respondents believed that fewer hypoglycemia events correlates to better clinical outcomes and are willing to adopt a nurse-driven protocol. Most respondents (52.8%) employed correct practices in hypoglycemia management. The FGDs identified the perceived facilitators and barriers to hypoglycemia management. Conclusion. There is a gap in knowledge and practices in managing hypoglycemia among health care providers which needs to be addressed further with education and training. Nevertheless, health care providers have a positive attitude towards having a standard hypoglycemia protocol that will contribute greatly to its implementation in the clinical area.


Subject(s)
Hypoglycemia , Surveys and Questionnaires
11.
Article in Chinese | WPRIM | ID: wpr-879552

ABSTRACT

OBJECTIVE@#To report on the clinical, metabolic and genetic characteristics of a child with carnitine palmitoyl transferase 1A (CPT1A) deficiency.@*METHODS@#Clinical data and the level of acylcarnitine for a child who initially presented as epilepsy were analyzed. Genomic DNA was extracted from peripheral blood samples of the child and her parents and subjected to next-generation sequencing (NGS).@*RESULTS@#Mass spectrometry of blood acylcarnitine indicated increased carnitine 0 (C0) and significantly increased C0/ (C16+C18). DNA sequencing revealed that the child has carried compound heterozygous variants of the CPT1A gene, namely c.1846G>A and c.2201T>C, which were respectively inherited from her mother and father.@*CONCLUSION@#CPT1A presenting initially as epilepsy was unreported previously. Analysis of blood acylcarnitine C0 and C0/ (C16 + C18) ratio and NGS are necessary for the identification and diagnosis of CPT1A deficiency. The c.1846G>A and c.2201T>C variants of the CPT1A gene probably underlay the disease in this child. Above finding has also enriched the spectrum of CPT1A gene variants.


Subject(s)
Carnitine/blood , Carnitine O-Palmitoyltransferase/genetics , Child , DNA Mutational Analysis , Female , Humans , Hypoglycemia/genetics , Lipid Metabolism, Inborn Errors/genetics
12.
Rev. enferm. UERJ ; 28: e50567, jan.-dez. 2020.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1146586

ABSTRACT

Objetivo: identificar os principais diagnósticos de enfermagem e suas respectivas intervenções em uma população de pacientes oncológicos submetidos a jejum prolongado no pós-operatório. Método: estudo descritivo, documental e transversal. O cenário do estudo foi um hospital federal de ensino no Rio de Janeiro, caracterizado como UNACON. Os dados foram coletados durante 60 dias em prontuários referentes aos anos de 2016 a 2018. Foram analisados 61 prontuários que atendiam aos critérios de inclusão e 208 complicações foram apresentadas pelos pacientes oncológicos. Resultados: Foram definidos oito diagnósticos de enfermagem, entre os quais os mais evidentes foram: Nutrição desequilibrada: menor que as necessidades corporais e Risco de glicemia instável. Onze intervenções de enfermagem foram definidas em consonância com a Taxonomia de NANDA-I e buscaram ser de fácil aplicação na prática assistencial de enfermagem. Conclusão: foi evidenciada uma ampla gama de diagnósticos e intervenções de enfermagem a qual se recomenda sua adoção no processo de enfermagem.


Objective: to identify the main nursing diagnoses and respective interventions in a population of cancer patients undergoing prolonged postoperative fasting. Method: descriptive, cross-sectional, documentary study. The study scenario was a federal teaching hospital in Rio de Janeiro, characterized as a high-complexity oncological facility. Data were collected for 60 days from medical records for the years 2016 to 2018. In the 61 medical records that met the inclusion criteria and were analyzed, cancer patients presented 208 complications. Results: eight diagnoses were established, the most in evidence being: nutrition imbalance: less than body requirements; and risk of unstable blood glucose level. Eleven nursing interventions, designed to be easily applied in nursing care practice, were specified in line with the NANDA-I Taxonomy. Conclusion: the wide range of nursing diagnoses and interventions evidenced are recommended for adoption in the nursing process.


Objetivo: identificar los principales diagnósticos de enfermería y sus respectivas intervenciones en una población de pacientes oncológicos sometidos a ayuno postoperatorio prolongado. Método: estudio descriptivo, transversal, documental. El escenario de estudio fue un hospital universitario federal en Río de Janeiro, caracterizado como una instalación oncológica de alta complejidad. Se recolectaron datos durante 60 días de las historias clínicas de los años 2016 a 2018. En las 61 historias clínicas que cumplieron con los criterios de inclusión y fueron analizadas, los pacientes con cáncer presentaron 208 complicaciones. Resultados: se establecieron ocho diagnósticos, siendo los más evidentes: desequilibrio nutricional: menor que los requerimientos corporales; y riesgo de niveles inestables de glucosa en sangre. Once intervenciones de enfermería, diseñadas para ser fácilmente aplicadas en la práctica del cuidado de enfermería, fueron especificadas de acuerdo con la Taxonomía NANDA-I. Conclusión: la amplia gama de diagnósticos e intervenciones de enfermería evidenciados se recomiendan para su adopción en el proceso de enfermería.


Subject(s)
Humans , Male , Female , Postoperative Care/nursing , Cancer Care Facilities , Fasting/adverse effects , Postanesthesia Nursing , Hospitals, Teaching , Nursing Process , Pain, Postoperative/nursing , Nursing Diagnosis/classification , Brazil , Cross-Sectional Studies , Standardized Nursing Terminology , Hypoglycemia/nursing , Nutrition Disorders/nursing
13.
Enferm. foco (Brasília) ; 11(5): 130-135, dez. 2020. ilus
Article in Portuguese | LILACS, BDENF | ID: biblio-1177528

ABSTRACT

Objetivo: construir aplicativo para educação em saúde de pessoas com Diabetes Mellitus sobre prevenção de complicações agudas da doença. Métodos: Estudo metodológico aplicado, exploratório, fase de produção tecnológica. Produção do aplicativo ocorreu em duas etapas: revisão de literatura; construção do aplicativo. Resultados: Revisão: identificou-se 13 estudos. Na produção do aplicativo "Descomplica, Dona Bete", optou-se pela construção em mídia, texto e áudio, com tela inicial de boas-vindas e tela secundária que direciona aos tópicos sobre prevenção das complicações agudas Hipoglicemia, Hiperglicemia, Cetoacidose Diabética e Estado Hiperglicêmico Hiperosmolar. Conclusão: o processo de construção do aplicativo baseado em evidências da literatura foi o primeiro passo para suprir parte de uma lacuna, considerando o déficit de conhecimento de pessoas diabéticas acerca das complicações agudas da doença. Portanto, constitui um suporte interativo para ações de educação em saúde com potencialidade para incentivar pessoas com diabetes a aprimorar o autocuidado preventivo. (AU)


Objective: To build an application for health education of people with Diabetes Mellitus on prevention of acute complications of the disease. Methods: Applied, exploratory methodological study, technological production phase. Application production took place in two stages: literature review; building the application. Results: 13 studies were identified. In the production of the application "Descomplica, Dona Bete", we opted for the construction in media, text and audio, with a welcome initial screen and a secondary screen that directs to topics on prevention of acute complications Hypoglycemia, Hyperglycemia, Diabetic Ketoacidosis and Status Hyperglycemic Hyperosmolar. Conclusion: The process of building the application based on evidence from the literature was the first step to fill part of a gap, considering the lack of knowledge of diabetic people about the acute complications of the disease. Therefore, it constitutes an interactive support for health education actions with the potential to encourage people with diabetes to improve preventive self-care. (AU)


Objetivo: Desarrollar una aplicación para la educación sanitaria de las personas con diabetes mellitus sobre la prevención de complicaciones agudas de la enfermedad. Métodos: Estudio metodológico exploratorio aplicado, fase de producción tecnológica. La producción de la aplicación se produjo en dos etapas: revisión de la literatura; construyendo la aplicación. Resultados: Revisión: se identificaron 13 estudios. En la producción de la aplicación "Descomplica, Dona Bete", elija construir en medios, texto y audio, con una pantalla de inicio de bienvenida y una pantalla secundaria que lo dirija a respuestas sobre complicaciones de complicaciones agudas Hipoglucemia, hiperglucemia, cetoacidosis diabética y estado hiperglucémico Hiperosmolar. Conclusión: El proceso de construcción de la aplicación basada en la literatura fue el primer paso para llenar un vacío, considerando la falta de conocimiento de las personas diabéticas sobre las complicaciones agudas de la enfermedad. Por lo tanto, ofrecer apoyo interactivo para acciones de educación en salud con el potencial de alentar a las personas con diabetes a mejorar o prevenir el autocuidado. (AU)


Subject(s)
Nursing , Diabetic Ketoacidosis , Educational Technology , Hyperglycemia , Hypoglycemia
14.
Rev. Soc. Argent. Diabetes ; 54(3): 140-154, sept.-dic. 2020. graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1147408

ABSTRACT

Las herramientas para evaluar el grado de control glucémico se modificaron últimamente. La emoglobina glicosilada (HbA1c), parámetro de referencia (gold standard), refleja el control glucémico de los últimos tres meses de manera retrospectiva, sin expresar la variabilidad glucémica. El automonitoreo glucémico capilar (AGC) brinda información inmediata y prospectiva, pero dispone de pocos datos glucémicos para generar promedios y desviaciones estándares representativas. No detecta tendencias y tiene limitaciones para obtener datos nocturnos o durante la actividad física. Es invasivo y muchas veces rechazado. Contrariamente, el monitoreo continuo de glucosa (MCG) mide la glucosa instantáneamente, y muestra sus tendencias y su variabilidad en forma continua, incorporando nuevas métricas de control. Mediante el perfil ambulatorio de glucosa (PAG) se analizan los patrones del control glucémico durante el sueño, los ayunos prolongados, la actividad física y las intercurrencias, expresándolos como curvas con sus desviaciones estándar durante períodos de horas (8 a 24 horas) o días (7, 14, 30 y 90 días). El PAG contiene las siguientes métricas: porcentaje de tiempo en rango TIR (del inglés, time in range), porcentaje de tiempo por encima del rango TAR (del inglés, time above range), porcentaje de tiempo por debajo del rango o hipoglucemia TBR (del inglés, time below range) y coeficiente de variabilidad (%CV). La información continua permite tomar decisiones inmediatas, ya sea con la ingesta de carbohidratos o con la aplicación de insulina. El MCG con terapéuticas insulínicas inyectables (TII) o bomba portable de insulina (BPI) es una herramienta muy útil y complementaria para el tratamiento de la diabetes mellitus tipo 1 (DM1) y la DM2 en la insulinoterapia. Su utilización se asoció con descensos significativos en la HbA1c, disminución de la variabilidad glucémica, reducción de las hipoglucemias totales y nocturnas, y mejoría de la calidad de vida en estos pacientes. Nuestro propósito como grupo de expertos es generar una guía práctica para regular la implementación del MCG.


The tools to assess the degree of glycemic control were modified lately. Glycosylated hemoglobin (HbA1c), the gold standard, reflects the glycemic control of the last 3 months retrospectively, without expressing glycemic variability. Selfblood glucose monitoring (SBGM) provides immediate and prospective information, but has little glycemic data to generate representative averages and standard deviations. It does not detect trends and has limitations to obtain nocturnal data or during physical activity. It is invasive and often rejected. On the contrary, continuous glucose monitoring (CGM), allows to measure glucose instantly, shows your trends and variability continuously, incorporating new control metrics. The ambulatory glucose profile (AGP) analyzes the patterns of glycemic control during sleep, prolonged fasting, physical activity and intercurrences, expressing them as curves with their standard deviations during periods of hours (8 to 24 hours) or days (7, 14, 30 and 90 days). The AGP contains the following metrics: percentage time in range (TIR), percentage time above range mg/dl (TAR), percentage time below range or hypoglycemia (TBR) and coefficient of variation (%CV). CGM with IIT or continuous subcutaneous insulin infusion (CSII), is a very useful and complementary tool for the treatment of DM1 and DM2 in insulin therapy. Its use was associated with significant decreases in HbA1c, decreased glycemic variability, reduction of total and nocturnal hypoglycemia and improvement of the quality of life in these patients. Our aim as a group of experts is to generate a practical guide to regulate the implementation of the CGM.


Subject(s)
Humans , Diabetes Mellitus, Type 1 , Exercise , Glucose , Hypoglycemia , Insulin , Motor Activity
15.
Rev. cuba. cir ; 59(4): e994, oct.-dic. 2020.
Article in Spanish | LILACS, CUMED | ID: biblio-1149851

ABSTRACT

RESUMEN Introducción: La Nesidioblastosis es una rara afección pancreática que provoca hipoglucemia por hipersinsulinismo endógeno en la infancia. Es poco habitual en el adulto; solo se han publicado casos aislados desde su descripción. Objetivo: Caracterizar la presentación de una hipoglucemia hiperinsulínica en un paciente adulto con Nesidioblastosis. Caso clínico: Paciente adulto de 35 años, blanco, sexo masculino, sospecha de insulinoma, con episodios de hipoglucemia en ayunas o tras un ejercicio que revertía con la ingesta de alimentos o soluciones glucosadas. Se le realizó pancreatectomía de un 85 por ciento y en el estudio histológico se detectó una Nesidioblastosis. Conclusiones: Es infrecuente en el adulto, realizar su diagnóstico es difícil, se llega a la cirugía con el conocimiento de un estado hiperinsulínico endógeno, sin la certeza de su origen(AU)


ABSTRACT Introduction: Nesidioblastosis is a rare pancreatic condition that causes hypoglycemia due to endogenous hypersinsulinism in childhood. It is unusual in adults; only isolated cases have been published including its description. Objective: To characterize a case of hyperinsulinic hypoglycemia, in an adult patient with nesidioblastosis. Clinical case: A 35-year-old, white, male, adult patient with suspected insulinoma, with episodes of hypoglycemia in the fasting state or after exercise that was reversed with ingestion of food or glucose solutions. 85 percent pancreatectomy was performed and nesidioblastosis was detected in the histological study. Conclusions: It is rare in adults, making its diagnosis is difficult, and surgery is reached with the knowledge of an endogenous hyperinsulinic state, without the certainty of its origin(AU)


Subject(s)
Humans , Male , Adult , Pancreatectomy/methods , Nesidioblastosis/diagnosis , Hypoglycemia/diagnostic imaging , Insulinoma/therapy
16.
Acta méd. colomb ; 45(3): 78-81, jul.-set. 2020. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1130704

ABSTRACT

Resumen El síndrome de Doege Potter es un síndrome caracterizado por hipoglucemia severa asociada a tumor fibroso de la pleura. Presentamos el caso de una paciente de 67 años con antecedente por biopsia de tumor fibroso de pleura, quien seis meses después de este diagnóstico presenta episodios de alteración del estado de conciencia con desorientación y documentación de hipoglucemia con triada de Whipple presente. Se realiza test de ayuno el cual es positivo para hipoglucemia no hiperinsulinémica y dado sus antecedentes, se hace el diagnóstico de un síndrome de Doege Potter. Se realiza manejo quirúrgico con resección total de masa tumoral con posterior resolución de la hipoglucemia.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1503).


Abstract Doege-Potter syndrome is characterized by severe hypoglycemia associated with a fibrous tumor of the pleura. We present the case of a 67-year-old patient with a history of a fibrous tumor of the pleura, diagnosed through biopsy, who six months after this diagnosis experienced episodes of altered consciousness with disorientation, and documented hypoglycemia with Whipple's triad. A fasting test was positive for non-hyperinsulinemic hypoglycemia and, given his history, he was diagnosed with Doege-Potter syndrome. He was treated surgically through total removal of the tumor mass, with subsequent resolution of the symptoms.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1503).


Subject(s)
Humans , Female , Aged , Pleural Neoplasms , Hypoglycemia , Syndrome , Somatomedins
17.
Medicina (B.Aires) ; 80(3): 203-210, jun. 2020. graf, tab
Article in English | LILACS | ID: biblio-1125071

ABSTRACT

Social vulnerability has proved to be an independent risk factor for hypoglycemia in patients with diabetes. In some countries, patients who are in a vulnerable situation are assisted in the public health system which provides free medical care. This study compares the prevalence of hypoglycemia among patients with type 2 diabetes (T2D), in public versus private sector and its relationship with social vulnerability. This multicentric descriptive study included 600 patients with T2D from public and private care institutions of Argentina. Socioeconomic level (SEL) was evaluated through the Marketing Argentinean Association survey. Number of severe, documented symptomatic and asymptomatic hypoglycemias were registered. Among the patients included, 66% were assisted in the public sector. The 41% of patients (n = 246) registered at least 1 episode of any hypoglycemia event being more prevalent in the public sector compared to the private sector (50% vs. 22%). In the adjusted analysis it was observed a greater risk of hypoglycemia in public sector (OR 4, 95% CI 2.65-6.04) and in patients that did not have diabetological education (OR 2.28 95% CI 1.35-3.84). Similarly, unemployment (OR 5.04 95% CI 2.69-9.46), and marginal SEL (OR 60.79 95% CI 14.89-248.13) increased the risk of hypoglycemia. Several factors related to social vulnerability as unemployment, marginal SEL and poor sanitary education showed a significant increase in the hypoglycemia risk. Professionals working with people with diabetes must take into account these factors for a safe treatment of the disease.


La vulnerabilidad social ha demostrado ser un factor de riesgo independiente de hipoglucemia en pacientes con diabetes. Los pacientes que se encuentran en situación de vulnerabilidad social reciben asistencia en el sistema de salud pública que brinda atención médica gratuita. Este estudio compara la prevalencia de hipoglucemia en pacientes con diabetes tipo 2 en el sector público frente al privado y su relación con la vulnerabilidad social. Se realizó un estudio multicéntrico descriptivo que incluyó 600 pacientes con diabetes tipo 2 de instituciones de atención pública y privada de Córdoba. El nivel socioeconómico se evaluó a través de la encuesta de la Asociación Argentina de Marketing que evalúa la dimensión social, educativa y económica para estratificar el nivel socioeconómico. Se registró el número de hipoglucemias graves, documentadas sintomáticas y asintomáticas. El 66% de los pacientes pertenecían al sector público. El 41% de los pacientes (n = 246) registró al menos 1 episodio de cualquier evento de hipoglucemia. En el análisis ajustado, se observó un mayor riesgo de hipoglucemia en el sector público (OR 4, 95% CI 2.65-6.04), en pacientes que no tenían educación diabetológica previa (OR 2.28, 95% CI 1.35-3.84), en desempleados (OR 5.04, 95% CI 2.69-9.46) y en aquellos con nivel socioeconómico marginal (OR 60.79 95% CI 14.89-248.13). Factores relacionados con la vulnerabilidad social como el desempleo, el nivel socioeconómico marginal y educación sanitaria deficiente mostraron un aumento en el riesgo de hipoglucemia. Los profesionales que trabajan con personas con diabetes deben tener en cuenta estos factores para un tratamiento seguro de la enfermedad.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Hospitals, Private/statistics & numerical data , Delivery of Health Care/statistics & numerical data , Diabetes Mellitus, Type 2/epidemiology , Hospitals, Public/statistics & numerical data , Hypoglycemia/epidemiology , Argentina/epidemiology , Socioeconomic Factors , Logistic Models , Prevalence , Cross-Sectional Studies , Risk Factors , Public Sector , Private Sector , Vulnerable Populations/statistics & numerical data , Diabetes Complications/epidemiology , Diabetes Mellitus, Type 2/physiopathology , Social Determinants of Health , Hypoglycemia/physiopathology
18.
Rev. chil. obstet. ginecol. (En línea) ; 85(3): 210-220, jun. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1126156

ABSTRACT

OBJETIVO: determinar el perfil clínico de pacientes con diabetes gestacional (DG) y la incidencia de las complicaciones neonatales. MÉTODOS: estudio descriptivo de una cohorte retrospectiva de gestantes con DG según criterios HAPO/ (IADPSG) International Association of Diabetes and Pregnancy Study Groups y Carpenter-Coustan y sus hijos, en un servicio de alta complejidad obstétrica de Medellín, Colombia entre 2012-2015. Se presentan medidas descriptivas de características maternas y neonatales e incidencia de las complicaciones neonatales. RESULTADOS: se incluyeron 197 maternas y 203 neonatos; 90,5 % maternas tenían sobrepeso u obesidad; la comorbilidad más frecuente fue el trastorno hipertensivo asociado al embarazo en 22,8 %. El manejo de la DG fue 59,3% nutricional exclusivo, 37,1% nutricional más insulina y 3.6% nutricional más metformina. La media de edad gestacional al parto fue 37 sem y 3 días; la DG fue la indicación más frecuente de inducción del parto en 76 % (38/50); 56,4 %, fueron partos vaginales y el 34,6% fueron cesáreas indicadas por DG. Un 11,3 % de los recién nacidos fueron grandes para la edad gestacional (P >90) y se encontraron 2 recién nacidos con peso > 4000 gr. La incidencia de al menos una complicación neonatal fue 27,6 %, 16,7 % presentaron hiperbilirrubinemia, 9,9 % síndrome de dificultad respiratoria (SDR), 3.0% hipoglicemia, 10.8% otras complicaciones y 12,3 % ingresaron a la unidad de cuidados intensivos neonatales. CONCLUSIONES: la DG es una indicación frecuente de inducción del parto y de indicación de cesárea. Las complicaciones neonatales ocurren en uno de cuatro recién nacidos, aunque observamos una baja incidencia de grandes para la edad gestacional (recién nacidos con peso > percentil 90), hubo 2 otras morbilidades neonatales relacionados con el diagnóstico materno como hiperbilirrubinemia y SDR.


AIM: To determine the clinical profile pregnant women with gestational diabetes and incidence of the neonatal complications. METHODS: Descriptive analysis of a retrospective cohort of pregnant women with gestational diabetes (GD) according to HAPO and Carpenter-Coustan criteria and their children, under a high complexity obstetric service in Medellin, Colombia between 2012-2015. Descriptive measures of maternal and neonatal characteristics and incidence of neonatal complications are presented. RESULTS: The study included 197 pregnant women and 203 neonates: 90.5 % of pregnancies were overweight or obese; the most frequent comorbidity was the hypertensive disorder associated with pregnancy in 22.8 %. The management of the DG was 99.0% nutritional, 37.1% insulin and 3.6 % metformin. The average gestational age at delivery was 37 weeks and 3 days; DG was the most frequent indication of induction of labor in 76 % (38/50); 56.4% were vaginal deliveries and 34.6 % were DG related caesarean sections, 11.3 % of newborns were large for gestational age (P > 90) and two newborns weighing > 4000 gr. The incidence of at least one neonatal complication was 27.6 %, 16.7 % had hyperbilirubinemia, 9.9 % respiratory distress syndrome (RDS), 3.0 % hypoglycemia, 10.8 % other complications and 12.3 % were admitted to the neonatal intensive care unit. CONCLUSIONS: DG is a frequent indication of induction of labor and indication of caesarean section. Neonatal complications occur in one of four newborns, although we observed a low incidence of macrosomia, there were other neonatal morbidities related to maternal diagnosis such as hyperbilirubinemia and RDS.


Subject(s)
Humans , Male , Female , Infant, Newborn , Adult , Pregnancy Complications/epidemiology , Diabetes, Gestational , Infant, Newborn, Diseases/epidemiology , Fetal Macrosomia/epidemiology , Comorbidity , Intensive Care, Neonatal , Cesarean Section , Epidemiology, Descriptive , Incidence , Retrospective Studies , Colombia , Hyperbilirubinemia, Neonatal/epidemiology , Overweight , Hypoglycemia , Labor, Induced
19.
Pesqui. vet. bras ; 40(4): 289-292, Apr. 2020. tab
Article in English | LILACS, VETINDEX | ID: biblio-1135619

ABSTRACT

Gastric emptying and plasma glucose were evaluated in young and adult dogs, fed with dry and wet food, submitted to different periods of pre-anesthetic fasting (6, 8, and 12 hours). Forty healthy dogs were selected, which were segmented into four groups according to the age group and type of diet. It was evaluated the gastric emptying by ultrasound and serum glycemia. Only 17.5% presented complete gastric emptying, and no significant differences were found between the 6 and 8-hour fasting evaluations, or between the age groups and the diets, considering significance level p<0.05. Mean plasma glucose values from the groups indicated normal glycemia at all times of evaluation. A significant difference was found between the means of glycemia in young and adult dogs, with the 8-hour fasting with wet diet (p=0.03) and with 12 hours with dry diet (p=0.04). Healthy young and adult dogs, in physiological equilibrium, maintain average values of plasma glucose despite prolonged periods of pre-anesthetic fasting, which may be necessary, since 8-hour fasting for solid food is not enough to provide complete gastric emptying.(AU)


Avaliou-se o esvaziamento gástrico e a glicemia plasmática em cães jovens e adultos, alimentados com ração seca e úmida, submetidos a diferentes períodos de jejum pré-anestésico (6, 8 e 12 horas). Foram selecionados 40 cães hígidos, os quais foram segmentados em 4 grupos de acordo com a faixa etária e o tipo de dieta administrada. Foi avaliado o esvaziamento gástrico por ultrassonografia e a glicemia sérica. Apenas 17,5% apresentaram completo esvaziamento gástrico, não sendo encontradas diferenças significativas entre as avaliações com 6 e 8 horas de jejum, ou entre as faixas etárias e dietas, considerando nível de significância p<0,05. Os valores médios da glicose plasmática dos grupos indicaram normoglicemia em todos os momentos de avaliação. Foi encontrada diferença significativa entre as médias da glicemia dos cães jovens e adultos, no período de 8 horas de jejum com dieta úmida (p=0,03) e com 12 horas nos animais com dieta seca (p=0,04). Conclui-se que cães hígidos jovens e adultos, em equilíbrio fisiológico, mantêm valores normais de glicemia plasmática apesar de períodos prolongados de jejum pré-anestésico, os quais podem ser necessários, tendo em vista que 8 horas de jejum alimentar de sólidos não é suficiente para proporcionar completo esvaziamento gástrico.(AU)


Subject(s)
Animals , Dogs , Blood Glucose/analysis , Fasting , Gastric Emptying , Hypoglycemia/veterinary , Anesthesia/veterinary , Diet/veterinary
20.
Rev. colomb. cancerol ; 24(1): 30-36, ene.-mar. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1115582

ABSTRACT

Resumen Los tumores neuroendocrinos pancreáticos (TNEsP) son un grupo poco frecuente de neoplasias, pueden ser funcionales y causan síndromes clínicos diversos, o no funcionales, con síntomas secundarios a invasión a estructuras cercanas o enfermedad metastásica (1). Se presenta el caso de una paciente de 55 años con insulinoma maligno con compromiso metastásico extenso, no candidata a intervención quirúrgica, hipoglucemia de difícil manejo sin respuesta a tratamiento con diazóxido y prednisolona, y que requirió manejo con quimioterapia y embolización de metástasis hepáticas, con posterior mejoría clínica, estabilidad de la enfermedad por imágenes diagnósticas y retiro de medicamentos para manejo de hipoglucemia. En seguimiento presenta síntomas de hiperglucemia con HbA1c en 12%, con lo cual se diagnosticó diabetes mellitus de novo y se inició manejo con insulina.


Abstract Pancreatic neuroendocrine tumors (TNEP) are a rare group of neoplasms, which can secrete peptide hormones causing various clinical syndromes, or be non-secretory, with symptoms secondary to invasion of neighboring or distant structures (1). The case of a 55-year-old patient with malignant insulinoma with extensive metastatic involvement, not operable, with persistent hypoglycemia refractory to treatment with diazoxide and prednisolone, who received management with chemotherapy and embolization of liver metastases, achieving the withdrawal of medications for the management of hypoglycemia and a tumor response of stable disease in the comparison of images during the 12-month follow-up. During the 15th cycle of chemotherapy, he presented symptoms of hyperglycemia with HbA1c in 12%, with which diabetes de novo mellitus was diagnosed and insulin management was initiated.


Subject(s)
Humans , Female , Middle Aged , Insulinoma , Insulinoma/drug therapy , Neuroendocrine Tumors , Capecitabine , Hypoglycemia
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